Digital health recognised as regional strength in Science and Innovation Audit

A recent audit into the science and innovation strengths of the South West and South East Wales has highlighted both health and life science and digital health.

The South West England and South East Wales Science and Innovation Audit (SWW–SIA) has been undertaken by a consortium of key organisations and businesses from across the region, including AHSNs, businesses, Local Enterprise Partnerships (LEPs) and higher education institutions.

Lars Sundstrom, Enterprise Director at the West of England AHSN, said: “I am really pleased that the Science and Innovation Audit has been able to underscore our local strengths in health and life science, and particularly our strengths in digital health.

“We look forward to working with our colleagues in South West England and South East Wales to continue our efforts towards making it one of the best environments to develop health care products in the world. We also look forward to fulfilling our new role as innovation exchanges with a role for supporting digital health as recommended by the Accelerated Access Review.”

“An opportunity for catalysing the region’s hi-tech SME cluster and the broader entrepreneurial community to respond to clearly defined challenges in the health system identified through the increased investment into health research”

The audit report refers to the region’s strength in leading the development of integrated care systems and suggests this presents an opportunity to “catalyse innovation, including attracting businesses to research, pilot and test innovations in the region, alongside catalysing the region’s hi-tech SME cluster and the broader entrepreneurial community to respond to clearly defined challenges in the health system identified through the increased investment into health research.”

The “exceptional capability” in population health research within our region is recognised in the report as providing companies with access to “world-leading expertise in evaluating the performance of digital technologies in improving population and individual health in the region. When combined with underpinning world leading capabilities in fields such as designing and evaluating complex health interventions wireless and optical communications technologies, data security and encryption and other major projects that are integrating data across, for example, primary, secondary and social care this provides a unique proposition to SMEs and larger corporations and will attract them to develop and grow in our region.”

The report welcomes the active support of the two Academic Health Science Networks NHS England in the region (West of England and South West) in supporting the development of the digital health sector and linking it into the NHS – the primary customer for digital interventions – and into the local authorities who now have responsibility for public health in England.

Our Healthcare Innovation Programme, which we run in partnership with SETsquared, Europe’s leading university business incubator is given a specific mention. This is our popular development programme, created to support healthcare innovators in the West of England, focusing on those with a clear business proposition or an innovative application in the healthcare sector. These are frequently in the Digital Health field.

The report also credits our involvement in both the development of local innovation hubs and the South West Interactive Healthcare Programme, a joint initiative between the West of England and South West AHSNs and SETsquared, financed by Creative England’s regional growth fund, to improve cross-sector collaborations and innovation, while opening up exciting practical opportunities for creative professionals to work with business clusters in the healthcare sector.

The Government has thanked the SWW-SIA consortium for its submission and is expected to make an announcement about its Industrial Strategy in the upcoming Autumn Statement.

Visit to read the full audit report. The summary report is available here, while the Digital Living annex report is available here.

Patient Safety Collaboratives: heartening, ambitious and innovative

What do you get when you cross an urgent care system under tremendous pressure with a newly formed Patient Safety Collaborative looking for a flagship project? asks Managing Director Deborah Evans ahead of our session at Patient First on 22 November.

Against all expectations, we found that our proposition to embed the National Early Warning Score  (NEWS) across the entire urgent care system in the West of England has captured the imagination of clinicians in primary care, acute hospitals, mental health, community services and the ambulance service.

Our clinical director Anne Pullyblank showed a short film at one of our conferences and a few months later 130 people turned up at an engagement event.  The very next day, we started getting phone calls from clinical teams saying they were starting to use NEWS in areas that had never used it before.

We have been living with the consequences ever since. How do you get a good baseline when blessed with clinicians who Just Do It? How do you set a measurement strategy for whole system change? How do you attribute causes when so much is being changed right across the urgent care system all the time?

Our NEWS journey will be the subject of our session in the Best Practice Theatre at Patient First later this month, “The deteriorating patient – what about Bobby?” which will highlight the huge potential NEWS has when used across the entire system at every handover of care.

We’re now 18 months into this journey and have been reflecting a great deal about the role that Patient Safety Collaboratives can play.

We are one of 15 Academic Health Science Networks, comprising the AHSN Network which covers the whole geography of England. Each AHSN coordinates the Patient Safety Collaborative covering the same patch.

The AHSN model of a network of member organisations gives us a strong basis for engagement and grassroots support. We thrive where clinicians and their organisations commit their discretionary effort. We have a system wide perspective because we include CCGs, NHS trusts and other providers of health care, and can draw in statutory and non-statutory partners. We are independent and are seen as such; we are not part of the performance management system experienced by so many. We work in partnership with Sign Up to Safety, the Health Foundation, NHS Improvement and many, many others.

In a landscape of overlaps and gaps we are giving many clinicians an opportunity to work together, rather than in competition.

Patient Safety Collaboratives are now in their third year of operation and all over the country there are heartening, ambitious and innovative projects in play.

We share and learn together and have developed a ‘logic model’ to provide a conceptual framework. We build capability with our member organisations and have developed a software platform ( Seedata Life system) which is already the repository for hundreds of quality improvement (QI) projects – offering all the tools to run QI work and share the learning.

