We are delighted to announce that PreciSSIon – a regional collaborative to reduce surgical site infection after elective colorectal surgery – has scooped an award in the Quality Improvement category at The BMJ Awards 2021.
The project – in partnership with Royal United Hospitals Bath NHS Foundation Trust; Gloucestershire Hospitals NHS Foundation Trust; North Bristol NHS Trust; University Hospitals Bristol and Weston NHS Foundation Trust; and Great Western Hospitals NHS Foundation Trust – was awarded the accolade for using original ideas in quality improvement to better outcomes for patients.
Anne Pullyblank, Medical Director, West of England AHSN said:
“This has been a fantastic project to be a part of, and the figures we have been able to achieve at such a challenging time for many in hospitals are absolutely incredible. Combined regional average baseline figures showed surgical site infection (SSI) was 18% pre-November 2019. Implementation of the PreciSSIon bundle elements in all trusts between November 2019 and June 2021 resulted in an amazing almost 50% improvement in SSI rate, leading to a regional average of just 9.5%; a significant improvement in patient experience.
The collaborative element enabled staff and trusts to support each other during the difficulties of the COVID-19 pandemic and engagement was high, with theatre teams in particular being empowered to make a difference. It’s amazing for the hard work of everyone involved to be recognised at the BMJ Awards in the Quality Improvement category.”
This follows PreciSSIon winning the Perioperative and Surgical Care Initiative of the Year at September’s HSJ Patient Safety Awards. The collaborative project was also shortlisted for the Infection Prevention and Control Award.
The West of England Academy are hosting a new series of five free-to-attend interactive online workshops each Friday from 16 April.
Attendees will gain a basic understanding and practical knowledge of applying Quality Improvement (QI) techniques to real-world challenges in primary care.
Modelled on our hugely successful QI Summer and Winter Series, this five-week course, held over 90-minutes each Friday from 12noon can be joined as single sessions or a series.
The workshops have been developed, and will be delivered by, the West of England Academy team alongside guest speakers. Topics include stakeholder mapping, process mapping, data management and the basics for change management.
Attendees can be in any role and/or grade within their organisation, for example from clinical, administration or facilities.
Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.
The West of England Academy are hosting a series of five online workshops each Wednesday from 27 January on quality improvement (QI). Free to attend, and for any innovator or employee within healthcare, each one-hour session is standalone so you can choose individual workshops or sign up for the series.
Each workshop will be interactive, so you can apply learning in real-world scenarios. The workshops will be beneficial regardless if you are working on a specific QI project or not. If you encounter challenges in your role (or outside work), and want to consider how these can be tackled through QI, these sessions will help.
Attendees can be in any role or level within their organisation or business; for example clinical, product development, administration or facilities.
Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.
The West of England Academy offers a wide range of free resources to healthcare professionals and innovators across the region. To find out more, visit our Academy pages or email firstname.lastname@example.org.
It is estimated that across the UK, a third of healthcare improvement projects never spread beyond their particular unit, a further third are embedded across their organisation but never spread further than that, and only the final third are spread across their own and other similar organisations. Through the West of England Academy supported by our new guide, we aim to support our member organisations and innovators increase the adoption and spread of successful innovations and improvements in the health and social care sector.
Successfully spreading improvements and ensuring changes are sustained requires overcoming numerous challenges, such as:
Creating an awareness of why the change is needed
Ensuring those involved have a desire to support and participate in the change
Knowledge of how to bring about change
The skills and resources to bring about the change
Ensuring processes to sustain the change
Our new guide (which you can download here) sets out suggestions to be considered for the successful adoption and spread of innovation and improvement projects. Our Academy will also be hosting a free series of workshops focusing on adoption and spread in spring 2021.
Our Academy also hosts free workshops and learning events. Whether you are looking to learn more about: inventing, innovating, improving or realising impact, and whatever your background or healthcare experience, we hope we’ll have something suitable for you. If you have any suggestions for potential events, or know of any training that we can share then please contact Academy@weahsn.net and let us know.
In this Q&A our West of England Academy Project Managers Kate Phillips and Vardeep Deogan share their reflections on the delivery of the Academy’s recent Quality Improvement (QI) Summer Series. They led 10 hours of online interactive workshops and delivery of QI theory by 12 different facilitators to around 60 delegates per session from across the West of England region and beyond. The Academy team have also compiled a series of slides with their top tips on hosting virtual learning.
What did you enjoy about the QI Summer Series?
