Neonatal care: collaborating to improving outcomes

Noshin Menzies, Senior Project Manager at the West of England AHSN reflects on prematurity interventions, ahead of World Prematurity Day.

This Sunday (17 November) is World Prematurity Day. It’s close to my heart, being a mum to a premature baby and working on PReCePT, an initiative to reduce risk of cerebral palsy in premature babies. I’ve worked on PReCePT since 2014 and seen the impact this simple intervention can have on families.

I’ll be feeling positive on this World Prematurity Day. At the West of England AHSN we are embarking on an exciting collaboration with University Hospitals Bristol and Great Western Hospitals to improve the outcomes for premature babies across the region through a new neonatal care bundle. The bundle is the first of its kind, and builds on what we have learned from PReCePT. It will support maternity and neonatal units in implementing or improving elements of care that will contribute to a reduction in brain injury and death in the smallest and earliest born babies. Magnesium sulphate (the basis of PReCePT) will be one of the interventions, but the bundle will bring together many more that collectively can make a really significant impact on brain injury and mortality rates amongst babies born prematurely.

This project will bring together neonatologists, obstetricians, midwives and neonatal nursing staff to redesign the way in which preterm babies are cared for, before and after birth. We aim to bring innovation and creativity into the design process to embed effective ways of working that we can then share nationally. Having wrapped up delivering quality improvement (QI) coaching to 13 units across the country for the PReCePT study, I am raring to go and share what I have learned with the local teams.

I’m looking forward to meeting parents across the region. We’re setting out to involve and co-produce this project with a wide range of people reflecting the diverse communities that make up our vibrant region. We know that outcomes for mothers and babies born to women of colour are poorer than women of other heritages and backgrounds. We will ensure that all women have a voice and are able to work in collaboration with us as team and I look forward to getting out and about and meeting them!

ReSPECT the process and talk early

Tony Goring, Project Manager on the Patient Safety Collaborative at the West of England AHSN reflects on a conversation with student paramedics on the day ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) rolls out across parts of the West of England.

As ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) launched across parts of the West of England today (10 October 2019), I had the absolute pleasure of meeting 50 student paramedics at The University of West of England’s Glenside Campus.

I spoke to this group of young and enthusiastic second year second students about the benefits a ReSPECT form provides for patient outcomes and for families. One question put to me by a student focussed on their concern that patient family members might be in opposition to the preferences that have been recorded on the ReSPECT form. To this I asked whether the benefit of having conversations much earlier in a patients’ prognosis would help patients’ families support a decision made by the patient in consultation with their doctor or specialist.

The group came to a consensus that earlier conversations around health and treatment preferences would enable patients and their families to have much broader conversations on other matters pertinent to end of life planning, and make it easier to support their loved one’s preferences. It was also agreed that having all family members made aware of the preferences made by their loved one on a ReSPECT form would help the best decisions to be made in the event of an emergency. A colleague of mine, from a paramedic background, often says that, ‘having something to help make a clinical decision in an emergency is far better than nothing at all’.

Hopefully the hour I spent with them this morning provided the students with a greater understanding of the ReSPECT process, probably more than the vast majority of their paramedic colleagues working in the field today.  It was great to help them get ‘ahead of the game’.

I left them with a few words from  another colleague who had recently had a conversation around end of life care and treatment preferences with a family member. He said that, following discussions with his wife and mother-in-law, he could honestly say that talking about health and treatment preferences ‘made all the relatives feel better and allowed us to talk more openly’.

For more information on the ReSPECT process and the adoption of ReSPECT in the West of England, visit https://www.weahsn.net/our-work/improving-patient-safety/respect/

Diversity in Innovation: Alan Bec’s story

Alan Bec, Founder of the Wellbeing Indicator Badge (wib) and graduate from our West of England AHSN Health Innovation Programme is one of the innovators featured in the recently published AHSN Network Diversity in innovation report. Alan shares his story of living with chronic fatigue syndrome and developing the wib as a shorthand way to communicate with people.

I became a healthcare innovator almost by accident. My career had taken me through a number of roles: psychologist, university lecturer, student mentor and executive coach. I was the first BAME head of coaching and training for the Institute of Directors.

Then I was struck by chronic fatigue syndrome and became housebound. Talking was exhausting. I just didn’t have the energy.

After three years of living like that, I created the Wellbeing Indicator Badge (wib), a shorthand way to communicate with people – family, friends, healthcare professionals. I’d been a high-functioning, respected professional and academic, and there I was a lump of meat in a bed. I wanted to reconnect.