Already we have some ambitious and large scale programmes. The Emergency Laparotomy Collaborative is a shared project across 25 acute hospitals in the West of England, Kent, Surrey and Sussex, and Wessex – we are improving the quality of care together and using a shared national set of metrics to review and learn. The South of England Mental Health Collaborative embraces 16 mental health trusts and offers inspiring learning sets on an ‘all share, all learn’ basis. This is parity for mental health services beginning to move from words to commitment.

We will have a strong presence at this year’s Patient First. Visit our Patient Safety stand to find out more about us and our work. Talk to people from your area. Make connections. Attend our Best Practice Theatre. Feel the energy.

The West of England AHSN’s performance of “The deteriorating patient – what about Bobby?” will take place on Tuesday 22 November at 14:30 in the Best Practice Theatre at Patient First.

Download the full programme here and register for a fully-subsidised place at using the code AHSN46.

Lost in translation

In his latest blog post, our Enterprise Director Lars Sundstrom reflects on the need for AHSNs to be multilingual.

When I first joined the AHSN three and a half years ago from my previous job at the University of Bristol, one of my esteemed colleagues at the time said I was crazy.

“Don’t go there,” he said. “I’m warning you as friend. People in NHS land speak a different language. They aren’t like us. You really won’t like it there, trust me.”

After being there a week I understood that he was probably right. I had no idea what my colleagues were on about in meetings and they soon got very fed up of me asking the same question, “Why are you doing it like that?”

I had to undergo an induction the following week. I had visions of magnets and coils but instead I was introduced to the patient safety lead.

“What’s patient safety?” I asked. “Is that something to do with making hospitals safe?” She smiled at me and said,  “Well it can be but it’s really about reducing variability across service providers.” I was none the wiser.

Then I was introduced to the improvement lead. “Hi, what do you do then?” I asked.

“Well,” she said, “We apply quality improvement support working in the local workforce to ensure they have appropriate skills to spread best practice.”  “Geez, sounds complicated,” was the only thing I could think of to say.

I feel like I’ve landed on Mars among a bunch of aliens! I have no clue what you guys are talking about in our team meetings.

After my first month our MD called me into her office for a chat. “How are you finding it?” she asked.

“Well, I feel like I’ve landed on Mars among a bunch of aliens! I have no clue what you guys are talking about in our team meetings.” “Don’t worry,” she said, “You’ll soon pick it up.”

I wasn’t so sure. However I was clearly amongst a new tribe of very bright and talented individuals with a passion for what they were doing, so I thought to myself, “Wow, this is great. I have so much to learn.”

“So, tell me about your plans for the wealth creation remit of our AHSN license,” our MD asked. Now, this I understood so I launched into my thoughts about translational medicine and the importance of building trusted partnerships to achieve effective co-creation in an open innovation environment, while encouraging horizontal innovation from multiple sectors and especially the importance of achieving joint value creation rather than operating merely in transactional mode with the private sector.

“Interesting,” she replied, looking at me with an air somewhere between bemusement and intrigue. “So what exactly does that mean then?”

Last week we had our third annual conference on the topic of innovation for sustainability and transformation. This morning I was having breakfast with one of our newest recruits; a bright young chap from a corporate finance background.

“So James, what did you think of the event last week?” I asked.

“Well,” he said tucking into a bacon sandwich, “Honestly, I was totally lost most of the time, didn’t understand what was going on. It’s a different world, clearly.”

“Don’t worry,” I said, “You’ll soon pick it up.”

Between bites he then added, “Well actually, the only bit I really got was when our MD spoke about how adopting open innovation and co-creating value leads to cost savings and the importance of partnerships across multiple stakeholders. What’s all this sustainability and transformation stuff all about anyway?”

“Well,” I said, “It’s the local road maps for delivery of the five year forward view.”

“Hmmm,” he said, and I could see from his expression he was none the wiser.

We are what you might call an eclectic mix and what I am looking for most is people who can bring their own perspective on what we do and are not afraid to question what we are doing.

So I realised that our AHSN has now become truly multilingual. I understand NHS speak, though my accent is apparently still a bit rough, and my colleagues now also speak a very different language too.

I have always tried as far as I can to hire people to our team that are as different to me as I can possibly find. We have people from many backgrounds: education, finance, health and government.  We are what you might call an eclectic mix and what I am looking for most is people who can bring their own perspective on what we do and are not afraid to question what we are doing.

The point is diversity of thought; the ability to see things in a different way. Feeling empowered to question the status quo and feeling empowered to do something about it is what really matters if you want to achieve truly sustainable transformation.

As a famous person once said, “We will not solve the problems we have by applying the same thinking that created them in the first place.”

How to make stuff happen…

Today something interesting happened as I was cleaning out two filing cabinets that I had manage to completely fill with paper over the past seven to eight years.

I put everything into two piles, one to keep and one to shred and get rid of. The pile for shredding was pretty big, but so was the keep pile. After a vigorous bout of shredding and filling I sat down with a cup of tea and peering at the two mountains of paper sill left on the floor I wondered to myself, why on earth had I kept so many useless papers?

What was the difference between the stuff I was discarding and the stuff I wasn’t?  I realised that the stuff I was throwing away had been kept because at the time it felt like it was really important, or at least at that time was equally valuable to the stuff I’m still keeping.