Vardeep: Every part of our workshops had a purpose, so being creative and thinking outside the box with activities without making them complicated was really important. Supporting our guest facilitators was a pleasure too. After our fifth session, we really felt a sense of achievement, and we cannot wait to deliver future online workshops.
Kate: An unanticipated pleasure was coaching our guest facilitators. Vardeep and I were the main hosts, but wanted the series to reflect the wealth of knowledge and range of experiences of working with QI across the West of England. We also figured that our voices might be a bit dull for two hours straight! Considering that online training was a fairly new concept, this meant that Vardeep and I mentored our guest facilitators to deliver their 25 minute activity. The feedback from the guest facilitators was lovely – they felt challenged by the experience but also supported. I think they were all very proud of themselves which was great to see.
The overwhelmingly positive response to the sessions has also been wonderful. Vardeep and I cooked these sessions up, combining our knowledge and experiences and we seemed to have stumbled upon a winning formula!
“Exceeded my expectations – I learnt so much.”
2. What are the differences between online and face-to-face delivery?
Vardeep: When delivering face to face it’s much easier to ‘read the room’ for non-verbal communication and how people interact with each other, and as a facilitator you respond accordingly. We had to think differently about how to get this feedback during and throughout each workshop. This involved designing activities and including opportunities for feedback using functions like slido, the chat box and voting.
We also considered different learning styles and made certain to include activities that reflected these. Using liberating structures supported this.
Kate: The whole experience is different- quite often I’d be looking at only one or two faces in the corner of my screen, but knowing I was talking to 50+ delegates who had prioritised our training over other work, it’s a bit of a barmy experience really! I think delivering online sessions brings a different type of nervous energy…the adrenaline flows!
3. Can you tell us about your biggest ‘aha’ moment?
Vardeep: As the series progressed, even though we may have been delivering our fourth or fifth session (and at times felt we were repeating ourselves with instructions for activities etc.) we kept in mind that this may be someone’s first experience on zoom or of virtual learning. I realised the value of clear instructions from the positive feedback we received where our clarity was praised. This was a key learning point.
Kate: For me, a lovely moment during our second session was when Vardeep asked a delegate to turn their mic on and share their experiences verbally with the entire group. We regularly asked delegates to share feedback via the Zoom chat box, but giving individuals the platform to voice their thoughts brought the session alive. It did mean having to relinquish some control, but it was worth it every time. Sharing the platform was important.
“I think I’ve learned more in this two-hour online session than any other face-to-face course I’ve attended!”
4. Have you learnt any new skills with online facilitation/delivery?
Vardeep: I’ve learnt you have to be even more adaptable and fluid when delivering online. Anything can happen at any time (tech issues!) and you have to be able to step in and pick up anything, whether this is the delivery of a session or an aspect of facilitation. Every member of the team needs to be able to pick up any role and this really stretched me and took me out of my comfort zone – we survived a few hairy moments.
Kate: I had delivered a few online webinars before, but they were very much ‘chalk and talk’ style. I’ve loved learning about, and using, Liberating Structures to keep delegates engaged and to facilitate interaction between them. I’ve also enjoyed thinking creatively to convert traditional face-to-face QI training for online delivery.
5. Have you learnt anything about yourselves during this project?
Vardeep: Working alongside Kate to plan every session in detail, really enabled me to be fluid and agile to the needs of others, particularly guest facilitators. I’ve learnt that with the right team around you, you can adapt to any last minute change and for it to still feel under control and most importantly – fun.
Kate: I’ve learnt that my happy place is extremely organised and where I’m in control. Fortunately Vardeep is very good at making me feel safe enough to step outside of that and allow space for spontaneity and discussion, and that’s where the magic happens! On the flip-side, I’ve learnt to value the skill of organisation and I don’t think we could have pulled off this series without it.
“Really good workshop today – best I’ve attended during this whole pandemic, so thanks to you and your colleagues”.
6. What has been the biggest challenge?
Vardeep: You never truly know how you’re being received online until you read the feedback. Over the five sessions I got used to smiling and talking to a camera instead of being able to make eye contact and responding to non-verbal cues. That often felt odd but it’s vital to the person the other side of the screen.
Kate: At the start I was overwhelmed with the task that lay ahead of us, thinking about all the details. Fortunately I work with brilliant colleagues who made this series a true team effort. I was able to focus on planning and delivering the sessions in a step-by-step way, knowing that the event logistics and marketing of the series were being expertly handled. Breaking down the roles, tasks and working as a team was crucial.
7. Do you have any top tips for online delivery?
As a facilitation team agree a way of communicating with each other behind the scenes (such as Whatsapp). This allows you to adapt, adjust or abandon as you go along.
