Q Exchange
Canal CPD: Learning Across Boundaries
- Proposal
- 2024
Meet the team
Also:
- Ajay Shah GP lead
- Atif Hassan GP lead
- Alison Jones LFE team
What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?
Since 2022, the Canal Project has looked to improve connections across system boundaries to improve children’s health in the City of Birmingham. We have done this through:
Canal Review: Secondary care advice delivered in the primary care patient record for specific patient questions.
Canal Consult: Secondary care consultations delivered in primary care locations.
Canal Learn: Teaching sessions to primary care.
Canal Schools: Co-producing solutions to health issues with secondary school-aged young people as part of Powering Up! collaboration (winning bid 2023)
Currently all feedback on clinical practice is linked directly to either patient communication or local governance systems. Our healthcare workforce is increasingly diverse and fragmented (https://www.england.nhs.uk/ltwp/). In this environment both positive and developmental feedback for practitioners is hard to give and receive. Barriers also include time and psychological safety. Learning from both what we do well and what we could do better has potential to drive positive change and enable connection across boundaries.
What does your project aim to achieve?
The main objective is to create a formal, safe space for cross boundary and interprofessional feedback. With colleagues at the lead of LfE already thinking about a national reporting system, this is an opportunity to explore this and feed into that workstream. LfE has been shown to drive improvement by increasing staff engagement, building self-confidence in clinical practice and aiding dissemination of ideas through prosocial interactions.
All health care professionals have a responsibility to undertake and evidence Continued Professional Development. This initiative would provide a mechanism to facilitate this.
How will the project be delivered?
- We have a diverse team with a range of perspectives, from different backgrounds to look at this issue including clinicians from both primary and secondary care, LfE founders, experts in Appreciative Inquiry, human factors, education and governance.The funding would be used to:
- meaningfully engage with stakeholders to ensure all potential issues are considered early, co-generating a process that will foster buy-in.
- Work through the conflict between the boundary of information sharing for patient care and information sharing for professional development.
- Bring in IT expertise to explore building a digital platform linked with current secure communications systems that are already in place e.g NHS.net. This would enable a feed-back loop between primary and secondary care.
- Support a data analyst to refine the offer using a PDSA process to ensure continued improvement of the platform.
How is your project going to share learning?
The system we want to build would be designed with an aim of scalability and spread to other areas and sectors. By starting in a small, containable area (paediatrics in Birmingham) we would have an opportunity to be agile and do rapid PDSA adaptations to our system.
LfE already has a large international community of practice. Intelligence gathered from positive reporting and Appreciative Inquiry informs teams of what is working within their systems and aids in the design of improvement initiatives that address complex healthcare challenges. Extending this methodology to interdepartmental and cross boundary pathways will ensure improvement is focussed on patient journeys and collaborative ways of working.
How you can contribute
- Comments on the concept of feedback across boundaries
- Ideas or suggestions for exploring the tension around patient information for professional development
- Connection with similar projects or other contributors
- We would love to hear your thoughts!
Plan timeline
| 1 Aug 2024 | Team roles and responsibilities, recruitment of project support team |
|---|---|
| 1 Oct 2024 | Stakeholder engagement around process |
| 1 Dec 2024 | Exploration and decision around IT partner |
| 1 Mar 2025 | Completion of design phase |
| 1 Jun 2025 | Testing and refining |
| 30 Jul 2025 | Go live date |
Comments
Bethan Page 20 Mar 2024
It's really great to see this project proposal- lots of parallels with our project proposal. It would be very helpful to learn from your coproduction work with young people. Cross boundary working is so important, learning together how to improve care for patients across different systems! Great idea.
Gill Phillips 16 Mar 2024
Wow! Wow! Wow!
Such a privilege to go along to Birmingham Children’s Hospital yesterday to witness first hand the fabulous Canal and Powering Up (see 2023 #QExchange) projects. A room full of young people, giving their views on health care. Doing excellent projects as citizen researchers and telling us their findings.
Small groups of young people (year 10 and year 12, I believe) presenting around such topics as mental health, asthma, vaccination, Performance Enhancing Drugs, social media and more. Reflecting on what had been easy / hard / what they had learned and recommendations for actions. Hugely insightful, particularly around for example TikTok algorithms, and full of common sense.
HUGE scope to make a difference here and oodles of passion from the team and everyone else involved!!
Mary Salama and Guddi Singh asked me what I thought and quite honestly, I was blown away - not just by the outcomes but by the authenticity of the approach and the opportunities offered, both now and as future spin-offs.
And then the young people asked questions, in open session, to the panel of experts – including Matthew Boazman, the CEO of the hospital. They were thoughtful and challenging - a junior version of question-time, with the key difference that the panellists actually answered the questions! 😳
There was huge interest in working in the NHS (yay!) and I’m hoping lots of youngsters take up opportunities to get involved with the work of the hospital, Birmingham Public Health, presenting through the arts (the ‘Powering Up’ London project) and … and even a chance of talking to doctors nationally!