Being a bit simple minded I thought, wow that’s amazing, I now have a pile of stuff that has become useless and a pile of stuff that has become valuable.

This obviously holds the secret of all success; all I had to do is see which ideas worked out and which ones didn’t and could learn how to make more ideas work out more often.

So picking up the first folder from the reject pile I mused to myself, yeah well that was a pretty crazy idea, no wonder that didn’t work out. OK, let’s see what’s on top of my success pile. Hmm… actually that’s also a pretty zany idea but that was great success. So I picked another folder off the success pile: absolute no brainer, obvious why that idea worked out. Next, I picked one from the reject pile. OK, so why didn’t that one work out? It was an even better idea than the one I just looked at.

Astonishingly, I had to admit that with hindsight there was no difference between the two piles except that some things had worked out and some hadn’t!

Now this really bothered me  because it means I can’t control it and I can’t use any of the knowledge, but in the back of my mind was a nagging feeling that I had been here before.

In a former life I used to teach a course explaining entrepreneurship to scientists and the one thing they all had a real hard time grasping was the fact that success is not an equation, and it’s not exactly reproducible. You can take the same ingredients in a business proposition that worked last year and try and do it again the next year with the same people and it could fail.

If you think about it, were it to be exactly reproducible we’d all be rich and famous, but in reality stuff happens that we don’t control. One business I was involved with went out to raise funds the week before the markets crashed in 2008. We couldn’t have controlled that.

So the same is true of my two piles, the difference is that other stuff happened and got in the way of things so some ideas worked out and others didn’t. So what is this magical stuff that decides what works and what doesn’t. The things we just don’t control, well I guess it’s just Life.

I’d like to think I am getting better at spotting good ideas from bad ones but i’m still left with the rather stark conclusion that fundamentally the only way to make more successful stuff happen is actually to do more stuff.

But then again I guess I also want to have a life!

Patient Safety Collaboratives – delivering on a promise

Dr Rosie Benneyworth is AHSN Network Lead for Patient Safety Collaboratives. In this special guest blog post, she celebrates the achievements of the Collaboratives in their first two years.

It has been two years since Patient Safety Collaboratives were set up in response to the Berwick Report, A promise to learn – a commitment to act.

Professor Don Berwick wrote:

“The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.”

The Patient Safety Collaboratives, the largest patient safety initiative in the history of the NHS, are run by England’s 15 Academic Health Science Networks and funded by NHS Improvement. They were the key recommendation in the Berwick Report to spread best practice and build skills and capabilities in patient safety and improvement science.

So what’s happened since then? Here are ten highlights of the work of Patient Safety Collaboratives, as showcased in their first collective report, Making care safer for all, launched at Patient Safety Congress last week.

  1. Mortality after emergency laparotomies (major stomach surgery) reduced by 42% over an eight-month period in 24 NHS acute trusts – led by Patient Safety Collaboratives Kent, Surrey, Sussex; West of England; and Wessex.
  2. A cluster of nine Patient Safety Collaboratives are working together to create a common process and outcome measurement for people with acute kidney injury. This will be reported by the UK Renal Registry and rolled out nationally to improve safety and quality of care.
  3. A 50 per cent increase in service users returning to mental health wards on time was achieved by Oxford Patient Safety Collaborative working with three NHS providers of mental health and community services, reducing the risk of self harm, self neglect and suicide when service users abscond from a mental health ward.
  4. Inpatient medication errors across six NHS trusts were reduced from 11 per cent to nine per cent, after Imperial College Health Partners Patient Safety Collaborative worked with ten organisations in North West London.
  5. Safety ‘huddles’ that led to a reduction of 60 per cent in falls by inpatients, as a result of Yorkshire and Humber Patient Safety Collaborative working with more than 66 frontline teams across 18 organisations, including two nursing homes and two GP teams. One ward moved from an average of one fall a week to repeatedly achieving no falls for more than 30 days.
  6. Twelve Patient Safety Collaboratives, led by the Innovation Agency in the North West Coast, are working with the National Board for Sepsis on earlier identification and treatment of people with sepsis and the deterioration that sometimes arises as a result of the condition.
  7. Six Patient Safety Collaboratives, led by East Midlands, are working together on safer discharge of patients and transfer of care.
  8. Ten Patient Safety Collaboratives have adopted a web-based platform which provides the tools needed for quality improvement projects, including sharing data and plotting results in run charts, developed by South West AHSN.
  9. The Collaboratives have created clusters around specific themes and health issues, to facilitate learning and adoption of innovation. The current priority areas include deterioration and sepsis; safer discharge; acute kidney injury; medicines optimisation; and mental health.
  10. Acknowledgement from Dr Mike Durkin, NHS National Director of Patient Safety, who said:“The Patient Safety Collaboratives have played a critical role in delivering changes in the culture of patient safety across the NHS. We must create conditions that make the best use of our resources, both human and financial. The Collaboratives are about doing the right thing first time and every time.”

The Patient Safety Collaborative programme was launched in 2014, and now falls under the responsibility of NHS Improvement. Each of the 15 Collaboratives is led by its local AHSN and works to tackle leading causes of avoidable harm, bringing together teams from across the local health economy to draw on talents from the NHS, academia and healthcare industries. The Collaboratives work to identify local safety priorities and develop solutions before testing and implementing them within local healthcare organisations.