I’d use the wib to show my energy levels on a scale of one to ten. People could instantly see how I was feeling and respond appropriately. This was particularly helpful with my GP, who could tailor his approach to consultations and care. With fluctuating symptoms, it helped me understand the impact of my illness and self-regulate my activity.

Others became interested in the wib and in 2017 I was put forward to do a TED talk, which attracted media attention. The West of England AHSN approached me to consider their Health Innovation Programme for healthcare entrepreneurs, and as I was getting better, using my time more strategically, I had more ability to work on the wib as a product to help others.

Looking back, feeling like an ‘outsider’ at key stages of my life was also influential in developing the wib. It’s all about leveling the playing field for people who find it hard to articulate their sense of wellbeing for whatever reason; it’s about inclusion and reducing social isolation.

I was born in Scotland. My mother is British and she fell for my father who came over from India on a boat at 16 – he is Anglo-Indian with mixed eastern cultural heritages. I didn’t know what racism was until we moved to England when I was eight when my dad was promoted. Then we went up in the world, moved to a posh house in the countryside amongst doctors and dentists. I experienced racism from day one.

But I don’t come from a place of anger; I come from a place of wanting to connect. Healthcare is for all, so must include all! Innovation is the result of the diversity of ideas and experience that drives cutting edge solutions. Organisations like AHSNs working in this space need to demonstrate to BAME innovators they are not simply ‘welcome’ but also essential to healthcare innovation. It’s exciting that together we are innovating our organisational culture to become genuinely representative. Together we can co-create social innovation and wellbeing for all.

This story is an extract from the AHSN Network’s Diversity in innovation report – celebrating diversity across the Network, and setting out pledges to further support the diversity and innovation agenda. Read the full report.

Could NEWS go international?

Hannah Little, Patient Safety Improvement Lead and Senior Project Manager, reflects on the spread of NEWS across the country, and beyond.

The National Early Warning Score (now NEWS2) saves lives. It provides a simple, objective overview of a person’s physiological condition by turning vital markers of deranged physiology into a score. The higher the score, the more likely it is that the person needs an urgent clinical review.

NEWS2 helps identify time-critical conditions, such as sepsis, early. It is a simple concept, initially developed to provide a common language of deterioration across acute settings. It is unsurprising that other areas of the health system have been keen to adopt this lifesaving tool, in order to provide clinicians working across an often discombobulated health system with a quick objective indicator of deterioration. NEWS2 can enable the easy track-and-trigger of deterioration and recovery across pathways, from the moment a person first presents as unwell to the moment they are discharged.

NEWS2 is in use across the health system in the West of England, which now has the lowest mortality from Suspicion of Sepsis in England, according to recent data from the Patient Safety Measurement Unit. England’s 14 other Patient Safety Collaboratives are now all working hard to spread NEWS2 beyond acute settings. In true quality improvement style, all are taking a slightly different approach – with workstream leads meeting often to learn from each other.

The reach of NEWS2 continues to grow. We have had enquiries from professionals and organisations looking to learn from the success of NEWS2 in Ireland, Scotland, Sweden, Ghana and most recently, Canada. The Royal College of Physicians (RCP) have also had international enquiries; the benefits and opportunity for easily applying this lifesaving initiative in other health systems is clear. Who knows, one day we could have an International Early Warning Score.

 

Mutual support amongst mortality reviewers

Melody Moxham, Project Support Officer, reflects on the collaborative and supportive work of our Mortality Reviews Steering Group.

I’ve been supporting our Mortality Reviews Steering Group since summer 2018. I think it is a fantastic example of how collaborating across our region helps to improve patient safety.

Since 2017 all of the acute trusts in the West of England region have used a standardised process for their mortality reviews – Structured Judgement Reviews (SJRs). (You can read more about how we implemented this process in the Patient Safety Journal).

The SJRs take place in each trust and the accumulated data is brought to the steering group meetings. For example, one trust might share that they had 200 deaths during the last quarter and that 70% of these qualified for an SJR. Of those, one or two were judged as having had poor care and one as having had very poor care, and that case has been escalated as a Serious Incident. The vast majority of cases identify good or excellent care. Critically, trusts also talk about their learning from the SJRs, either positive feedback or areas to improve, and how this is shared. For example in their internal newsletters or magazines, through quality improvement projects, feedback to teams or individuals, and at Board level.

