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What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

NHS breastfeeding support has been paralysed by COVID-19[1][2]. A Sep-20 UK-wide survey to understand impact on breastfeeding experience found 81% of 706 respondents felt they received insufficient breastfeeding support due to social distancing measures.

LatchAid offers an exciting solution. This revolutionary app (a winner of Innovate UK’s COVID-19 Rapid-Response competition) was created by a mother with lived experience of breastfeeding issues and co-designed with infant-feeding, public health & AI experts, plus Beta-tested with 400 mothers across 6 continents. It uses 3D interactive technology, virtual breastfeeding support groups, and an AI powered virtual supporter to deliver evidence-based, 24/7 breastfeeding education/support.

COVID has meant that NHS maternity services have been looking for partners to help complement their provision, which led to emergent conversations between North-West England maternity services and LatchAid around potential collaborations. Shel Banks, Chair of the Local Infant Feeding Information Board and a trustee of Lactation Consultants of Great Britain led on scoping a potential pilot.

What does your project aim to achieve?

This project will pilot the incorporation of the LatchAid app within 3 NHS Trusts (Chelsea & Westminster, Torbay & South Devon, Blackpool Teaching Hospitals). It’ll explore the feasibility of using digital  breastfeeding support (leveraging AI and real-life specialists), within antenatal/postnatal maternity services.

The UK has the worst breastfeeding rate globally[3]; 90% of women give up breastfeeding before they want to[4]. Socioeconomically disadvantaged groups tend to have poorer breastfeeding outcomes[5], research shows health inequities were heightened post-COVID[1].

Our innovative partnership would enable:

  • all families to access 24/7 peer-to-peer/professional support to breastfeed for longer
  • improved maternal & baby mental and physical health, reducing health inequalities by providing accessible, cost-efficient breastfeeding guidance
  • meeting of public health targets for breastfeeding
  • better-designed services & staff training; analysis of pilot’s conversational datasets will provide insight into prevalent challenges

We’ll collaboratively design/collect KPIs (e.g. breastfeeding duration/exclusivity) and Patient-Reported-Outcomes through in-app surveys &  user studies.

How will the project be delivered?

Maternity units in the NHS Trusts will work alongside the LatchAid team (comprising technology, digital health, and breastfeeding-support specialists). The 12-months’ project will:

Plan: objectives/processes with NHS partners for informing expectant/new mothers and training support staff about LatchAid.

Do: LatchAid’s AI-powered virtual supporter chatbot will resolve over-80% enquiries and flag complex cases to LatchAid breastfeeding support team, who will escalate the most urgent/critical issues to NHS staff through a proprietary in-app/web-based pathway, through which they can respond to mothers directly.

Check: KPIs measurement tools, AI performance analysis, and regular meetings/communications with NHS partners are used to co-evaluate/co-refine technology, workflow and effectiveness.

Act/Adjust: Continuous improvement for triage/escalation/support workflows and technology. We apply a top-down risk management approach. A plan will be co-developed with NHS partners to ensure long term sustainability.

We’ll continuously involve Q members to share findings, key outcomes, and seek expertise, suggestions and support for workflow and service improvement.

How is your project going to share learning?

This project generates valuable learnings for the Q community on the feasibility, effectiveness and best practice of using digital breastfeeding support leveraging AI and real-life specialists within the NHS.

Key outcomes including mothers’ breastfeeding outcome, feeling of self-efficacy and NHS staff’s feedback on how this approach helps improve communication with mothers and increase their capacity in resolving complex issues, will be measured and shared. Analysis of conversational dataset using LatchAid will recognise prevalent challenges, important for informing future service development, health policies, and NHS staff training.

We will actively connect with Q members, especially AI and maternity projects for discussions and knowledge-sharing. LatchAid will produce a 9-months evaluation report to share with the Q Community / partners based on findings from questionnaires and tracked KPI metrics, contributing to research on
enhancing digital support. We’ll develop a social-media package to share key outcomes and run workshops & shared-learning events.

How you can contribute

  • Feedback on this proposal & plans to partner with NHS maternity/neonatal/paediatric/community services
  • Q members’ input into our impact evaluation, especially appreciative inquiry to decide how to embed and roll-out LatchAid tools and solutions with front-line staff, and to plan how to most effectively share our findings as we evaluate.
  • Assistance in providing appropriate educational, supportive, and informative webinars for app users on topics suggested by usage of the chat functions, with usefulness measured by uptake and questionnaires.
  • Ongoing support from Q Community members and partners to look at the scalability of rolling-out this programme and LatchAid product and services to NHS trusts and maternity services across the UK, based on the learnings of this project.

Plan timeline

1 Apr 2021 Co-define project objectives, management/monitoring/engagement plans
12 Apr 2021 Co-design methods for participants/staff enrollment & app usage/support training
19 Apr 2021 Co-define KPIs metrics, Patient-Reported-Outcome, and in-app checkpoint survey & measurement tools
26 Apr 2021 Co-design proprietary escalation, communication, support workflow and tools
3 May 2021 Develop in-app checkpoint KPIs-measurement and survey tools
24 May 2021 Customise LatchAid-app allowing NHS-staff to receive escalation-notifications & respond to mothers
5 Jul 2021 Roll-out app-pilot; PDCA-approach for workflow/tool evaluation & improvement; AI analysis/improvements
27 Sep 2021 Ongoing knowledge-sharing, engagement, and discussions with Q community
27 Dec 2021 Produce evaluation report and a social-media package for knowledge sharing
24 Jan 2022 Design and conduct workshops and shared-learning events
7 Feb 2022 Planning partners for deploying & scaling-up LatchAid to wider NHS trusts

Project updates

  • 1 Oct 2021

    Key learnings

    Time scales
    While the project is on track to be completed within the predicted time frame, certain activities took longer than expected and there has been a shift in terms of when different activities have to be conducted. For example, ensuring data protection and quality of service was a top priority and led to an additional unexpected activity (such as applying for ORCHA certification) – this took longer than had we not applied. Additionally, when receiving advice from WAHSN on effective implementation and evaluation of the pilot, we realised we should customise the app to create an area-specific token system in order for us to understand a user’s journey within a specific community while keeping sensitive information anonymous (this would also help us collect more nuanced data for our analysis). Any changes to the app come with extra time and all of these small improvements led to a later roll out date for prescribing the app to patients.