The Collaboratives also work together nationally to share successful initiatives so they can be implemented in other parts of the country – accelerating improvement across all care settings from maternity care and nursing homes, to GP practices and acute hospitals.

Watch Rosie’s introduction to the launch of the first national PSC report, Making care safer for all, below on YouTube:

Why I’m proud to support the Don’t Wait to Anticoagulate project

Jo Jerrome is a public contributor on the steering group of our Don’t Wait to Anticoagulate project, which aims to improve the management of stroke risk for people with atrial fibrillation (AF). Here she explains why she is so proud to be part of the initiative.

It has been enlightening to be part of the Don’t Wait to Anticoagulate project. I truly believe it is an exemplar model in integrated patient decision-making tools.

I’m really keen for it to get picked up more widely as there is so much we can learn and implement from the project to benefit AF services in other parts of the country.

“I feel very privileged to be part of the project. It really is utilising all the learning available on AF to move it forward.”

For me, what makes the project special is that from the start patients and clinicians have been involved equally – identifying the challenges, listing the needs and constantly reviewing and feeding back into the draft versions.

The result is uplifting – I want to use it with my Mum. It dispels myths and fears, from aspirin to bleeding, while supporting that really important patient-GP conversation.

Until recently, I was the deputy CEO for the Atrial Fibrillation Association, a national patient charity. When I started the only anticoagulant available was warfarin and there was an awful lack of information and shared knowledge about the condition.

The prevalence of AF

What was coming through was the prevalence of AF amongst the population and the risk factors that previously had not been recognised. Very quickly on the back of that was evidence on the ineffectiveness of aspirin.

At the charity we were looking at how to make information available and accessible to patients, their families and people working with them.

But the big challenge we could see was that it’s one thing having all this knowledge but what do you do with it? I sat on five or six NICE committees and was involved in scoping NICE guidelines and in 2014 I sat on the committee to develop the NICE stroke prevention in AF patient decision-making aid.

There was a wealth of guidance then about AF pointing to what we should be doing and yet take that on a year and AF management still isn’t great. Over 40% of patients who should be anticoagulating aren’t, and there remains a real lack of confidence in knowing what the best anticoagulant is. People still ask why they can’t use aspirin – isn’t it safer? There are still myths that needed busting.

Due to my parents’ health, I stepped down from the AF Association 18 months ago. At that time I’d be liaising with the West of England AHSN on the initiation of Don’t Wait to Anticoagulate and right from the start I’d been really excited by it because it was everything could see we needed, as well as being back up by NICE guidance.

So when I stepped down, I contacted the West of England AHSN to register as a public contributor because I wanted to remain involved, and they invited me to be on the project steering group.

Translating the information

NICE had created a great deal of excellent guidance but it wasn’t particularly accessible. Their patient decision-making aid was only online and about 33 pages long. It had everything you needed in it but it wasn’t user-friendly: it needed translating.

So what excited me was that the West of England AHSN saw this; they saw the need clinically; they saw the need economically across healthcare and social services; but they also saw the patient need. And they wanted to make it accessible right at that point of partnership between the GP and the patient, because that’s when most of those conversations about AF management happen.

What’s most innovative about Don’t Wait to Anticoagulate is this toolkit they’ve developed to support that conversation that’s also accessible when the patient has left the surgery and wants to go back and read more, either online or in print.

Making an informed choice

As a carer myself, I’ve attended appointments with my parents and you hear all these figures but what you actually want to know is, what does this mean to me? Don’t Wait to Anticoagulate helps to interpret this using pictures and comparisons. For instance, if I were on a bus, how many people on that bus would be affected? It’s real life. You can put that into your life and make an informed choice.

Shared conversation

The shared conversation is the key to this project that will change things. It’s building on what was already there. It hasn’t tried to duplicate things. It’s built on solid foundations and has identified where the need is. This tool helps the patient and the general practitioner implement the NICE guidelines by having that conversation around the personal risk, your options on reducing risk, why some therapies might not be as beneficial as we once thought, and why others are really better at safeguarding you from a catastrophic stroke.

All the important stakeholders have been involved, working with clinicians, specialists and also general practitioners because they’re the ones who are going to be using it. And to my knowledge well over 20 patients have been involved in reviewing and sharing ideas. They really had all those key stakeholders at the heart. And out of all of them, patients outnumbered them all.

The team has been amazing in how they’ve constantly been reviewing and looking at ways to improve. This is always based on what the users have fed back, as well as what the steering group has commented on.

The project is so refreshing. It’s taking really good clinical evidence and guidelines into real life practice and saying, how do you make it work?

Innovative and sustainable

That’s why I think it’s innovative; it’s about sustainability; and it’s got all the voices needed represented in it. And at every phase it’s willing to amend and it does it quickly. Change can take a long time in healthcare. This project proves that’s not necessary. This project is driven by outcomes to improve the service and for the patient, and that is critical.

I feel very privileged to be part of the project. It really is utilising all the learning available on AF to move it forward.

We needed something like an algorithm from the NICE guidelines; something to simplify and interpret. And the West of England AHSN has done it with Don’t Wait to Anticoagulate and they’ve done it really well.

Visit the Don’t Wait to Anticoagulate website here.

