Q Exchange
Outpatients Innovation Collaborative
- Winning idea
- 2019
Meet the team
Tony Jamieson
Carole Hallam
Kay Baxter
Megan Humphreys
Graham Prestwich
Suzanne Mason
Norman Fickling
Adele Coulthard
Also:
- Simon Enright - MD
- Tracey Radnall - QI
- Clare Ginnis - Enthusiast
- Tom Davidson - Data
- Andrew Wiles - Innovation
- Sophie Bates- Industry partnerships
What is the challenge your project is going to address and how does it connect to your chosen theme?
This project is a partnership between Y&H AHSN and Barnsley Hospital NHS Foundation Trust (BHNFT) to test and refine an improvement and innovation approach. An Innovation Collaborative, for short.
BHNFT have identified the challenge that could be tackled using this approach as “Accessing outpatients – different ways of carrying out clinics instead of face to face”. BHNFT are using their service data to identify the three specialities with their longest waiting times to give a focus to the work.
At Y&H AHSN we will utilise our experience and knowledge to support BHNFT to identify and address challenges by brokering introductions with industry, signposting to existing solutions, supporting the horizon scanning of new technologies and real world testing of solutions. We will also support the introduction and implementation of these innovations with a contextually appropriate and systematic QI support programme, encompassing QI methodologies, tailored on a case by case basis.
What does your project aim to achieve?
We want people to have a better experience of care by breaking the mould of the traditional out-patients model (measured through focus groups of service users and staff).
We aim to bring down the time people wait for their out-patient appointment and improve the accessibility of care (measuring waiting times and the uptake of new ways of delivering care across a range of demographics and barriers to access; such as not having English as a first language or having learning difficulty or disability)
We also aim to learn how to use the methods of continuous improvement in tandem with testing and adoption of innovation.
There are hundreds of potential digital and medtech solutions on the market (or close to market) that might help people with undiagnosed or chronic illness get the care they need from their hospital. But which one is the right one to implement for their illness, their circumstances, their environment and is within the realms of possibility for the hospital?
How will the project be delivered?
The Innovation Collaborative will broadly follow a breakthrough series collaborative structure. With a series of learning events interspersed with multiple small cycles of testing. In addition to the generation of change ideas from front-line staff and service users, Y&H AHSN will source medtech and digital companies who are willing to support the small scale testing of their innovations in the real-world. Each of these innovations will become change ideas, rapidly testing them for potential. The rapid testing allows for the risk of implementation failure to be managed.
Our team of Q members includes skills and experience of; managing collaborative programmes; coaching of front-line teams, clinical leadership, public participation, and adoption of innovation. We have a broad range of QI methods to call upon to meet the unique challenges of rapid testing of innovations.
Our wider team, from Barnsley Hospital and Y&H AHSN complement these skills with industry partnerships and teamwork.
What and how is your project going to share learning throughout?
This project is a learning journey.
BHNFT has culture of learning and celebrating the efforts of its staff (Check out Channel 5’s Casualty 24/7). Using a breakthrough series collaborative approach leaning is generated in every small testing cycle and shared at each learning event. The hospital’s Board have committed to using the leaning from this project to shape the organisations Quality Strategy which is due to be revised in 2020.
Barnsley hospital is part of South Yorkshire & Bassetlaw Integrated Care System (ICS). This ICS has developed an Innovation Hub with Y&H AHSN that will benefit from the lessons from this project and can transfer them across system which covers a population of about 1.5m people.
This will provide critical lessons for the rapid uptake of innovation, a critical element of the Long-term Plan, that can be utilised by the national AHSNnetwork and all the organisations it supports across England.
How you can contribute
- Local Q members could get involved with coaching or public participation, Pointers from people who have done Experience Based Co-Design would be much appreciated.
- We are looking for advice on Human Factors or Ergonomics and how to use this skill set to optimise every learning opportunity as we test multiple HealthTect or Digital products.
- Any bright ideas from Q members on promising HealthTect or Digital products that could be tested on a small scale.
- Any bright ideas about real-world testing of HealthTect or Digital products?
Plan timeline
| 13 Nov 2019 | Identify the pathways with the longest waitinglist |
|---|---|
| 29 Nov 2019 | Staff Engagement & Recruitment |
| 31 Dec 2019 | Innovation Scouting Starts |
| 31 Dec 2019 | Public participation group 1 |
| 14 Feb 2020 | Process mapping (work as done) - Baseline data |
| 14 Feb 2020 | Staff Engagement session- Familiarisation |
| 28 Feb 2020 | Driver diagrame production |
| 31 Mar 2020 | Failure Mode Effect Analysis of interventions |
| 30 Apr 2020 | Learning workshop 1 -staff & public |
| 14 May 2020 | Learning workshop 2 - Industry & staff |
| 19 Jun 2020 | learning workshop 3 - All participants |
| 24 Jul 2020 | Learning workshop 4 - Celebration Garden Party |
| 31 Aug 2020 | Evaluation reporting |
| 30 Sep 2020 | Produce Sustainability & Spread Guidance |
Project updates
3 Jun 2020
Overview to date:
Our project commenced in September 2019 with a meeting of YHAHSN (QI and E&I) teams and senior management at BHNFT with the aim of exploring outpatient pathways in the form of a deep-dive. The outcome goal of the meeting was to identify and agree a specific outpatient pathway for project focus. The group also discussed how best the project would be measured in terms of metrics and how we would know that any change undertaken had made an improvement.
