Q Exchange
One Big Front Door for children’s community health.
- Winning idea
- 2022
Meet the team
Also:
- Paula Tyler - Parent with lived experience lead
- Aishea Buckle - Family Participation Lead
- Johanna Johnson - Therapy Services Manager
- Louise Maclean - Manager, Community Paediatric Medical Services
- Nick Le Prevost - Lead Consultant Community Paediatrician
- Michelle Swindell - Business Support and Evaluation Lead
- Brooke Lowry - Project coordinator
- Kelly Pierce - Digital Lead - Children and Families Services
What is the challenge your project is going to address and how does it connect to the theme?
When a family is concerned about their child’s development, they need support from different services, including community paediatricians, community children’s nurses and therapy services. Families often experience making multiple referrals to these services and delays in care due to referrals being inappropriate and families being signposted to other services. This places children at risk of potential harm and poorer long term health outcomes.
Across the counties of Hampshire and the Isle of Wight (including Portsmouth and Southampton cities) around 1100 referrals are made per month to these services. Families have told us they experience real challenges getting timely access to support, reporting feeling they are ‘passed from pillar to post’.
The aim of this project is to establish a digitally facilitated single point of access, that is one Big Front Door, so that families only have to raise concerns about their child once, and experience more timely and streamlined care.
What does your project aim to achieve?
The aim is to co-design with families a single access point (Big Front Door) for them to use when they need support for their child. This will include digital options as determined by our families that could include improvements in web access, virtual consultations and development of digital access through existing portals (e.g. an app for public health called Family Assist) and social media.
There are three objectives:
1. When families request support, they will get access to the right clinician, first time. This will result in a reduction in multiple referrals being made for the same child.
2. Through digital capture of requests for help, our integrated teams will be able to analyse more holistically client need and address future service improvement and commissioning priorities.
3. The Big Front Door will lead to greater levels of integrated multidisciplinary working, leading to a joined up and seamless experience of care for families.
How will the project be delivered?
Through rapid qualitative research (process mapping, experience based design) we will co-design with families and community partners (primary care, education and voluntary services) the Big Front Door. The project will follow iterative plan, do, study, act cycles of improvement over 12 months, with three workstreams:
Workstream 1: Co-produced digital information resources.
Workstream 2: Co-design of a new request for support pathway incorporating digital methods
Workstream 3: Co-design of clinical response to requests for support (triage, allocation, response methods and timing, levels of support).
Through collaborative working with other projects in the Integrated Care System this project will benefit from existing digital development investment. The project team (listed below) have capabilities to enable co-production, clinical, business, digital and evaluation functionality.
A baseline evaluation will include quantitative and qualitative analysis of referrals. Evaluation will consist of a quantitative analysis of requests for support (number of referrals, response times) as well as qualitative experiences of care.
How is your project going to share learning?
Learning will be shared with the Q community through updates on the Q website, as well as presentation at Q events. Updates will be shared via social media. The project lead will provide a regular more detailed update via a blog, which will be shared on the Q community website.
The project will be shared with the wider Health System across the UK and Ireland through traditional routes (e.g. publication and presentation at meetings and conferences). Sharing will be targeted to specific networks, including those associated with child health, paediatrics and allied health networks (eg the British Association for Community Child Health).
The project will be shared with children, families and the wider network of professionals associated with children using accessible information methods and platforms identified by our experts by experience. Creative communication routes, including use of storytelling will be considered.
How you can contribute
- We would very much appreciate Q community colleagues to act as promotors and networkers for our project, in order to gain interest in our work, and to share it widely so we are able to benefit from wider collaboration and learning.
- We would value advice and critical support from Q community members with expertise in the following; community child health, referrals process mapping and redesign, experience based design and the use of digital functionality to support access to services.
- We would also welcome critical friends who will feedback and guide us as we embark on but also update on the progress of our project.
Plan timeline
| 22 Mar 2022 | March - Develop idea, form core team and submit to QExchange |
|---|---|
| 27 May 2022 | Co-design wider group and stakeholders |
| 14 Jun 2022 | QExchange funding announced |
| 29 Sep 2022 | July-September Experienced-based design focus groups, staff, stakeholder engagement, process mapping |
| 28 Oct 2022 | October PDSA (planning) - co-production of pathway, processes and resources |
| 31 Jan 2023 | November-January PDSA cycle one (delivery and rapid evaluation) |
| 28 Feb 2023 | February co-review and revise pathway, processes and resources |
| 31 May 2023 | March - May 2023 PDSA cycle two (delivery and rapid evaluation) |
| 30 Jun 2023 | June 23 on: Share outcomes and wider rollout |
Project updates
16 Jan 2023
Our Big Front Door project has been progressing steadily since we were awarded the Q Exchange Funding. The Q Exchange endorsement has been really helpful, not only in supporting the funding of our project, but also by acting as a communication platform and a wider endorsement of the use of Quality Improvement Methods to develop this work. We’ve used our project page as a tool to share our work with staff, families and stakeholders, and it’s proved to be a really good way to start the conversation about the Big Front Door.