Using QI methodology to win Euro 2016

Natasha Owen, Quality Improvement Lead at the West of England AHSN, combines her passion for improvement science with her (basic) knowledge of football to get us in the mood for Euro 2016…

This year will see the Quality Improvement (QI) team at the West of England AHSN continue in its aim to increase the capacity and capability of colleagues in our member organisations, through the understanding and use of QI methodology and tools.

What better way to achieve this than by starting with our own teams here at the AHSN office?

Sometimes when using QI tools we have to step outside our own sector, in this case healthcare and the NHS, and develop people’s understanding of the concept using a more relatable topic. Say football for instance. The impending European Football Finals (Euro 2016) felt to us like the perfect opportunity to combine some office fun, in the form of a sweepstake, with an example of how to apply the Model for Improvement.

The QI team set about thinking: how would a football team apply the Model for Improvement to their tactical approach in the competition?

When specialist knowledge and QI skills are combined you can develop what Don Berwick called ‘the knowledge base for continual improvement’, which any team in any industry or field can strive for.

I mean who wants to stand still when you could improve?

As a QI expert or trainer, you are not expected to have the specialist knowledge. The key is allowing specialist teams to apply their knowledge to the Model.

In this case, I had the knowledge of applying the model combined with just enough football knowledge to make this example work!

The Model for Improvement requires a systematic approach to its application. It is a step by step process, which, when applied as described in the correct order, will provide a consistent approach to improving the quality of your performance, or processes, as a team.

Skipping a step, doing step three before step one, or taking steps out completely will not glean the same results. More importantly it is not guaranteed to achieve an improvement every time.

However the ‘test small and quick’ method allows you to rule out bad change ideas as easily as identifying ideas that create an improvement. Both outcomes are essential to promote continuous change.

So back to our football team… How on earth can a methodology created for a healthcare environment help a football team win the Euro 2016 Final?

Picture the scene. It is the month before the finals begin, the football season has ended, and Roy has called up the England boys to play for their country. What an honour!

During the football season all the players play for different teams, where different tactics and skills are used. Bringing them together in the short term is comparable to creating a Quality Improvement team. Roy does not have long to get this team to gel together to be a high quality goal scoring machine: the finals start on 10 June!

Training as a team gets underway. In other words, the planning of the QI project begins. Step One of the Model for Improvement is to establish your aim: what are we trying to accomplish?

For this team the aim is to win the European Football Tournament by 10 July 2016. Aims should be specific. Note that the team want/need to achieve their aim by a certain date.

The next thing they need to do is decide what data they could use to decide whether an improvement has been made. This is Step Two of the Model: how will we know a change is an improvement?

Measurement is key to distinguishing between a change, and a change that makes an improvement. If we don’t know what the data looks like beforehand, the data we collect afterwards will be meaningless.

A football team may have many sources of data they can measure, from the number of goals they score to how fast each player runs during a game. However they need to decide which measures are applicable to their aim. Does running faster contribute to winning? I don’t think it would be a team’s primary concern.

Before you decide what to change, you need to decide if it can be measured. So Roy and the boys have got together and had a discussion in the changing room and came up with the following measures…

Primary measure: number of points scored. Essentially this is how football is governed so that measure is set for the team. This might happen from time to time when undertaking improvement projects where measures are set externally – by CQC or NHS England for example.

Secondary measures

  • Number of goals scored
  • Number of yellow cards given
  • Number of opponent goals saved or avoided.

Your primary measure is the main source of data you will use to establish if your aim has been achieved. Secondary measures can provide further data to indicate to what level a change is driving towards or away from making an improvement.

For example, where the team draws and only scores one point, this could be explained by the number of goals scored being equivalent to the opposing team, but an increase in yellow cards being given might suggest an underlying behavioural issue that led to a poorer performance, ultimately leading to the lack of goals scored or saved.

Now the fun begins! Step Three is all about getting creative: what changes will make an improvement? It’s all about generating ideas, no matter how crazy they might seem as long as they can be conducted within the rules of the game. I am pretty sure EUFA won’t allow players to wear rocket boosters on their shoes!

Finally we move into the testing phase. The team might decide what ideas to test using a prioritisation matrix. Remember, test one idea at a time. Test small, test quickly. This way you will limit the damage a change could cause and create less disruption in a full system which could have a ripple effect in other areas or departments.

This style of testing is called PDSA cycles (Plan-Do-Study-Act).

The team decide their first test of change will be: players will only pass the ball five times before whoever has the ball shoots for the goal during the game against Turkey on 22 May.

Plan: your change. What will you do? What measures will you use? Who will do it? When will you do it? How will you do it?



Implement by

Measure of success

Install beeper on the ball that will beep after it is passed five times


16 May

Number of times players shoot after hearing the beep

Number of goals scored

Practice the five pass tactic in training

Players and Coach

16 May

Number of times ball is aimed at the goal after five passes

Use the five pass tactic during the game


22 May

Number of points scored

Number of goals scored

Do: put it into practice. The timescale for the test will be the duration of the next game (around 90 minutes).

Study. Using the measures you set out, has an improvement been made? Run charts are the recommended way to present and analyse your data to indicate improvement.

Act. Did you see an improvement? Yes? Try it again in the next match see if it continues to improve the team performance. No? Reflect on why it did not create an improvement and refine the idea, or scrap it and move on to the next idea.