    Roles and boundaries
    One of the project’s initial intentions was to create a triaging system which would communicate details about a patient’s case with participating trusts. This was unfeasible for a number of reasons. For one, it would involve a much more rigorous data security review, additionally, the pilot has now grown to include 12 NHS Trusts and the practicality of setting up this type of communication within each individual system would be too arduous to fit within the scope and timeline of this project. Finally, we wanted to be clear that LatchAid is not a medical device and should not be used in lieu of emergency or healthcare support; instead the app should be seen as a source of information to supplement medical support. Understanding partner roles and the boundaries of what these partnerships could entail was key in creating an achievable project plan.

    Evaluation
    Part of the delay to rolling out the prescription model was the need to get the evaluation and survey checkpoints agreed. We secured support from WAHSN and University of Exeter which meant this was a more comprehensive activity, but one that is truly worthwhile to help us accurately measure the project’s success.

    Learnings for others 

    Be open to adaptation and learning along the journey
    Understanding that this is a pilot and something that has never been done, all partners have been really open to adapting areas of the project as and when needed. It is a true collaborative effort where all participating partners are learning along the way and with that comes a need for flexibility. We have also been offered different support throughout our journey, which may slow activities down slightly, but are always in the project’s best interest.

    If your intention is to scale up, keep it in mind throughout
    We have always hoped that with the success of this pilot, we would be able to roll out a licensing scheme whereby NHS trusts can license the LatchAid app to prescribe it for free to their new mothers. With this in mind, we have worked on meeting a higher level of data protections than required for this pilot, we have co-developed business cases for what this partnership would look like beyond the Q Exchange funding and pilot programme and have worked to build senior level buy-in across the board from the outset. If this pilot is successful, we want to ensure that level of care is available to mothers long beyond its end date.

    Implementation planning is not to be overlooked
    The original plan was to send flyers to healthcare professionals looking to prescribe the LatchAid app to new parents. It is important to consider the nuance of that process. For example, how are professionals made aware of the app, when exactly are they prescribing it in a mother’s journey, how do mothers sign up for free and how do we track that the app is prescribed. We have spent a great deal of time working across the project’s partners to agree to a very detailed implementation plan to ensure that those frontline professionals who are already very busy, have everything they need to effectively champion this service without hassle.

    Keep the technology development process agile 
    During the implementation framework development, we have pivoted from a per-user token system to a per-region token system based on the valuable feedback from the pilot partners. The additional software development takes time but is worthwhile to increase the pilot take-up rates and ease the roll-out process. This highlights the needs and benefits of the agile development process to continually communicate with end users and make sure that the technology / solutions developed are what they want and need.

    What is working well

    We have expanded the project from 3 NHS trusts to 12 NHS which has been encouraging in helping us understand that this service is needed and wanted.
    We have a strong project team that are in regular communication and have kept things flowing smoothly.
    Because of delays in rolling the prescription model out, we have had more time to input recommendations from LatchAid’s beta study, conducted in March 2021, which means quality has been further improved.
    All of the implementing partners have shown the same passion for the project as the project team, which is very rewarding and encouraging.

    Challenges

    Summer! Because capacity is tight during the summer, we further delayed the roll out, however there are benefits to this as well (such as further app developments).
    Despite the grant from Q Exchange, which has been extremely beneficial, we have needed to seek out additional funding to ensure app development could be speedy and could provide the crucial customisations.
    It has been difficult to set up necessary processes to ensure smooth transition into a licensing framework post-pilot. Evidence is integral, however evidence of effectiveness won’t be available until quite late towards the end of the project. This means there will inevitably be a lag where some mothers are not given the app for free.

    What are the next steps?

    4 October 2021
    Implementation of the prescription model where mothers are given premium versions of the LatchAid app for free.
    15 November 2021
    Analysis of the project’s effectiveness against local benchmarks begins.
    27 December 2021
    Produce mid-pilot evaluation report and a social media package for knowledge sharing.
    24 January 2022
    Design and conduct workshops and shared-learning events.
    4 February 2022
    Project implementation ends.
    7 February 2022
    Planning partners for deploying & scaling up LatchAid to wider NHS trusts.

    How can the community get involved?

    Guidance with knowledge sharing activity
    Feedback on evaluation and feasibility of future similar work
    Scaling up support

Comments

  1. Thanks so much for your comment Emma - the team & I will definitely be checking out those other projects you've suggested. We are working on adding more detail into the bid ready for submission as well... hoping to update soon!

  2. Really interesting project. I'm working with the Health Foundation to connect Q members around Q Exchange.  There are a number of maternity-focused projects suggested this year (one of them even has AI in it) that you might want to have a look at and consider whether there is scope for collaboration. There are also quite a few projects around developing apps and AI which might also be of interest. I'd suggest your project could benefit from a bit more information as to how your would collaborate with others and what specifically you might use the funding for. It's also worth having a look at some of the technology and digital groups that are ran by members within the community.  They may be interested to hear your ideas.  Good luck! best wishes, Emma

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