We have carried out a great deal of engagement activity, which has ranged from our expert by experience regularly attending our project meetings, attending broader community engagement events across the region, holding Zoom updates for parent representative groups and updating into parent project forums. We have also benefited from the engagement we have had with our Q community colleagues through the comments section on our webpage. Some of the key things we have learned through the engagement we have done are:
- Overwhelming support for the development of a single point of access to improve family’s experience of care
- The importance of the engagement part of our project. One Q Community colleague recommended that we adjust our timeline to increase engagement and have one PDSA cycle, instead of aiming for the original two (outlined above). We have taken this advice and have focussed our first half of the project on building the right process in co-production with our families.
- Families have also indicated that they would appreciate a care navigator as part of the Big Front Door Team. Whilst this was not originally costed in we are exploring whether we can incorporate this within budget – or at least develop some navigator roles within the team to test this as a proof of concept.
We have experienced some delays to the implementation of our first trial (the D of the PDSA cycle), and this has been due to the demands on our digital development team, which has led to a wait for some of the digital infrastructure that we need for the pilot. We hope that this will be in place for us to deliver this first PDSA within timescale, and will update on progress.
We are currently planning the pilot team and when the digital referral and patient records system has been developed we hope to go live with the first pilot. We have a group of parents who have volunteered to share their experiences as part of the evaluation of this project and have established some baseline measures of referral information. I’d be really keen to hear from any Q community members of any specific experienced based questionnaire designs or interview structures that we may use to capture the stories of some of our families.
Comments
Gemma Cole 15 Nov 2022
We have an admin role working in Families, Young People and Children's services, called a care navigator. They act as a point of contact for families and professionals to ensure a child's journey through health services runs smoothly. Happy to discuss and share ideas further if this is something that could benefit your project.
Alex Lee 30 May 2022
Having a single point of access to the various specialist service would help many families with complex medical needs. This avoids unnecessary delays and anxieties. To include the parents/carers in the co-production (development and testing) and relevant stakeholders of the digital platforms is crucial for success to ensure they are user-centred and workable for all who may be involved.
Aideen Naughton 20 May 2022
Thank you for sharing this project. We had developed the ISCAN (integrated service for children with additional needs) in SE Wales along similar lines pre-pandemic but without the digital aspect until virtual meetings and consultations became the norm. One important feature which I could not see as mentioned in the project, is the inclusion of agency partners from education psychology, early years, early help as well as CAMHS. Self referrals from families for a particular service ( e.g OT) may have that need better met by early help or education ALN support. How is this being factored into the project? With the increasing domination of ND referrals to child development services are these being filtered out before hand on on what basis? These points are made as learning from the ISCAN experience if a different type of revolving door to your big main door is to be avoided.
John Fitzsimons 18 May 2022
This is a widely shared problem. Keen to hear about your work in co-creating a solution that might be generalised
Clare Smith 19 May 2022
Thank you, John, for your interest, there have been a few Q members who have highlighted that they are either doing similar work or have the same challenges, so we are conisdering setting something up (potentially a Q online group) with a view of sharing practice in this area.
Thomas Weijburg 18 May 2022
I really like the idea. I'd be eager to learn more about the "digitally facilitated single point of access". Is this web-based or app-based? And how will this be facilitated operationally and interface the different services?
Clare Smith 18 May 2022
Thank you Thomas for your interest in our project. The digital interface is to be determined / refined as part of the project as we aim to co-produce this with families, based on how they want to engage with our service and request help. That said, we have the capacity within our services to utilise an app, known as Family Assist to support access. It is likely that although we have one Front Door, the ways in which our families can access the Door may be varied, to ensure that we don't digitally disadvantage families, so we may have app access, but also web based access, alongside more traditional methods (such as telephone advice line). We have costed in additional business support and clinical time to coordinate this and bring together the clinical teams to facilitate a unified triage process - so that requests for support are diverted quickly to the best placed clinician to respond.