Now you have this knowledge, you might want to give Roy and the England boys* a call to see if you can help them with their tactics and WIN WIN WIN!

*or any other manager and team in the tournament

What happens in Gothenburg doesn’t stay in Gothenburg

Four members of our Quality Improvement team were able to attend the Internation Forum on Quality and Safety in Healthcare held in April in Gothenburg, Sweden. Sarah White, Quality Improvement Adviser, offers this round-up of their experiences, thoughts and learning.

Four head to Sweden

Having overcome the vagaries of booking systems to organise our planes, trains and automobiles, the team set off for Gothenburg; a fairly epic trans-European trek across the hinterland of well, Belgium!

As you would expect, the conference was hugely popular and well attended with over 3,000 delegates from all over the world, including India, Australia and the USA – who presumably made far more epic treks than me in order to get there!

There is no doubt, it is exciting to be part of such a big and well-respected event and our Quality Improvement team was proud to be presenting two posters on key projects: PreCePT (Prevention of Cerebral Palsy in Pre-term births) and Don’t Wait to Anticoagulate.

The Godfather of Improvement Science

My week started first thing on Wednesday morning with Don Berwick giving the keynote speech. Natasha and I secured front row seats and settled back to enjoy the Red Bead exercise on the main stage.  If you’ve not heard of it, it’s a good tool for demonstrating that…

We as workers most of the time have no control over our experiences. We the worker did not make the company – our bosses did – and we should not be held responsible for most of the mistakes. Yes, we can control about four out each 100 problems but not the other 96. They are problems created by the system.

It was great to have the solid theories and principles showcased that inspired all the work we were about to see.

There was lots of talk about patient flow. Steve attended some interesting sessions on learning from supply chain management in managing patient flow, highlighting that the concept of ‘emotional flow’ is really important.

Learning and leading

Also, in support of our West of England Academy, the international stage is finding evidence that a coaching approach can be the key ingredient in successful improvement. The Vinnvard research programme demonstrated that improvement is best based around specific improvement projects, and that ‘learning by doing’ is critical, demonstrated by the experience from the Vastra Gotaland region.

In a ‘learning stuff for QI’ way, Natasha managed to get hold of a useful tool for our toolkit. In a session entitled Accountability in Care she learnt about what motivates us in the workplace and changing from a Quality Assurance culture to a Quality Improvement culture. An exercise using Polarity Maps made her think about how we get a balance between two concepts: how we identify if the balance is wrong and how we can correct it. Natasha was so enthused by the session that 1) she didn’t stop talking about it and 2) she would love to deliver something similar for our team sometime in the future.

The Sheffield Microsystem Coaching Academy team was represented by Tom Downes, whom Steve found particularly inspiring. A key piece of advice was to start each improvement meeting with a patient story to help maintain engagement with improvement work.

(I should probably mention at this point, that the conference was fuelled by coffee and cake; Fika heaven and the breaks provided loads of opportunities for networking, which seems much easier when sugar and caffeine are combined.)

Steve and I presented the PreCePT poster – tag teaming the information like we’d done it before! For me, this gave an opportunity to reflect on the work we have done as a team and what we have achieved during the last two years. Our poster was a great success; one conference attendee picked up a handful of leaflets saying…

“I will be shamelessly stealing this project and implementing it in my hospital in Scotland!”


The reception evening was held on Wednesday and delegates stayed on after the sessions finished to enjoy canapes and wine.  We spent a good deal of time speaking to our AHSN colleagues from other regions and also the delegates from East London Foundation Trust (ELFT).

The work that ELFT is doing is truly inspiring and they seem to be at the forefront of QI in secondary care in the UK, presenting four sessions during the conference and contributing to another panel discussion.  We were able to tag along with our new ELFT friends to sample some another of Gothenburg’s cultural highlights: Thai food. This was an excellent opportunity to reflect on the first day with a group of delegates and swap stories and experiences.

Thursday brought another full day of total immersion into all things QI. I found the Q Foundation’s session on Mobilising Improvement and Learning at Scale across Systems particularly interesting for the networking analysis that they undertook. It demonstrated the power of creating and sustaining viable networks across the country for sharing knowledge. The delegates were asked to indicate how comfortable they were with change and uncertainty using a clock face, acknowledging that both ends of the comfort scale were required to successfully run a programme.

Unsurprisingly, I chose the ‘five past twelve’ position which is Very Comfortable with change, but it was clear that both ends of the comfort scale are required for successful projects as someone needs to have the plan!

Different things stood out for different team members; different things resonate based on the work they’re engaged with. Here are some of the highlights…

King of Lean

Steve’s highlight was two presentations from Gary Kaplan and Jack Silversin from Virginia Mason Hospital on engaging doctors in transformation, although the learning was applicable to all clinical staff.

I also attended this session and was impressed by focus on human factors demonstrated by Virginia Mason as they transform the patient experience of healthcare, stating that organisational change is most effective when lean management method engages employees at all levels — from leaders, to providers, to frontline staff. When lean tools and methods are used at every level of the organisation, focused improvement will create value, eliminate waste and reduce the burden of work.