During my time supporting the group I’ve noticed how the monthly meetings provide a ‘safe space’ for colleagues from six trusts to access peer support regarding the results of their SJRs. By sharing their monthly and quarterly SJR data, and more in-depth information about specific (anonymised) reviews, common themes can be identified and solutions shared; all which help to improve patient safety. I’ve been impressed at how open the group discussions have been, which really nurtures collaboration across the region.

We followed the IHI (Institute for Healthcare Improvement) Breakthrough Collaborative Series model for this project, which enabled our trust representatives to learn from each other and improve together. The clinicians in the group have shared resources, such as Board Reports and recruitment documents for specific roles to further learn from each other and replicate effective systems. This has saved work being duplicated and allows others to adopt tested solutions more efficiently.

In my role at the AHSN, I’m a few steps removed from the front line delivery of patient care, so for me this has been a fascinating window into our colleagues’ world, working in acute services. The most immediate impact that I experience is not seeing how systems and care are improved from the SJR process, but the benefits that these meetings bring to the clinicians. The support that they provide each other is clearly so beneficial, and helps to create and sustain a culture of sharing learning within our region, for the ultimate benefit of improving our patients’ safety.

Commitment and evidence drive Emergency Laparotomy Collaborative

Greg Harris, Project Support Officer, reflects on the commitment of our Emergency Laparotomy Collaborative members, now recognised as a national improvement programme.

Half a year ago I became the Project Lead for the Emergency Laparotomy Collaborative (ELC). Conceived as a two-year quality improvement (QI) project between three Academic Health Science Networks (AHSNs); the West of England, Wessex, and Kent Surrey & Sussex, it delivered a care bundle across 28 hospitals that reduced the length of hospital stays by 1.3 days, and crude mortality rates by 11%.

The project ended in 2017 but what impresses me is that our Clinical Leads have continued to meet in the West of England! One of the greatest challenges to QI projects is sustainability – how do you ensure that all that great work doesn’t disappear after the official project end date?

Hopefully you considered sustainability right from the outset of your project but, beyond its life cycle, committed individuals are key to championing the work within their trusts; to keep on top of achieving until it’s not a stretch target anymore but the standard.

It also helps if the work becomes a national programme…

Earlier this year, NHS England + Improvement asked all trusts across England to roll out the ELC care bundle in their hospitals.  This wouldn’t have been possible without the strong evidence collected from the original ELC project showing the significant improvement achieved. The evidence wouldn’t have been there without committed individuals.

Our Clinical Leads now meet on a quarterly basis, rotating the meetings across their hospitals. They continue to maintain the high standard of delivering the ELC care bundle but they are now looking at adding to this with new QI work – the Best Practice Tariff, Surgical Site Infections, Enhanced Peri-Operative Care for High-risk patients (EPOCH), Enhanced Recovery, and FLuid Optimisation in Emergency LAparotomy trial (FLOELA).

Individuals such as our Clinical Leads have the ambition for continuous improvement – a taste for it, in fact! – and I’m sure this positively rubs off on the staff they encounter on a daily basis.

This is where the West of England AHSN comes in. We facilitate, support, and offer our QI skills to those individuals with the ideas, and help them deliver evidence-based work – from junior to senior staff, to those within and those outside the NHS.

We support commitment.

Diversity in innovation: Seema Srivastava’s story

Seema Srivastava, Consultant Physician and Associate Medical Director at North Bristol NHS Trust, tells the story of how she got to where she is today.

My parents came to the UK in the 60s as first generation Indian migrants. I watched how my father – a single-handed GP and my mother – a teacher, worked hard to build their careers. Despite experiencing racism when he first moved here, my father was loved by his practice patients, who were from all backgrounds in inner city London.

It was a huge inspiration to see how my parents contributed to their community. This has influenced my career aspirations and also gave me the confidence to never consider gender or race as a barrier.

My love of science and connection with people meant I followed Dad’s footsteps into medicine. In my first year as a consultant I was nominated by North Bristol NHS Trust to work with the Institute for Healthcare Improvement, later becoming a regional faculty member, in an NHS South West Quality Improvement (QI) and Patient Safety programme.

I have a passion to strengthen the care provided to patients through QI and have worked with the West of England AHSN through its Patient Safety Collaborative since 2014 to improve patient care across our health community.

I was hugely proud to receive an MBE in 2018 for my work in Falls and Patient Safety in the NHS. My Trust and the Patient Safety Collaborative have been incredibly supportive and I’m keen to inspire other women from BAME backgrounds to be leaders in healthcare improvement. I am fortunate that I’ve never felt restricted in my ambitions from a BAME perspective. I feel much of this has been through my upbringing but also the welcoming NHS environments I’ve found myself in. But I do recognise that not everyone from BAME communities are lucky enough to receive such encouragement and support, which is where I think we can proactively do more work.

