6 months since we last posted – and it is change again! The further 2 national lockdowns and second COVID wave have had a significant impact on our system priorities and our resources have had to shift to support emergent pressures and priorities. Like many others, we have learnt so much from these shifts and gear changes but it has meant that we have been delayed in achieving other goals we had hoped to work on.

We are now in a position where we feel able to refocus again and now we want to progress the coproduction element of our bid. A whole year behind schedule, but I guess that that is a reality of delivering health and care services during a pandemic!

Our plan for the next few weeks is to assess the current state of how we use coproduction, codesign and public engagement in service change and improvement work. We will review all of our toolkit and guidance documents and then look back to see how these were used and applied in practice.

So far our findings are pretty predictable – we have lots of information and resources available. There are pockets of really incredible practice and some highly skilled staff. But there is a variation in how well these toolkits are applied and quite often there is limited evidence of coproduction or codesign taking place throughout the change process.

Our next step is going to be using this information to rethink and redesign our approaches to improve and increase our use of coproduction – we will then test the change in a few areas (maintaining a focus on Outpatients, this will be tested with services using virtual consultations, and will include Cardiac Rehab).

Any ideas from members of their learning in this area are really welcomed. We want to know anything that could be relevant but in particular if there were any changes made in systems that really increased the use and application of coproduction tools and approaches and if there are any resources we might be able to review to help inform our next steps?

In light of the post COVID pandemic, our cardiac rehab project has changed significantly since its initial conception. The original intention was to understand why individuals who have experienced a cardiac event refused the option to take up rehabilitation services to support healthier lifestyle choices.  The extract below is from the original brief:

“Circulatory diseases cause nearly a quarter of early deaths and 90% of people with Coronary Heart Disease have one or more long term conditions. Demand is growing, yet the traditional model of outpatient services is unsustainable and often doesn’t meet patient need. We propose a project that takes a coproduction approach to designing a solution to the outpatient challenge, with a focus on Cardiac Rehab. People recovering from a heart or circulatory event should be offered support to help them live healthier lives and protect against further harmful events. Such services reduce hospital readmissions and deliver better outcomes but only half of those eligible take up these services. To understand this, we had aspired to bring together patients and clinicians across the system to improve the existing pathway using a rapid improvement event to review the current value stream, identify the wastes and develop a new pathway, supported by standard work to sustain the change.”

During the Covid response and recovery phase, the Cardiac Rehab team made a number of significant and rapid changes to service delivery. Within this context, the original project remit no longer felt fit for purpose and on review, the project team wanted to re-scope the purpose of the quality improvement intervention.

The cardiac rehab team evaluated the current service using the local Provider quality improvement tool, collective sense making approach, in order to understand the following:

·       What activities have been introduced to respond to the immediate demands specific to the pandemic crisis?

·       What new activities have we been able to try and have shown some promise of continuation in the future?

·       What activities have we been able to stop that is no longer fit for purpose in this new normal?

·       What activities have we had to stop in order to focus on the pandemic crisis but now need to be picked up in this new normal?

Following this evaluation, we have revised our focus for quality improvement activity. The cardiac rehab team have strongly reflected that the virtual initial assessment process has improved accessibility although it has not been an approach for everyone. Whilst the new initial assessment approach is still at the learning phase, we have recognised the real benefit in applying Quality Improvement methodology such as Plan, Do, Study & Act (PDSA) in order to facilitate team learning in a live environment and to then codify a standard approach to this activity. Application of the PDSA approach in this project will replicate some of the benefits seen in the style used in the Covid response phase (whereby QI and Programme Management colleagues ‘lessons learned’ reflections strongly highlighted the value of implementing rapid test of change cycles). The project team is keen to build on this learning and apply the approach within this Cardiac Rehab project.

In conclusion the ‘current state’ of services has completely changed over the Covid period. The increased range of service offered and accessibility that has emerged during Covid has certainly expanded opportunities. It feels like it is no longer relevant to undertake an end to end process redesign and improvement event however, patient engagement around the changes to delivery would be really valuable to understand what can be done to drive a new normal forward and there is significant opportunity to apply the PDSA approach to refine the virtual initial assessment model, and to codify an intervention that could be shared more globally across other services, to support service delivery and improved access into Covid recovery and beyond.