Coproduction at its best. Huge congratulations to my pal, Mary Salama and everyone who made this happen.
Well done to the teachers who prepared the young people to make presentations, on camera, to a large audience. It takes courage to speak, particularly in front of your school peer group!
“What if I mess up and look stupid?”, and all those other teenage thoughts that would have plagued me and stopped me doing any such thing at that age! Quite quite extraordinary!
Looking forward to speaking to both Mary and Guddi on my ‘Wild Card - Whose Shoes?’ podcast series. 🍋💡🍋
And … watch this space. This will all feed in and link up brilliantly with the short mini podcast series. I’m planning with Profs Becky Malby and Tom Holliday, LSBU, to share best practice like this and promote the Universal Healthcare National Inquiry which is so relevant here: https://www.lsbu.ac.uk/__data/assets/pdf_file/0019/373033/Universal-Healthcare-National-Inquiry.pdf
Mary Salama 19 Mar 2024
Dear Gill,
Your passion and energy for co-production knows no bounds! This is high praise coming from someone who knows and seeks authentic coproduction. We are so excited to have your support for this bid which is looking at another angle to connect people across our fragmented healthcare systems to channel learning and improvement. Crossed fingers!
Lisa van Geyzel 19 Mar 2024
Thank you Gill - it was truly an inspiring day & great wrap up to our first run of Canal Schools co-production work. Glad you could make it! Look forward to listening to the podcast! :)
Hannah Zhu 15 Mar 2024
Exciting project and great to hear about the primary care connections - sounds like a great example for integrated care! Love the coproduction and will be really exciting to build on the schools coproduction project with young people :) How are you planning to follow up and measure this?
Can I also ask you for tips on engaging primary care in a very stretched and pressured system? We're doing something similar at GSTT and have a good integrated care setup with general paediatrics but struggling to get engagement with community paediatrics.
Lisa van Geyzel 19 Mar 2024
Hi Hannah!
We are collating some initial feedback from the Canal School event last week and then will reflect, adapt and run again...
In terms of primary care engagement - yes! very tough - Mary & I have tried very very hard, attending various stakeholder events (new GPs developing portfolio careers, PCN meetings, practices meeting etc) and slowly we have found key interested people to continue to link up with and plan how we go forward.
We have realised that GP Partners would not have time to sit alongside us in our Canal Clinics - as time is money! Instead - we have opened up the clinic to our GP trainees (ST2s) and they have joined us in the clinics and given their perspective as well as hopefully learned a lot! We are keeping up our connections with these cohort of GPs - and investing in them for the future!
The GPs we have spoken to though are really open to CPD - and though this has started a little via emails because we've started building a connection with our GP colleagues via our Canal Consults & Reviews. Canal CPD aims to bring this one step further, using LfE tools and a platform outside of the patient record.
Alison Tennant 14 Mar 2024
Hi Mary
I love the way this project is building on the first phase. With my ‘not a doctor, not a nurse’ hat on, can i ask how broadly you are going to engage with other professions like AHPs and Pharmacy? I know that the physios would love to engage so they can see hoe they could support families at home and advise schools. Obviously i would love to see how we can support with medicines using tools like PADDINGTON but also explore issues such as poly pharmacy which many of our complex children are now experiencing.
Mary Salama 19 Mar 2024
Many thanks for your comments Alison. As someone who understands both pharmacy and leads on complex systems we would be keen to explore your views on how this could be useful to AHPs in their many aspects of work. We appreciate that our understanding of need may be different to actual challenges. How lovely to be able to feedback positively across boundaries to foster understanding and collaborative working.
Lisa van Geyzel 19 Mar 2024
sorry Alison, I clicked send before I finished. I was going to say, I think you are asking about involving AHPs in the hospital with feedback to primary care? Mary can respond too, but I don't think we have considered this yet - we wanted to start with trialling it within general paediatrics to primary care ( that would include AHPs working there).. but if all goes well, definitely then option to scale up to other teams using it too.. (Hope I understood your question correctly!)
Lisa van Geyzel 19 Mar 2024
Really important point Alison about engaging with other AHPs. From a General Paediatrics perspective, we do realise we are getting a lot of referrals in from primary care from AHPs such as PAs, pharmacist etc who are seeing patients in primary care. We definitely want to include them in this and I think that would value the feedback.
Gill Phillips 27 Feb 2024
Yay! I will definitely be supporting this project. It very much reflects and builds upon the themes that we have been finding in our ongoing collaboration with Midlands Partnership NHS Foundation Trust, where the crying out need is to build more integrated care across the health and care system for children and families.
I love the way that this project uses the principles of learning from excellence, where Mary, Adrian and team are not only real experts, but also truly inspirational.
Families have been telling us how they wish that acute services could see them as whole people, and incorporate other aspects of their lives, such as relationships with GPs and particularly with schools. This project has it all! Let me know if there is any way that I can help!