Having an inclusive improvement and innovation community is vital in encouraging a diverse range of perspectives and experiences to address the complex issues facing health and social care, today and in the future. If our innovators and change agents don’t represent the population we serve, we risk missing out on those voices and their talent.

I hold a core belief that whoever we are and wherever we come from, we can achieve so much if we all see the value of connection and meet every interaction with kindness. This does take courage, especially when faced with differences in views or people who may not share the same values.

I am really excited to be considered a role model for other BAME healthcare professionals. I really hope I can inspire future leaders from diverse backgrounds.

My advice to others? Get connected. Use social media, follow leaders who support diversity and say “hi”, sharing the great things you are doing to support our population to lead happy and healthy lives.

This story is an extract from the AHSN Network’s Diversity in innovation report – celebrating diversity across the Network, and setting out pledges to further support the diversity and innovation agenda. Read the full report.

Five things I learned at Expo

Last week over 5,000 NHS managers, clinicians and innovators descended on Manchester to attend the NHS Health and Care Innovation Expo. Here are five things Lauren Hoskin, our Communications and Marketing Officer, learned over the two day conference.

1. The AHSN Network is taking diversity and equality seriously

At Expo, Richard Stubbs, CEO at Yorkshire and Humber AHSN launched the AHSN Network’s Diversity in innovation report – a celebration of Black, Asian and Minority Ethnic (BAME) innovators and our pledges to do more.

The Network has made clear and decisive pledges to promote and deliver equality and diversity across the 15 organisations. These include very practical steps such as ensuring all staff undertake unconscious bias training by 2020; actively engaging and involving diverse communities and people from marginalised groups in our work; and appointing a person in each organisation with whom concerns about equality and diversity can be raised.

The report also includes lots of great stories from BAME innovators from across the Network, including two from the West of England – Seema Srivastava and Alan Bec.

2. Change is as much about feelings as it is about data

On the first day of Expo I went to a session led by the South West AHSN who were sharing what they’ve learned through Professor Trisha Greenhalgh and the Billions Institute in defining their approach to spread and adoption.

One point that struck me was a shift in the framing of a question we all seem to be asking ourselves when we set out on an adoption and spread programme. This was to move from asking: ‘How can I get all these people to do what I want them to do?’ to: ‘How can I help all these people to do what they want to do?’

This is all about taking people along with you and not imposing changes on others without finding out what they want first. Spark change through making people feel something: data alone is rarely enough to change a system. Then when you are making progress, celebrate the changes through sharing stories as well as data.

3. The NHS understands the climate emergency as a healthcare challenge

On day two of Expo, Simon Stevens (Chief Executive of NHS England), Andy Burnham (Mayor of Greater Manchester) and Dame Jackie Daniel (Chief Executive of Newcastle upon Tyne Hospitals NHS Foundation Trust) led a brilliant panel discussion on ‘the climate change challenge – how can local government and the NHS work together to meet it’.

I learned that earlier this year Newcastle Hospitals became the first NHS trust in the UK to declare a climate emergency. The Trust has made a commitment to take action on the climate crisis, aiming to become carbon neutral by 2040.

In her talk, Dame Jackie talked about how climate breakdown is the greatest threat to population health and that it is everyone’s moral duty to take action. She has been actively encouraging staff to think creatively about reducing their department’s environmental impact, and is working with Newcastle City Council and other partners to help tackle this vast challenge.

4. PReCePT is a shining example of adoption and spread

PReCePT, one of the AHSN Network’s national programmes, seemed to be everywhere at Expo. PReCePT stands for the Prevention of Cerebral Palsy in PreTerm Labour. The programme is reducing the incidence of cerebral palsy by offering magnesium sulphate to all eligible women in England during preterm labour (less than 30 weeks).

Dr Karen Luyt, Clinical Lead on PReCePT talked about the fact that this is an intervention that has gone from one Trust to 149 Trusts in England over the course of a few years.

In one of her many presentations at Expo, Karen said: “If doctors believe in a treatment and you make it easy to implement, they’ll do it. After all, as clinicians we all want the best outcomes for our patients, so you just have to give them the opportunity to do so. Use facts and stories – tell the story of why it’s going to work and win hearts and minds”.