Colin Barnes 16 May 2022
This is a fantastic idea with so much potential to improve the way children and families experience services and receive timely care.
Clare Smith 17 May 2022
Thank you Colin for your support
Joanne Beckmann 14 May 2022
We’re also looking at this in our service (altho my QExchandge 2022 idea is of a different theme), would be interested to know what the barriers are and how this will be addressed, for example, supporting non-English speaking familiars navigating the complex system? Thanks!
Clare Smith 17 May 2022
Thankyou Joanne for your comment and your interest in our project, and we are really interested to hear that you are also looking at this in your area. We'd be very interested to link with you and learn from each other. You make a really important comment about barriers to access, for example for those who do not have English as their first language, but also for those who have other accessible information needs or who have difficulties with accessing digital resources. We do hope that the Big Front Door will help to mitigate in part against these barriers, but you are quite right that we need to include this within our quality impact assessments and consider the adjustments or enhancements we would need to make. I think it is also really important that we support the voice of families who may experience these barriers in our co-production efforts, and our parent / carer forums are really well placed to help us with this.
MARINA CRAIL 11 May 2022
This sounds really promising. Its often something we hear in Special School Nursing and I think would assist families in navigating systems which are not user friendly. Often parents don't know who they need their child referred to but they identify the need so having one contact to start the ball and have a conversation makes real sense. It also gives ownership and empowers parents to feel in control of their child health needs. It would be great to ensure that at co-production stage their are parents from all areas we cover within our services geographically and information about services that may sit outside of Solent commissioning. Also to ensure accessible info. is included as we have a number of parents/carers with their own needs who struggle to access complicated systems/processes/forms.
Clare Smith 17 May 2022
Thank you Marina, these are really valuable suggestions, supporting the voice of all our parents in co-production is a key element in this project's success.
Clare Smith 6 May 2022
Thank you, Adrienne, your time to look at and comment on our project is really appreciated. I really appreciate your advice around timing of the workstreams and the redesign process, and we will consider this, if we move through the stages in the timeline too quickly, I think you're right about 'baking' in activity that doesn't help.
Thomas Weijburg 13 May 2022
Hi,
I think this is a great idea with huge potential. Given this year's theme around digital and improvement, I wondered how you could draw out the digital elements more clearly. You mention the three different workstreams, but it would be great to see what digital solutions and strategies you are aiming to deploy to achieve this.
Adrienne Rogers 6 May 2022
I love the idea in principle. I would want to know more about the timing of the workstreams around digital responses to requests and redesigning of the processes - if the aren't done in the right order there is a danger that unhelpful activity is 'baked in' to the digital solutions.
Adele Markland 6 May 2022
I think this is a great idea as it is so hard to navigate around the healthcare system. When I have been involved in QI projects it is really good to engage with the service users/families to understand their current challenges and test out small scale digital solutions. Sometimes what we think are issues aren't the real barriers or challenges. You could perhaps contact your local AHSN to see if they have learning/evaluations around digital projects. Another organisation that might have some learning to share for your project is ORCHA https://orchahealth.com. Good luck with your project.
Clare Smith 6 May 2022
Thank you, Adele, for your comments and advice. We will definitely link in with our AHSN and will also have a look at ORCHA. Thank you for taking the time to look at our project and commenting.
Lyse Edwards 5 May 2022
Hi
This is really interesting to read as we are working on a similar project (in phases) with the first phase being our 0-19 service (Health Visiting and School Nursing) and our mental health services (including our local third sector provider) with a view to subsequent phases including wider services (we provide a huge range). I'm curious how you decided your scope of services. Would also be great to share practice and learning!
Clare Smith 6 May 2022
Hello Lyse,
Thank you for your interest in our project and it is great to hear about your similar work. We determined our scope of practice based on the significant overlap between these services with many children being referred to multiple services for the same condition, as well as the feasibility of being able to integrate these services as a first phase. That isn't to say that there isn't overlap with other services too, such as CAMHS and 0-19 as you have indicated and there is potential to develop this in phases as you are doing.
I'd be really interested in sharing ideas and challenges with you. Thank you for getting in touch.
Danielle Eves 22 Mar 2022
This sounds like a great idea that will hopefully stop the parents feeling so overwhelmed by the process. Multi-disciplinary working is always paramount when working with children with complex needs and this new 'One Big Front Door' appears to offer a more streamlined service in which to do that.