Plan your sessions with timings in mind. This is invaluable and is a skill – things often take longer virtually. This also includes prepping any guests.
Allow time for a team pre-brief and de-brief after each session. Kate, Shomais and I always spent time reflecting on what went well, what didn’t go so well and we also captured new ideas to incorporate for the next session on ideaz boards or jamboards.
Kate: I think one of my favourite phrases from this series was “team work makes the dream work”. We couldn’t have delivered such a slick series without the designated online technical support that our colleague Shomais provided. Having clear roles and responsibilities in the team was important, e.g. being clear on who is responding to questions in the chat box, who is co-ordinating break-out rooms and who is introducing facilitators and welcoming delegates back from breaks. I think the clarity of roles and knowing we could depend on each other, created a safe space to do each of our jobs really well.
Thanks to Kate and Vardeep for sharing their experiences.
Further information about the West of England Academy’s online resources and future events can be found here.
During July and August 2020 the West of England Academy, aided by guest facilitators and speakers, held weekly Quality Improvement (QI) webinars. This season of learning, known as the QI Summer Series, was fully booked with a lengthy waiting list. We are also delighted to say the series received 100% positive feedback from attendees, no mean feat in a world where virtual fatigue is setting in.
Before and during the series our Academy team compiled their thoughts and tips on hosting learning sessions via webinar: To download the slides as a PowerPoint, please click here.
In the coming weeks, our Academy team will also be sharing a Getting Started with QI Guide alongside a blog about their experiences organising and leading the QI Summer Series.
The West of England Academy will be hosting further QI webinars, alongside other virtual events.
You can browse the full range of AHSN events here.
The AHSN Network, of which the West of England AHSN is a member, is planning a series of “Bridging the gap” events this autumn aimed at providing support, information and advice for innovators across industry. The plans have been developed following a roundtable discussion hosted by the AHSN Network to listen to the experiences and challenges faced by industry during the COVID-19 pandemic.
The roundtable, titled Lessons learned and lived experiences of industry during the pandemic – how these can help us reset health and care together, was primarily an opportunity to hear from industry. The group discussed how the views and experiences of industry could be taken forward and inform the NHS Reset process as we move into “phase 3” of the response to the pandemic. You can watch a short film summarising the event here.
In essence, the key themes of discussion around actions that need to involve industry insights to support reset included:
Effectively embedding new care/service models that have developed during the pandemic
Getting rapid evaluation and reimbursement models working more effectively, building on the lessons learned in recent months
Managing the consequences of the dramatic decrease in non-COVID care and considering digital interventions that can help manage patient care and outcomes.
Organisations joining the AHSN Network in this virtual roundtable included:
the Association of the British Pharmaceutical Industry (ABPI),
the British In Vitro Diagnostic Association (BIVDA),
the Digital Health and Care Alliance (DHACA),
the Association of British Health Industries (ABHI),
Accelerated Access Collaborative (AAC),
the Office for Life Sciences (OLS),
Spirit Health Group, and
the NHS Confederation.
Niall Dickson, Chief Executive of the NHS Confederation, said:
“The NHS has been through the most traumatic period in its history – we have seen some of most awful consequences of this terrible pandemic and some of the most fantastic responses from both health and care staff.
“We have seen innovation and its implementation at an unimaginable speed and scale that’s never been seen before, and we now urgently need to review what has happened and make sure we capture the positive transformations have been made possible by working with industry.
“We are keen for these relationships to continue and for us all to work hard to maintain this momentum.”
This event forms part of the AHSN Network work on supporting the health and care reset, ensuring that we work across both NHS and industry to sustain and maximise on potential advances and transformative ways of working.
Two of the West of England AHSN’s member organisations have been nominated across five categories in the 2020 HSJ Patient Safety Awards.
Avon and Wiltshire Mental Health Partnership Trust (AWMHP) received three nominations:
Learning Disabilities Initiative of the Year (Improving Patient Safety on the Daisy Unit),
Mental Health Initiative of the Year (Reducing Restrictive Practice on a Medium Secure Unit) and
Quality Improvement Initiative of the Year (A Collaborative QI approach to improving the quality of care on the Daisy Unit).
Royal United Hospitals (RUH) Bath received two nominations:
Deteriorating Patients & Rapid Response Systems Award (Improving Patient Outcomes from Sepsis and Acute Kidney Injury) and
Patient Safety Team of the Year (The Sepsis and Kidney Injury Prevention (SKIP) team improving outcomes for patients).