I know @Lyse Edwards and her colleagues will also love it!
How exciting will it be when these various projects join up and become even stronger together!
Gill Phillips 13 Mar 2024
Thanks, Mary. Yes, I think I can particularly add connection with similar projects and other movers and shakers in this space! :)
Two immediate opportunities come to mind:
It was great that you were able to join our recent event with @Lyse Edwards and the innovative #TeamMPFT to explore the challenges around children and young people's mental health and how there needs to be much more joined up care and support, as you are proposing here. We can build on this together. https://youtu.be/MnXc2Sm3P24?si=kKXSLxxOtGXHVd2T
I'm going to be doing a mini podcast series, in collaboration with the fab team at LSBU who do such amazing work bringing real imagination and deep listening to complex health systems. We will be helping people understand the importance of universal healthcare and sharing practical stories demonstrating how it can be done really well - very much in tune with the 'Learning from Excellence' focus here.
I'm looking forward to coming along to your innovative 'Ides of March' event in Birmingham and learning more! Lots to talk about and explore further!
Mary Salama 4 Mar 2024
Thanks Gill for your comments!
Yes it was a real coup to have the LFE team support on this idea as it would be so nice to have some positivity transferred across our working boundaries.
We will of course be looking for your support especially with ideas around stakeholder engagement. I know you and Lyse have been doing some great work together.
Thanks for your enthusiasm as always
Mary
Gill Phillips 27 Feb 2024
I apparently wasn’t logged in! Now I am! That was my comment. ⬆️
Guddi Singh 27 Feb 2024
What an innovative proposal, Mary!
It brings together some of the most pressing concerns in the NHS right now: interprofessional communication (which all too often is siloed), safe sharing of information across institutional and sectoral boundaries, and the use of digital to effectively bring teams together. In addition, by focusing on professional development, you have a real opportunity here to address the increasing problem of workforce wellbeing: the potential benefits to morale and developing a learning culture beyond the physical bounds of one’s team are really promising.
Any ambitious project will face challenges though, so I have a few friendly questions to prompt your thinking:
Congratulations on the proposal - I'm very interested to see how this project evolves. Everything you are doing with CANAL is fantastic so far, so I have high hopes ;)
Guddi
Alison Jones 19 Mar 2024
There is a paradox in digital security / privacy and dissemination of the positive impact!
We have done lots of work on 'how do you know (LfE) works?' and what is learned by way of anonymized thematic analysis. Most recently we have interviewed staff about how it actually changes practice - why do departmentwide metrics improve when individuals receive personal positive feedback? The staff told us that it supports improvement in 3 ways: Engagement 'I will actively participate', Self-belief 'Confident I have understood' and Dissemination 'I can role model'. And so it seems that the benefits of positive feedback leak out from recipients because they engage confidently and reinforce excellence with and for others.
We have all the elements of a diverse and enthusiastic team to work through challenges - thank you for the opportunity to be involved Mary
Alison
Emma Plunkett 17 Mar 2024
Dear Guddi,
Thanks for the support and equally for the questions - they do indeed prompt thinking :)
As we have watched LfE grow and spread within organisations we have heard many examples of how learning is shared within teams and themes from reports analysed - this will be useful information to bring to this project. We have seen that the mechanisms for positive reporting vary within organisations and are adapted to the local culture but united through an overarching uniting philosophy: that positive feedback enables learning, quality improvement and staff engagement. I agree it will be important to consider the differences (and similarities) between different cultures, staff groups and settings.
How to capturing and measure the learning is such an interesting and important point to consider and applies to all feedback systems. I am looking forward to working with the CANAL team to help develop our thinking around this.
Bryan Healy 13 Mar 2024
Hi Guddi
I think the questions you ask are key to the proposal. We can recognize the desirability of feedback. We can build technical solutions- that's almost the easy bit. Designing the rules around privacy, protection, and consent are the tricky bits. Likewise the communication barriers. But we do this by exploring systems boundary issues (purpose, knowledge, impacts on those outside the system) from different perspectives.
Capturing learning is also a key interest. Tangible, written knowledge is one thing. But how do we capture the sticky knowledge that's never written down? But learning how to do that is the transferable bit (in different work, we've set up a meta-learning system around our PSIRF implementation, so we'll maybe see the transfer going the other way initially).
Mary Salama 27 Feb 2024
Dear Guddi,
What a lovely first comment. Really falls you like the idea.
Great challenges and some we have already started discussing in our project group…
The issue of privacy is one of the stickiest barriers. Bryan has suggested using critical system heuristics as a way of exploring where the boundary is between information for patient care and information for professional development.
Measurement is always key and the nuance and themes of feedback will need to be tailored to professional needs also.
These themes could well be used to identify variation in culture and the language used in the proposed model will need to be thought out and tested in different arenas.
Thank you for sparking so much thought and for your enthusiasm for our project.
Mary 😊
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