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?​

Although the transition between paediatric and adult services has long been recognised as an issue leading to inequalities and inefficiencies in care, few improvements have been achieved, and progress tends to be condition-specific.

RCPCH will work with willing Q Community members, children and young people, and teams delivering innovative improvements to transition to demonstrate how different sectors can work effectively together across multiple conditions.

This project will demonstrate how access inequalities can be reduced; capabilities, structures and culture of collaboration for improvement can be fostered across adult and paediatric care; how this can reduce waste and increase productivity; and illustrate how these improvements can be embedded into management systems and processes.

What does your project aim to achieve?

The project will achieve aims linked to five project stages:

1. Articulate common themes with the transition between paediatric and adult services across health conditions. These are likely to include challenges and gaps in care experienced during the transition process and available programmes developed and available (e.g. Ready Steady Go).
2. Understand the use and effectiveness of initiatives to improve transition, including challenges to improve and examples of successful initiatives to improve transition.
3. Co-production of improvement initiatives with children and young people (CYP) and other experts with experience across system boundaries.
4. Production of various communication outputs (podcasts, guidance for CYP academic articles, webinars, etc.) that illustrate tangible examples of good transition practice and initiatives to improve transition developed in part three (see aim 3).
5. Detailed design of an improvement programme for delivery in a potential stage two to pilot this approach across health boundaries.

How will the project be delivered?

The funding will enable the delivery of the project as described to meet the stated aims. A part-time improvement lead will organise and deliver the project, including interviews, delivery of the co-production sessions, and production of communications outputs.

The project team will input into the detailed design and delivery of the project.

The first five months will focus on Aims One and Two, building on the current evidence transition (e.g., see ref 1) and qualitative interviews (including research and ethics approval if needed).

The next five months will be spent setting up and delivering Aim Three – co-production of interventions. Our RCPCH&US team are expert in running co-production processes for QI in partnership with service providers. Building upon evidence and practice, interventions will likely include improvements in communication, culture, and policy pressures.

The final four months will focus on Aims Four and Five.

(1) Colver, Rapley, and Vale et al. Clinical Medicine, 2020. DOI:10.7861/clinmed.2019-0077

How is your project going to share learning?

We will actively ask for and collate input and feedback throughout the project and beyond through our QI Central sharing platform, the Q Community,  and RCPCH communications mechanisms.

We will develop an initial programme theory at the start of the project, which will be adapted and developed throughout the project in response to participant feedback, Q Community and broader feedback.

We will develop outcome and impact measures linked to the programme theory, with data captured during the project – where relevant – and captured after the project, where outcomes and impact are expected after the first year. This is likely to include metrics on breadth and effective use of initiatives, process measures linked to testing initiatives in practice and improvements in outcomes from projects tested on this topic.

Part four of the project focuses on developing outputs for shared learning linked to Aim Four.