In a news release, Dr Lesley Jordan, RUH Consultant Anaesthetist and Patient Safety Lead at the RUH, said: “We’re very proud to be shortlisted and recognised for our continued work in improving outcomes for patients with sepsis and acute kidney injury.
“Sepsis is a life-threatening reaction to an infection, when a person’s immune system overreacts and starts to damage the body’s tissues and organs. Acute kidney injury is when a person’s kidneys suddenly stop working properly, usually as complication of an acute illness, and this can range from minor loss of kidney function to complete kidney failure.
“These can have serious consequences and early detection of both conditions is really important to improve outcomes for patients. We have focused on identifying the conditions as early as possible, introducing process and tools to enable our frontline staff to implement treatment promptly and improve the care we deliver. We have also established a new senior nursing support team, the Sepsis and Kidney Injury Prevention (SKIP) team, to continue to drive this work and support frontline staff.”
Noshin Menzies, Senior Project Manager, shares her experiences of launching a Quality Improvement programme during COVID.
If you’d told me 4 months ago we would be where we are today with PERIPRem, I’d have wondered what planet you were from. This exciting, ambitious care bundle, the vision of two extraordinary neonatologists, was going to launch in April and change the way that perinatal care is delivered across the entire South West region. It was a seed reliant on collaboration. However, 2020 had other plans…
The fundamentals of PERIPRem – nurturing a regional clinical community dedicated to improving outcomes for our most vulnerable babies and working side by side with women and their families – were, in an instant, stopped in their tracks.
Pre-COVID, I had been lucky enough to attend the Royal College of Obstetrics and Gynaecology’s “Let’s Talk about Race” event for International Women’s Day. The stories I heard further cemented the commitment we had to reducing inequalities. We could not deliver a perinatal quality improvement project without ensuring that we were actively listening – and considering how to chip away at the barriers that result in Black and Minority Ethnic women being 5 times more likely to die in childbirth and their children to experience poorer outcomes. This was even before we knew the increased risk of COVID to people of colour and the raised chance of preterm labour for those women unfortunate enough to contract the virus whilst pregnant.
Just as we finalised plans for launch, and to get out into the communities and find every opportunity to involve those who lives are imprinted by the experience of preterm birth, COVID hit. Our PERIPRem teams were now on the battle lines, and we were nestled behind our laptop screens, shell shocked. Our ability to be agile and adapt to novel ways of working mattered now more than ever.
I’ll admit, I was sceptical how we could launch what was still a seedling of a programme to twelve units across the whole of the South West, when we were unable to leave our kitchens, let alone realise our plans to provide fertile ground for the creation of a regional PERIPRem clinical community. Without a physical launch, how could we provide space for those small but mighty moments, that when cultivated, have more of an impact than any toolkit or presentation?
I often struggle when I have to describe QI; in my experience it is much bigger than a framework or a process by which you can input your problem and wait for gold-standard results. For me, QI has its foundations in the people, the team and the culture. It is the introductions to new faces, teams huddled together around meeting tables, clinicians whispering to colleagues they had not seen for years and the camaraderie brewed alongside the substandard coffee. We grow highly functioning teams, and the most exciting part of any QI project, on these blocks. It was boom or bust but I needn’t have worried.
We have formed strong bonds as a PERIPRem team; we have even managed a team social. My treasured counterpart in the South West AHSN and I have never met, we joke that we do not know what each other look like from the shoulders down. We have bonded over the many cameos from the PERIPRem teams’ children – or Assistant QI Coaches as they are now known.
Most importantly, the PERIPRem perinatal teams have flourished. Whilst in the pressure cooker of the pandemic, we gave space and time to focus on delivering patient care – when they got a handle on what it meant for them as clinicians, they came back raring to go. We have digitised all of our resources and are now holding webinars on each of the bundle elements – they are so well attended we cannot fit on a screen!
People have pushed through discomfort to record themselves sharing the clinical fundamentals and to provide the presence (all be it through a screen) we all miss. We are exploring new ways to engage with the women we were so keen to meet and listen to, and we are forever indebted to our patient representatives who are now pillars of our PERIPRem team.
The takeaway message from that tired trope of “these unprecedented times” is that we are stronger than we think. At the end of each exhausting day, when we have had our fill of fighting for bandwidth with Xboxing teenagers, with tired mouths from calmly saying, “you’re on mute”, we have been and will continue to be successful. More significantly, we have supported frazzled teammates, butted horns and laughed until we cried.