Following a deep-dive into the top 10 services ranked by longest appointment waiting times, dermatology was identified by the trust as the best place to target innovation adoption, this decision took into account a 12 week wait for new appointments and an 18 week wait for FU appointments, in addition to the identification of dermatology as a team committed to delivering QI/Innovation at project pace.
The Trust also hosted a clinical engagement event which was well received and highlighted ideas about which services are keen to explore the digital transformation further. Following the event BHNFT produced a driver diagram mapping dermatology transformation in addition to process mapping and logic modelling done in collaboration with YHAHSN’s QI Team. YHAHSN E&I began the innovation scouting process and in April 2020 a comprehensive list of varying digital outpatient solutions with a dermatology focused approach was submitted to BHNFT for consideration.
What have we learned so far, either from the successes we have had or from where things haven’t gone to plan?
Due to the ongoing situation with the Coronavirus pandemic, from Mid-March 2020 the project has been on a hiatus in order to allow BHNFT to focus staff resource where most needed at this unprecedented time. Naturally this has caused the project to veer away from initial plans and timescales however YHAHSN are keen to readily support BHNFT throughout the pandemic response, and following the May virtual call with the project group there is an identified opportunity to refine project focus to support the trust within the initial project outline and defined aim. This agile and adaptive way of working will likely look to use QI methodology to undergo rapid evaluation of a video consultation or AI product in dermatology and build on learnings initiated by the response to the pandemic with regards to the changing landscape of delivering safe outpatient services.
What could others learn from our experience of working with a range of stakeholders and collaborating across boundaries (geographical, professional, sector) – what is working well and any challenges we have faced?
The project has employed a wholly collaborative approach, made easier by the involvement of senior clinical leads and management at BHNFT, PPI (public & patient involvement) and senior QI & E&I Leads from YHAHSN. All parties have been involved as key decision makers at each step of the project process and will continue to support each other collaboratively through the difficult pandemic challenge, particularly with a shifting focus on priorities across the outpatient department to align with the Covid- 19 recovery period.
Comments
Claire Higdon 3 Dec 2019
Hello Tony - I'm working in Cornwall and have recently run a Cornwall & Isles of Scilly Expo where many SMEs came to demonstrate their latest tech developments. A number of these were for OP transformation and I'm getting involved in a potential research study as well, so would be very interested to be included in your scouting exercise.
Norman Fickling 4 Dec 2019
Hi Claire, thanks for your message. I will forward this to colleagues who are looking at the tech aspects of this.
Cheryl Crocker 7 Oct 2019
Great project, looking forward to how we can support the spread .
Jenni Guest 1 Oct 2019
Really interesting area for improvement and look forward to hearing how the project progresses and learning that can support similar innovation locally for us in West London.
Jenni
Tony Jamieson 6 Oct 2019
Hi Jenni, Thanks for your comment.
I hope to get two things out of this project; test of the methodology and a list of possible innovations for further testing.
Both I think could be transferrable.
I'd value your vote and I look forward to sharing.
Cheers
Tony
Tony Jamieson 26 Jul 2019
Bother...Now we have submitted the proposal I've thought of a better name
Geekin' Out.
Its going to be a geek-fest, MedTech geeks, digital geeks, QI geeks all helping front-line staff and the people of Barnsley.
Maybe we should keep this for the video!
Tony Jamieson 26 Jul 2019
And its about Out-Patients; Geekin' OUT
Tony Jamieson 26 Jul 2019
We are pleased to invite Adele COULTHARD to the team. Adele works across North of England and will help to connect us with like-minded people to share the learning.
Graham Prestwich 10 Jul 2019
Great to see the AHSN catalysing improvement in health and wellbeing outcomes through closer inclusion and involvement of people who use services and who can bring their lived experiences to both the design and then the delivery of new and innovative person centred solutions.
Through earlier diagnosis the likelihood is the outcomes will be better and the wellbeing of those affected will be far better in the long term.
Patients through their focus on what matters to them will also be able to contribute to developing measures that are meaningful to those experiencing care and this will help to identify and drive the more important activities that lead to the better outcomes. This is particularly important as the patient journey from their home life to the entrance to the NHS is so unacceptably variable, often those with the greatest needs having the greatest difficulty.
It is vital that the AHSN brings the skills to work not only across public and private partnerships. More importantly to drive work across organisations who do not have the capacity to devote to the hard work of making cross organisational partnerships work more efficiently.
Tony Jamieson 26 Jul 2019
Graham, Thanks for this Graham, If we get through please help us with some Experience Based Co-Design.
Carole Hallam 23 Jul 2019
Further thoughts on the well being of patients waiting for appointments particularly for their diagnosis, patients often say it 'the not knowing being worse than the actual diagnosis'. Thanks for this focus Graham
Carole Hallam 22 Jul 2019
Thanks for your comments Graham. This project absolutely needs to include the patient voice, it is so important to know what is important to them and how we can transform the service to meet their needs
Carole Hallam 9 Jul 2019
It would be good to hear from other Qs that have used Experience based co-design around transformation of outpatients
Carole Hallam 9 Jul 2019
This is a great idea which includes listening to service users to find the most appropriate innovation to improve access to outpatient services and moving on from the tradional outpatient model. This project has great potential for transformation of services for adoption and spread which will be patient focused. Looking forward to working on this project and the celebration garden party, anticipating the sun shining on the project
Norman Fickling 5 Jul 2019
Looking forward to collaborating with the great team at Barnsley on this exciting opportunity to develop and combine innovation and an Improvement Mindset in outpatients!
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