The Q Lab’s current project – in partnership with Mind – is focusing on understanding the experiences of people living with both mental health problems and persistent back and neck pain, and how care can be designed to best meet their health and wellbeing needs.

As you may have seen in my colleague Anindita’s blogs, we are currently in the latter part of that challenge, focusing on ‘designing care’.

Recap

As Anindita outlines, four organisations (‘test teams’) are working with us and Mind over the next six months to develop and test practical actions to improve care for people with both mental health problems and persistent back and neck pain.

• Health Innovation Network
• Keele University, working with Midlands Partnership NHS Foundation Trust
• Powys Teaching Health Board
• Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

Each team is developing different ideas and interventions that build on the insights and learning from our learning on this topic to date, and translate this to their local organisations and context.

This blog shares a bit about how the start of that process has been.

The approach for developing and testing ideas

The test teams are following a (loosely structured) design process, that is based on the ‘triple diamond’. The triple diamond is an adaptation of the ‘double diamond’ process originally developed by the Design Council. The ‘double diamond’ illustrates simply and broadly the steps of the creative process; with the diamonds showing where thinking diverges and converges.

The additional diamond represents the work needed at the beginning of the creative process to develop a team and properly diagnose the problem that you are trying to solve. It was originally added by Policy Lab and has been used by organisations such as Nesta.

Challenge statement

So far the test teams have mainly been working on activities in this first diamond.

Each of the teams are following the same process but will take different paths through it depending on their own contexts. There are some key activities that all the teams will be doing. The first of these is to formulate a ‘challenge statement’ – a comprehensive outline of their project which includes:

• Understanding the problem that the team is trying to solve. We’re encouraging teams to identify the different connected issues they are experiencing locally around the problem, to bring in different perspectives and sources of information on the problem, and better understand some of the underlying causes
• Defining the who and what. This involves the teams being clear about what they are seeking to improve and who is involved. This includes the people who may use or benefit from the interventions, who will help to deliver it, and other key stakeholders or partners who can help it succeed.
• What success looks like. Many of the teams are bringing together people who haven’t worked with each other before and so creating a shared vision of what a successful outcome might be helps ensure there aren’t misunderstandings about what is being worked towards.

Over the last six weeks the Lab team have travelled across the UK to work with the test teams in developing their ‘challenge statements’ and it has been great to meet the wider group of people who will be working together, and finding out more about their organisations and existing work in mental health and/or persistent back and neck pain.

Thank you to this amazing group of people. Helping to improve services and experiences for those with MSK and mental health issues. @mpftnhs @KeeleIAU @Rachel66Mckeown @bjeeves @PCSciences @QITeamMPFT @HealthFdn @MPFTResearch pic.twitter.com/MvfMFRgukN

— kay stevenson (@KayPaulBollie) March 26, 2019

Great discussions happening in the room today. Very interesting to hear thoughts on how we can start to improve care for people with mental health #QLabs https://t.co/Z5tczUKPn4

— Sammy Davies (@Sammy_Davies) April 3, 2019

Some early reflections

So far, our time with each organisation has been quite different. While all teams want to improve care for people with both mental health and problems and persistent back and neck pain, each are navigating different contexts. However, we’re already seeing some common themes emerging about ways to improve care, and ways the teams can learn from each other and share with the Q community.

One example is how a person initially engages with a service. Teams have identified that people’s expectations of services vary widely – which often relates to services being positioned as either a mental health or a musculoskeletal / pain service – rather than both. This may alter the quality of interactions and how comfortable people are to discuss their mental and physical health. Teams are considering how they can improve people’s experiences when accessing the service for the first time, ranging from altering the referral information, changing how services are advertised, to trialing different assessment tools.

Another common thread is how to better support people to have conversations about mental health – particularly health care professionals for whom mental health is not their specialism. For this particular topic on persistent back and neck pain, this is focused most on physiotherapists. We have heard from physios about their different levels of confidence in discussing mental health, and knowing how best to support and/or signpost when it feels appropriate. Teams are considering different mental health training for staff, and developing expertise in different consultant techniques such as motivational interviewing.

Finally, for each of the test teams, their involvement in the Lab is also developmental, with teams working in collaborative, and in some cases – new ways. In the first month, we have been particularly supporting teams to take an explorative approach to their improvement work, dedicating time upfront to understand the different issues they may want to address, before jumping straight to solutions. This can sometimes feel counter-intuitive, particularly in times of scare resource, and we’ll be paying attention to whether this extra time will lead to better ideas further down the line.

Get involved

We’ll be sharing more on the test teams over the next month – including more details on their contexts and the challenges they’ll be looking to make progress on – so do look out for that. If you have any questions, please feel free to drop a line to the Q Lab team. Finally, we’ll be sharing some ‘beta’ tools and methods that we’ve been using during this process on the online group – so join if you’d like to be part of the discussion.