5. Collaboration is at the heart of adopting innovation

Sam Roberts, CEO of the Accelerated Access Collaborative (AAC), chaired a session on the AAC: getting the best new treatments to patients quicker. This panel included Piers Ricketts, AHSN Network Chair and CEO of Eastern AHSN, Dr Karen Luyt, Haseeb Ahmad and Professor Julia Newton.

The AHSN Network is a key partner in the AAC, which brings together industry, government and the NHS in order to deliver the world-leading innovation that will be transformational for patient outcomes.

In this discussion Sam said: “Adopting innovation in the NHS is hard, but it’s not impossible. It involves collaboration at every part of the system – Government, NHS, general managers, clinicians. We’re all learning by doing.

“This is something where you have to change every part of the system, and get it to all work together. That isn’t necessarily a bad thing – we see it as an opportunity”.

Understanding the unintended consequences of healthcare apps

Dr Andrew Turner, Senior Research Associate, CLAHRC West, discusses the move towards ‘digital first’ care, the possible unintended consequences of healthcare apps, and how the DECODE study aims to improve the adoption of a range of digital health tools in primary care by understanding these unintended consequences.

We all know that people are living longer, but often with multiple long-term health conditions. Maintaining people’s quality of life in these circumstances requires a lot of support from the NHS.

At the same time, GP practices are under pressure to improve patients’ access to healthcare while coping with their own workloads and growing patient demand. Policymakers are proposing new ways to relieve the strain by using digital technologies such as phone apps to improve the convenience and reduce the cost of healthcare.

The move towards ‘digital first’ care is explicit in the new NHS Long Term Plan. It puts forward a vision in which “people will have more control over the care they receive and more support to manage their health, to keep themselves well and better manage their conditions, while assisting carers in their vital work.” Continue reading “Understanding the unintended consequences of healthcare apps”

Driving sustainable, responsible and inclusive economic growth

As well as being Vice-Chancellor of the University of the West of England and chair for the West of England AHSN, Professor Steve West chairs the West of England Local Enterprise Partnership (LEP). Here Steve writes about how the LEP is working alongside authorities across the region to drive sustainable economic growth and improve health and social care for local communities.

How do you drive economic growth in a way that is sustainable, responsible and inclusive? What do businesses need in order to thrive, sustain and grow? And how do we do that in a way that delivers prosperity to all? These questions are exactly what the West of England Local Enterprise Partnership (LEP) has been working on since our formation about six years ago now.

LEPs are business-led organisations designed to drive local economies. Our job is to fund projects that are benefiting businesses, schools, colleges, universities and residents across the region, considering three core issues.

Firstly, we’re here to bring the voice of businesses and universities to local authorities in terms of skills and education. We’re increasingly thinking about how to join up our efforts across schools, universities, colleges, businesses and employers to get a sense of how to grow a workforce in a sensible way, and with the right skills mix. We want to get the balance right, so that some jobs will be high-end graduate jobs and others will require different skills. If we don’t have the mechanisms to feed industry or public sector services with the right skills, they’re not going to flourish.

Secondly, we have to consider infrastructure, both digital and physical. We want to make sure that the balance works across an entire region, so we don’t end up with ‘dead spots’. If we’ve got rubbish infrastructure and people can’t get to the right places to work, then chances are those businesses are not going to thrive.

And the third issue is housing and employment facilities. If people can’t afford to live in the region, then we’ve got a real problem.

The workforce challenge

When we apply those principles to health and social care we can see that we have a huge workforce challenge. The thing that will derail us in the future won’t be the fact that we haven’t managed to open up another engineering company. The thing that will derail us will be that we have an ageing population that isn’t ageing well, and we haven’t got the right people in place to take care of them.

If we’ve got an ageing population as well as challenges in getting a health and social care workforce, we need to resolve that somehow. Some solutions will be between innovation, technology, robotics and artificial intelligence (AI), but people are always going to be crucial.

Where do those people come from and how do we make health and social care an attractive career? How do we get the skills mix right? Where will those employees live and how will they travel around the region? This is where all my roles come together, and I can see that health and social care has to be a central part of the LEP.

What we’re starting to do is to bring the right people from across the NHS, AHSN, LEP and local authorities around the table. Together we want to start thinking about how we do things differently, how we innovate and how we spread that innovation. These problems are never going to be solved through people working in silos.

And that’s where my various roles really begin to fit together. Because I chair both the West of England AHSN and LEP, as well as being Vice Chancellor for UWE and holding roles with other national bodies, I may be able to help solve a few problems by enabling collaborations. I can bring the health and care component right to the heart of economic growth, and that’s where things begin to get really exciting.