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From problems to tangible prototypes: improving care across mental health and persistent pain

The ideas being tested by teams across the UK – and their potential for scale

Since March four organisations (‘test teams’) have been generating and testing ideas to improve care for people with mental health problems and persistent back and neck pain (as part of the Q Lab and Mind project).

Four months into this work it’s exciting to see how the ideas have developed from problems to solve, to the seeds of an idea, to tangible prototypes that are now being tested and iterated with staff and patients.

So here is a very brief overview of what the ideas are, their progress, how the wider group of Lab participants have been involved, and what the broader learning across all teams is telling us about the realities of working and innovating across mental and physical health.

Updates from the test teams

Supporting physios – Health Innovation Network and St George’s and Kingston Hospitals

Aim: To develop a training programme supporting physiotherapists to have conversations about mental health with their patients.

The test team held focus groups with the physiotherapy teams to understand how confident physios feel in discussing and supporting people’s mental health, and barriers they face. These insights have then been used to develop the new training programme. There can be apprehension from staff when implementing changes to busy services, however they found the overall response from physios to be very positive, as it provided support for a common issue they were facing.

What next: The new training will be delivered at St George’s Hospital and refined before it is delivered to Kingston Hospital. There’s also potential for the training to be accredited and adapted for health care professionals in other settings.

Adapting Joint Pain Advice – Health Innovation Network and Sydenham Gardens

Aim: To explore whether their Joint Pain Advice (JPA) approach – an intervention which supports people to self-manage chronic joint pain – could be adapted for people who are being seen for their mental health and who also have joint pain.

During the last couple of months the test team have focused on reviewing the JPA intervention with mental health service users and staff from Sydenham Gardens to make it suitable to use in a mental health setting. Key staff at Sydenham Gardens have received training and have begun trialling the intervention.

What next: Early signs have been positive and indicate that the team will be able to embed JPA as part of the existing appointments they hold with people (for example, having conversations about pain as part of the main consultation).

One of the biggest concerns has been balancing data collection on the adapted JPA’s effectiveness, but without adding too many outcome tools to one appointment. Sydenham Gardens and Health Innovation Network have worked together to scale back to the most essential metrics that will be easy to collect and indicate its effectiveness.

It’ll take more time to see whether JPA will work well in mental health settings, and the team be looking to work with other sites from the autumn. If you’re interested in finding out more, please get in touch with Fay Sibley.

New animation and mental health training – Keele University and Midlands Partnership NHS Foundation Trust

Aim: To improve mental health awareness and signposting for patients and clinicians in an MSK setting.

The team have been developing an animation with evidence-based messages to encourage patients to have conversations about their mental health and wellbeing in MSK appointments. If successful, this could be a valuable resource for other teams across the UK. To support these conversations, clinicians and volunteers at the Haywood Hospital are also undergoing joint training on mental health awareness. Volunteers have also developed a mental health directory to help support signposting for patients to the services available in the local area.

What next: The training session is due to take place in September and they will be looking at ways this can be evaluated. The next version of the animation will then be tested with Lab participants, and potentially in GP waiting rooms.

Testing and iterating new materials – Powys Health Teaching Board

Aim: To reduce dropout rates and improve engagement through providing clear and timely information to potential participants who have been referred into their Pain and Fatigue Management Service.

The team have redesigned the information that people receive at different stages prior to their first assessment, and are currently prototyping a set of revised materials with a number of Lab participants and people in their waiting rooms to gather feedback. Some of the changes in the redesign include sending information in more manageable ‘chunks’, producing a roadmap to show what the team will be doing and what the patient can expect at different points in the journey and having clear next steps for each interaction.

What next: The prototype will be improved based on feedback and the changes will be introduced within their services.

Improved signposting of local services – Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

Aim: To explore how patients can have accurate information at their fingertips to access the right care for their mental health needs.

The team have been gathering information on what services are available across Shropshire to support people’s mental health and have prototyped a new leaflet for patients about the connection between mental and physical health, what people can do to self-manage and signposting to other local services. They are testing this leaflet with patients and members of the public, their patient panel and physios.

What next: Further testing with a small number of physios, as well as developing an iteration for use with outpatients and pre-operative patients. Once finalised they hope to disseminate resources throughout the hospital and the Shrewsbury and Telford Hospital NHS Trust. In the future they hope these resources may also be used more widely across the Shropshire region.

Broader learning from across the teams

While the teams have been developing and testing their ideas, a key role of the Q Lab has been to support the teams to capture and share their learning during the process.

This is important for a number of reasons. Firstly, to support the test teams to learn from and provide peer support to each other, and to distil this learning about the topic and share with the Q community. It is also important so that the Q Lab can improve and inform our own thinking about what it takes for collaborative change to happen in health and care.

One of the ways in which we are doing this is by bringing the teams together regularly to reflect on their learning.

In a recent workshop, it was interesting to hear how the teams have really found value in ‘slowing down’ to develop a deeper understanding of the problem. As discussed in an earlier blog, teams have been following a ‘design process’ to help guide their thinking and approach through testing, and they reflected on how this has helped them to think differently about problems and bring in new perspectives.

We heard how teams have been proactive in creating opportunities for meaningful patient engagement. They acknowledged that it is not always easy and requires careful planning to ensure it is as meaningful as possible –  however they have taken time to reflect on this throughout the process and learned from both success and failure.

You can think you have the best service on the planet but you have to be able to hear the uncomfortable truths – we need to go and talk to people to get a different perspective.

There have been some interesting learning that will likely resonate with many Q members running QI projects. For example, reflections on the value of playing into individual organisation’s strengths and seeking out the internal demand – to ensure ownership, openness and alignment for the solution and testing in practice. In terms of partnership working, teams have found it important to ensure there is cultural alignment, particularly with external partners. They found they made most progress when building on existing partnerships – ensuring there is enough time for this to establish, and that there is an honest and open relationship.

Finally, there has been lots of learning on how to develop new training programmes – particularly those that involve addressing a knowledge/confidence gap or to embed cultural change. Teams have found this can be achieved through mentoring and involving the whole team.

What’s next?

This blog is just a snapshot of what we’re capturing but we’ll be sharing more in the Autumn. We’ll also be running a session at the Q Community event so do come along to hear from the teams themselves about their experiences.

Can’t wait until November? Join us at our workshops in September where we will be sharing this and other learning from the topic.

Register for the London workshop on 18 September

Register for the Manchester workshop on 27 September

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