So I may not be a Lean convert just yet, but maybe, in time…

Rebels with a Cause

The final day came far quicker than expected and it started with Lois Kelly talking about a subject close to my heart; Rebels at Work. Lois was inspiring us to be a ‘brave-hearted rebel’ at work and empowering change within our organisations.

Improving healthcare starts one rebel spirit at a time, daring to embrace new ideas, new people, new ways of working, and our true, naked-hearted selves. Lois Kelly of the Rebels at Work movement opened our heads and hearts to what it takes to shake up healthcare-as-usual, from running with rebellious wild packs and communicating like an activist to having difficult conversations and developing practices of resiliency and optimism.

I loved this. It was inspiring and challenging but realistic. Lois also talked about knowing when to back down, which is absolutely as important as knowing when to rebel.

Innovation for Life

This was followed by Jaideep Prabhu talking about Frugal Innovation: How to Do More with Less. Jaideep Prabhu discussed the creation of better and cheaper solutions that employ fewer resources—and how it helps to meet the unmet needs of large numbers of people around the world in core areas such as health, education, energy, and financial services.

This session highlighted examples of such innovation by entrepreneurs, NGOs, emerging market firms and multinationals in the North and South, and discussed the challenges and opportunities for small and large organisations alike.

Round the World

After the obligatory coffee and cake break, we found ourselves back in the auditorium for a round the world trip in Quality Improvement in Mental Health.

This session consisted of Pecha Kucha style presentations from different groups around the world that are applying quality improvement techniques to tackle complex problems in mental health services. We got a glimpse into the breadth and scale of mental health improvement work taking place across the globe.

Don’t Wait to Anticoagulate

Friday also brought us the opportunity to show off our Don’t Wait to Anticoagulate poster.

We saw some impressive work that had a huge impact on a small scale from colleagues in Sweden and Denmark. After the group session we stood with the poster and talked to more people who were around for the session but were not in our group, and generally collared people to show off our work. It was engaging, and a great way to share learning.

Museums Theatre and Health

Finally for me there was a session on Culture on Prescription.  This session explained how undertaking cultural experiences actively can contribute to improve health and enhance rehabilitation. This was really powerful with interesting stuff on holistic healthcare emanating from School of Health Science, Jönköping University.

What I found so interesting was the massive influence on people’s lives that a seemingly simple intervention can have. The study was small with only 76 participants but showed that over 50% were able to go back to work following the project. Small changes making big impacts once again!

Twitter Meltdown

The whole team really got into the Twitter culture at Gothenburg and although the spirit was willing, the technology was weak.  The internet connection dropped out every time the audience got excited about something as we were all tweeting like mad!

Horsing Around

Any international travel is an opportunity to sample the local cuisine and our little team found some great food in Gothenburg.  The first night was spent in what could only be referred to as Hipster Heaven – bearded young men in too-short trousers drinking artisan beers, and us!  The food and ambience was great though and the team had an opportunity to plan out the sessions and seminars that we would be attending.

Poor Natasha was upset that we didn’t get a selfie with Don Berwick – but his keynote speech kicked off the conference with a good dose of ABBA!  This got two Quality Improvement leads swaying in their seats and waving (imaginary) ‘WE LOVE DON’ banners!

Gothenburg is lovely, the rain held off until the last day, the hotel staff were pleasant and effective and the public transport was on time every time.  Although, it has to be said that there are some more eccentric sights to be seen…

Sharing NEWs to save money, bed days and most importantly lives

Anne Pullyblank, Clinical Director, West of England Patient Safety Collaborative, looks back at the first year of the Safer Care Through Early Warning Scores programme in the West of England – what’s been achieved so far and what more is to come.

We recently held an event in Swindon to celebrate the first anniversary of the Safer Care Through Early Warning Scores programme, led by our West of England Academic Health Science Network (AHSN) Patient Safety Collaborative.

We started this exciting programme in March 2015 to adopt the use of early warning scores across our entire health community and have made fantastic progress in a short time.

An early warning score (EWS) is an objective measure of how sick a patient is. It is a numerical score based on a full set of observations and we know that EWS is better at detecting a deteriorating patient than clinical review alone. Some hospitals were using the National Early Warning Score (NEWS) and since this was recommended for adoption nationally, our Patient Safety Collaborative, made up of all clinical commissioning groups, NHS trusts and social enterprises in our patch, agreed this was the one we would adopt.

In the first year all six acute trusts in the West of England have standardised to NEWS, which on its own is a tremendous achievement.

By changing our system response, the vision is to get the sickest patient treated at the right time, in the right place, by a clinician of appropriate seniority.

The aim is to use NEWS at every handover of care. Wouldn’t it be great if the NEWScore was communicated along the entire pathway for the acutely unwell patient? Sick patients might be recognised sooner (a colleague of mine compares this to ‘Where’s Wally?’!) and NEWS can trigger earlier recognition and treatment of sepsis.

More importantly, by changing our system response, the vision is to get the sickest patient treated at the right time, in the right place, by a clinician of appropriate seniority. If a patient needs to be transferred to hospital, the ambulance response will be quicker for a patient with a raised NEWScore; they will not wait in the ambulance queue and will be reviewed in the emergency department (ED) by a senior clinician. They would then be transferred to the right bed, which could include ITU but would exclude outlying on a non-specialist ward.