Michelle Hallett 22 Mar 2022
This sounds like a great idea, it will make it easier for our families to access the correct support that they need. It will provide a holistic approach to their care to help ensure that they are supported to achieve the best outcomes. It will help to save time for the families and staff by having one route to referral for multiple services which will help to reduce overall costs.
Karen Dick 21 Mar 2022
This sounds like it would be really positive for families whose children have complex needs. Often they feel overwhelmed by keeping track of all the different appointments, therapists, doctors etc they need to see, and exhausted by repeating themselves.
As a therapist, it would be useful to have all the information together in one place. I already value being able to see shared notes from others professionals, and a shared referral form with the relevant information would help with planning.
I wonder if the Big Front Door also calls for a sort of 'Doorperson' role, not someone blocking the entry, but someone who can show the parents around once they are through the front door, as the door is only the first part of it, and whether it leads to a big open space with lots of professionals in, or a corridor with a few more doors, parents will still need some support finding their way.
I'd also like to know any plans about working with services which are outside of Solent, and if there are plans to link with them in a more joined up way.
Clare Smith 21 Mar 2022
Thank you Karen for this suggestion, I like the idea of a doorperson, and certainly we are wanting to ensure that families are supported as they navigate the different appointments and services they may need to access.
Dave Owen 21 Mar 2022
This sounds an amazing idea, there are many successful and not so successful examples across other dimensions of healthcare, so would need feedback from those services. I suppose the critical elements would be robust triage of referrals with an MDT approach.
Heloise Young 21 Mar 2022
This will save time and money to our teams as well as provide a holistic treatment approach. It'd be great to have an idea of estimated costs Vs savings.
I admire this quality improvement idea based on users' feedback.
I am looking forward to seeing this idea turn into a plan and a reality!
Katie Unwin 21 Mar 2022
This sounds like a great idea to help make families' access to support more streamlined and for clinical staff to save themselves and families' time in gathering information and providing the right support from the right professional(s) at the right time. I can see it working well in the cities where there is already collaborative work across services. It seems more challenging in other parts of the county where services are currently provided by different Trusts and educational providers. I'm hoping for an open plan, connected, flexible space behind that Front Door and hoping it's not one Big Front Door with lots of different rooms hiding behind it still...
Aishea Buckle 21 Mar 2022
Involving children and families in the Big Front Door will help us to improve the services we deliver, as they have direct experience and they know better than anyone what works and what does not. Having experts by experience as part of the team will bring unique insights and intelligence.
Kelda Oldman 21 Mar 2022
This is a brilliant idea! It could be really helpful for parents who feel overwhelmed and have difficulty getting to all their initial assessments without someone to guide them.
Jane Hardwick 21 Mar 2022
Good Luck with this project, it sounds fantastic! Great choice for the name too; One Big Door that leads to multidisciplinary working, with a patient centred approach, ensures efficiency and better outcomes.
Elaine Davis 21 Mar 2022
What a fantastic idea. One place for families to get all the advise and support they need.
Allyson Wild 21 Mar 2022
This will make a huge difference to families in accessing the right support from the right people at the right time. It will also help the professionals/business support team running the services, avoiding duplication of work and waste of clinical time in trying to find the right team to signpost/refer people into.
I love the name, too!
Paula Tyler 18 Mar 2022
Omg 😳 this sounds amazing, as a parent carer of children with additional needs this would save so much time for the parent and child to be signposted to the correct place at a time of need . From my experience this is very well needed. Unfortunately health visiting team have such a big busy work load you could be waiting some time just to get an appointment, they could go here and get the correct information and referral which is very much needed . I’m 💯 behind this , good luck Carl and team I’m behind you on this .
Clare Smith 21 Mar 2022
Thank you very much Paula for your support for this project. Your experience and your links with other families are going to be so vital to the project's success.
Carl Adams 21 Mar 2022
Thank you for supporting and yes we really do hope it will improve work flow and give nurses more time to provide care.
Charlotte Jewell 18 Mar 2022
This is such a brilliant idea. It seems extraordinary that something like this does not exist already. Surely it would save time and it would give so much more confidence to the medical and clinical profession and parents alike. I really like the name too; simple and welcoming.
Reanne Stanton 18 Mar 2022
This is a fantastic idea!
julie waine 18 Mar 2022
A single point of access and the right clinician first time is so important for families for whom attending an appointment can be a massive and stressful undertaking. I really like the idea of an app co-constructed with a family. Not everyone has access to a laptop but most people have a smart phone and being able to provide access to advice out of hours is very important.