There is a sense of freedom this way of working has granted us. Whilst before, there was a tendency to stick to the tried and tested method of engaging and working with our clinical communities, COVID allowed us to think again. We used technology to enable hospital teams scattered across the entire southwest to meaningfully engage in PERIPRem without ever having to leave their wards. I was worried connecting through screens and keyboards would reinforce the distance between us all, but I am surprised to realise that it has in fact accelerated relationships and in turn progress.
Having to rely on the written word in email has meant that tone and intonation have been more carefully considered and the periods of chat offered through video calls means each sentence really counts. Of more significance, is a flattening of the hierarchy within our team. Each person no matter what their seniority is vital in keeping the PERIPRem wheel turning – be it because they know how to record a MS Teams meeting, or because they have the complex clinical knowledge of a perinatal intervention. It is not that we did not appreciate this before, but the situation forced us to see beyond the limitations of a job description.
I have reflected on whether, upon return to ‘normality’, if we as a team will revert to the pre-COVID way of working. Whilst I would like to think there would be a time when we are able to sit in offices and meet with units, I do not think that is the whole question. I can honestly say I hope we do not – I do not want to forget our swift response to the restrictions placed on us, or our unwavering faith in our ability to make improvements.
I believe that we have fundamentally changed the way we will approach projects such as this in the future. We are braver in our ways of facilitating community, we have lived experience of delivering change programmes utilising technology rather than travel and we know that when needed, we can free ourselves of the legacy of traditional and more restrictive ways of working.
Our Don’t Wait to Anticoagulate (DWAC) project won a prestigious Anticoagulation Achievement Award this month for its achievements in stroke prevention.
DWAC won the category ‘The centre best able to demonstrate adherence to NICE quality standards for atrial fibrillation’. The Anticoagulation Achievement Awards celebrate outstanding practice in the management, education and provision of anticoagulation across the UK. Staff from the West of England AHSN attended the award ceremony on Wednesday 11 October at the House of Commons.
The West of England AHSN have been working in collaboration with Gloucestershire Clinical Commissioning Group (CCG) and Bayer Healthcare to prevent strokes amongst patients with atrial fibrillation by improving medicines management in primary care.
Effective anticoagulation has been shown to reduce the risk of stroke for patients with atrial fibrillation; an abnormal heart rhythm. Anticoagulation is the process of hindering the clotting of blood; especially the use of an anticoagulant medicine to prevent the formation of blood clots.
For the DWAC project, the West of England AHSN co-designed resources with a wide range of stakeholders, including NICE, patient representatives and clinical partners. These resources include guidance for clinicians, pharmacists and patients to aid shared decision making and improve take up of anti-coagulant medicines. The resources are supported by quality improvement (QI) and clinical skills training. For more information visit www.dontwaittoanticoagulate.com
During the 36 weeks of phases one, two and three of the project’s roll-out in the westcountry, DWAC has potentially prevented 27 strokes amongst people with atrial fibrillation, representing an estimated saving of over £629,000.
Additionally, feedback from users confirms that the DWAC approach has led to improved patient care, increased confidence in shared decision making, and improved working practices. There has been a strong shift in focus from “Why anticoagulate?” to “Why not anticoagulate?”
This award demonstrates that DWAC is an important part of the national drive to reduce the number of strokes. The project is being adopted across the North West of England, Yorkshire and Humberside, Buckinghamshire and East Berkshire with 85 GP practices involved and many more engaged to start, plus further spread is planned across the West.
“I am really proud that all the hard work in GP practices across Gloucestershire, with the support of the West of England AHSN, has been recognised by winning this award. Furthermore, it is fantastic that the principles and methods developed within the DWAC programme are being rolled out to primary care in other CCG areas across England.”
Dr Jim Moore, GP, Stoke Road Surgery, Cheltenham
The organisers were delighted at the level of interest and applications received for this first year of the Anticoagulation Achievement Awards. The awards are hosted by leading charities, Anticoagulation UK, AF Association, Thrombosis UK, Arrhythmia Alliance and training establishments – Anticoagulation in practice and Thrombus. They invited applications from teams and individuals across secondary, primary and community services who can demonstrate innovation and excellence in delivering anticoagulation services, resources or individual leadership. There were six award categories and DWAC was up against some tough competition.
The winning entries from each category received a £1,000 bursary, which will be used to aid continuous improvement of services.
Photo: Jim Moore, GP at Stoke Road Surgery; Steve Ray, Healthcare Partnership Manager at Bayer; Dave Evans, Quality Improvement Programme Manager at the West of England AHSN; Tasha Swinscoe, Chief Operating Officer at the West of England AHSN; and Tabinda Rashid-Fadel, Circulatory Programme Manager at Gloucestershire Clinical Commissioning Group.
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