In order to achieve this we are utilising all the technology available to us. For instance NEWS now features in the new ambulance service electronic patient record and it has been introduced to some GP systems. We are spreading the use of an ED safety checklist, which again includes the use of NEWS.

So far we are spreading evidenced-based practice but there are exciting possibilities to help shape the evidence of the future.

NEWS has been adopted by our community colleagues, prisons and mental health trusts, helping to escalate the care of sick patients between health providers. NEWS has not been validated for detecting the deteriorating patient in the community setting, so there is huge excitement around the possibility of using a baseline for patients with long-term conditions, using NEWS at end of life or as a decision aid for admission avoidance. We are collaborating with researchers to systematically evaluate our work.

The next step for the WEAHSN is to link innovation to practice. There are gadgets that can take observations and communicate wirelessly to electronic devices. There is an app to calculate the NEWS score and we are working with industry to enable easy calculation of a NEWScore in the community and in patients’ own homes. If we can link this to electronic systems that talk to each other, then that would be real progress! We are also working with third sector and carers organisations because for patients with long term conditions, asking about a NEWScore when unwell will empower patients and carers to raise concerns.

We are making progress faster than expected with this project. This is because people believe in it.

The work is happening not because of a government diktat or because we are being paid to do it, but because dedicated people across a health system believe this will make patient care safer.

The objective is to reduce mortality from sepsis, rescue acutely unwell patients and ultimately treat some patients at home appropriately leading to admission avoidance.

Having the right patient treated at the right time, in the right place, by the right person will improve flow across the system – saving money, bed days and most importantly lives.

Find out more

To find out more about the roll-out of NEWS in the West of England visit or email Ellie Wetz Patient Safety Improvement Lead at

“I’ve lost Wales!”

Ann Remmers, Patient Safety Programme Director for the West of England AHSN, reflects on using the Open Space technique to get people sharing knowledge and working together in new ways…

“Let’s run our next Falls event as an Open Space,” said Nathalie. “Yes,” I replied. “Great idea!”

Now, this particular member of my team is renowned for coming up with good ideas and they are always worth listening to. However, after our initial enthusiasm had died down, we started to consider the reality and the enormity of what we would be taking on. Was it such a good idea after all…?

The main issue, and this was obviously quite an important one, was that we had never run an Open Space before. Between us, our only experience was that I had attended one, once. It was beginning to sound a bit like see one, do one…

Time for some serious research and what we discovered encouraged us.

Open Space is an ideal way to run an event when you want to ensure that everyone has an opportunity to contribute to the agenda – in real time, on the day.

When you bring together a large group of people who already have extensive knowledge and expertise in their field, Open Space enables all that expertise to be shared.

Sometimes, when an agenda for an event is planned in advance it can leave some people feeling that a particular issue or topic close to their heart was not covered. The idea with Open Space is that anyone attending can put forward the topic they wish to discuss: they agree to convene a group and then see who would like to join them. Once everyone who wishes to has had a chance to put forward their topics, people then get a chance to sign up to the groups they want to take part in.

The event we decided might work as an Open Space was our ‘Reducing the harm from falls: next steps’ event, which took place in March in Taunton.

We knew that the majority of the attendees, from across the health sector, including mental health, community, care homes and acute services, have great knowledge and experience to share, and a wide range of organisations were involved who likewise all had their own experiences and expertise.

People attending had been working hard on reducing harm from falls and had probably attended many meetings and events before. Evaluation from our last event showed that people wanted less time on presentations and more time on networking and sharing. In fact they told us they wanted more ‘coffee break’ time to network, and that is exactly what happens with Open Space.

Open Space is not for the faint hearted though.

One guide I read said that control freaks would find it especially difficult to facilitate as you have to live in the moment and see what happens as the day unfolds – that’s the scary bit!

Then there is standing in the middle of a circle with nearly 100 people around the room, some wondering what on earth is happening, while you hope that you are going to sell the idea enough for that first person to come forward.

I need not have worried though. These people were raring to go and had a lot they wanted to discuss and get out of the day. Soon I was surrounded by enthusiastic people all wanting to put themselves forward to convene a group. This is going well I thought, better than I could have expected! Right, what’s the next bit?!

Probably the next bit is best described as organised chaos. Or maybe just chaos. “What’s happening?” “Where do I go now?” “When’s coffee?” “I’ve lost Wales!” (Nathalie had the great idea of giving each group a rugby nation’s flag to identify their table. We were at Taunton Rugby Club after all).

Open Space Collage

The Open Space gurus tell you to expect a bit of mayhem at this point, as people sign up for groups. 100 people are a lot of people moving around a room looking at sign-up sheets and they do a lot of talking. We definitely thought of some ways we could improve in future, but amazingly everyone did get to a group and we were conscious of a real buzz in the room as people shared ideas and thoughts and came up with new ideas.

Overall I think we would count it as a success. We certainly had some very positive feedback from participants. There were some real enthusiasts who valued the opportunity to work together in this way, while there were also some who felt a bit uncomfortable with the perceived lack of order who would have preferred more structure.

Would we do it again? I think yes we would in the right circumstance. It is a fantastic way to achieve some really good connections and outcomes.

And I’m very glad to say that we did find Wales!

For more information on Open Space, take a look at this video.

Devoted and Disgruntled – A video guide from Improbable on Vimeo.