Carl Adams 18 Mar 2022
Thanks for supporting and by working with parents/families you are right we need to consider choice and accessibility. We are planning on utilising and improving current process as this needs to be part of the 'Big Front Door'. In this we ensure those without access or able to use smartphone get to the single point of access.
Claire Blackshaw 18 Mar 2022
This sounds a fantastic idea and will help parents in Portsmouth get the right support in a timely way.
Siobhan Moad 18 Mar 2022
This sounds like a fantastic idea! Making things more accessible to families would have a huge impact. Love the name!
Carl Adams 18 Mar 2022
Thanks for support. Is the big question, What colour is the Big Front Door? #canofworms
Sophie Kynoch 18 Mar 2022
For parents having to repeat their story every time is simply exhausting. A patient centred approach with a single point of access is a wonderful idea. From experience of working with and supporting vulnerable families in the past, meeting new people, multiple meetings, assessments, professionals and repetition is often such a barrier to getting the right support. Anything to remove these barriers is imperative. Good luck with the project.
Clare Smith 21 Mar 2022
Thank you very much for your comments Sophie.
Cassie 18 Mar 2022
Great idea, this potentially will make the referral process so much easier. It will promote multidisciplinary working improving patient care.
Corrina Bishop 18 Mar 2022
This project would help simplify the process for children and the families . this project will impact the service for professionals improving efficiency and patient care. children and their anxious families need a simpler way into the care they need
Carl Adams 18 Mar 2022
Thanks for liking our idea. We hope by using Experience base design we truly can capture and learn these anxieties and frustrations, so design a Big Front Door which overcomes them
Richard Brown 18 Mar 2022
I think this is a fantastic innovative approach that will have a significant positive impact for children and their families who are accessing the service - ensuring that the right support is offered by the right team without delay. Am really excited about seeing these plans and aspirations become reality
Mandi Robertson 18 Mar 2022
Great proposal which will make services more accessible, relatable and demystify the referral process. This will benefit the child and their parents/ caters whilst cutting out unnecessary process, bureaucracy, error, duplication and cost. Should be replicated throughout.
Emma Wilson 18 Mar 2022
Such a great project and fantastic that service users will experience a service that's easy to access, responsive and reduces the frustrations families feel when they don't know where to go for help.
Cariad 17 Mar 2022
Anything that makes families' access to the right services at the right time is going to benefit the families, as well as helping stretched services be more streamlined. One point of access for families will make the process much easier for them, so reducing stress and anxiety when they are already concerned about their child and his/her future. It should also ease the process of considering which service/s is/are needed at that time, so reducing clinical time spent rejecting referrals, signposting or referring to a different service and the family starting at the bottom of a new waiting list. It will be important to include times of review/transfer between different services in this new process, as which services are needed will change over time for a child with longer-term needs. In some Hampshire localities this will require outside agencies/other Trusts also taking part in this new process as they fall under other Trusts and County Council teams.
Clare Smith 21 Mar 2022
Thank you for your comments Cariad. We are really keen to ensure we evaluate the impact of the Big Front Door on experiences with our current referrals proceses.
Rophina Yeld 17 Mar 2022
Fabulous idea which will potentially simplify the referral process directly benefiting families and making it easier for clinicians to refer appropriately and effectively for timely interventions reducing unnecessary time delays expense and frustrations for affected families
Clare Smith 21 Mar 2022
Thank you very much for your comments Rophina, really good to get the opinion of our colleagues in Primary Care :).
Kerry Mathieson 17 Mar 2022
I think this will enable parents to access services in a timely manner without multiple referrals and having to give the same information numerous times. The name makes it sound all encompassing and in turn, reassuring. Good luck with the project.
laura dearling 17 Mar 2022
Really great idea and so important for families to stop repetition and for them to get the right support first time round. Also i really like the name 'BigFrontDoor' very welcoming.
Corrina Davies 17 Mar 2022
Co-design on this service is greatly needed and will provide a much needed simplified access point for referrers. I wonder whether the SEIPS 3.0 model 'SEIPS 3.0: Human-centered design of the patient journey for patient safety - ScienceDirect' would help with the design work for this proposal.
Carl Adams 18 Mar 2022
Hi Corrina
Thanks for commenting and I hope you are well?
Great point and we are planning to use Experience based design to understand the current process, which focus on touch points and emotional. You have a good point around integrating Human Factors and Ergonomics needs in the single point access. As this will be key to design and usability of it.
Michael Smith 17 Mar 2022
This sounds like a great idea and much needed for Families who need to get the right advice quickly. All the best with your project!
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