Q Exchange
New perspectives on system improvement through collaborative incident analysis
- Proposal
- 2024
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?
We want to enhance the way we learn about cross-organisational patient safety. NHS Wales already has a clear policy approach to joint patient safety investigations between two or more Health bodies; a “systems-based approach” with the patient “at the centre”. This aspiration is being increasingly reduced into a transactional process of parallel investigations due to logistical working differences and a lack of shared digital infrastructure. Our project aims to meet the needs of affected patients and their loved ones or representatives in a seamless way and promote shared ownership of improvement for entire pathways of care. We hope to do this by utilising a truly collaborative approach to analysing and reviewing patient concerns that is rooted in systems-thinking, pooling resources and expertise from across Welsh Health bodies in a shared digital workspace to produce timely and unified learning about our Work As Done.
What does your project aim to achieve?
For patients and their representatives: A timely and unified response, unfettered by organisational constraints or service boundaries. Patients affected by an adverse event or experience should feel confident that we are considering them in a holistic way. They deserve a single point of contact and a more timely, coherent response focused on resolution and system improvement.
For staff: to share expertise and try out new ways of working, to build capacity and develop skills in systems analysis, to increase empathy for colleagues in other services and organisations and better understand the actions being taken on all sides to respond to increasing challenges and demands.
For NHS Wales: To gain collective perspectives on the impact of our services and care, to access a rich database of learning and experience from a whole nation, helping to build a strong NHS Wales culture of collaborative patient safety and collective responsibility.
How will the project be delivered?
Infrastructure– we know that a shared digital workspace, including a collective database for managing cases for analysis will be essential if we are to work in a truly collective way and end many parallel analyses done in different ways. We need to be able to share information among a number of staff from different employers in a secure and timely way. We will also focus on developing unified processes for engaging and supporting those involved.
Analytical approach– the team will source training in an investigation methodology such as Systems Engineering Initiative for Patient Safety (SEIPS) or Functional Resonance Analysis Methodology (FRAM).
Outputs– a single unified understanding of events that takes everyone’s perspectives into account. A thoughtful analysis of an episode of care or patient pathway that promotes empathy among individuals and understanding of where our collective efforts might bring most benefit. Collective ownership of improvement initiatives, action plans and learning.
How is your project going to share learning?
We anticipate shared learning being one of the key benefits to this project as cross-organisational working naturally leads to shared cross-organisational learning. Collaborative learning will be stored in a central repository and begin building the infrastructure necessary for national thematic learning.
We will utilise existing peer learning networks and the Welsh Learning From Events process to ensure spread across organisations and among stakeholders. We also intend to convene (at least) one end of project learning event, reflecting on findings, experiences and informing Phase 2 work.
We expect that the mutual trust created through bringing together patient safety, QI, clinical leaders and service managers will create informal interpersonal networks for connecting over professional issues and future improvements.
Any cases that result in Redress will be managed through the existing reimbursement process.
Evaluation of the project itself will be driven through experience surveys (PREMs) and quantitative analysis of completion timescales.
How you can contribute
- Guidance, expertise and knowledge in FRAM or other systems-based analysis methods.
- Past experience of data sharing agreements for purposes of shared learning and improvement.
- Guidance on how we might better capture the qualitative elements of the project – measuring increased collaboration, for example.
Plan timeline
1 May 2024 | Continued stakeholder engagement, refining project scope, exploring national governance arrangements |
---|---|
1 Jun 2024 | Evaluation of current practice and processes using appreciative inquiry |
1 Jul 2024 | Procure systems-based training |
1 Aug 2024 | Brief report and reflection on appreciative inquiry findings |
1 Aug 2024 | Confirm national governance arrangements and oversight |
1 Sep 2024 | Provide systems-based accident analysis training |
1 Oct 2024 | Confirm digital working arrangements and access |
1 Nov 2024 | Selection of pilot cases from different services and systems |
1 Jan 2025 | Collaborative incident analyses |
1 Feb 2025 | Evaluation of changes in approach and experience measures |
1 Mar 2025 | Analysis of quantitative impacts (timeliness, ombudsman referrals, claims costs) |
1 May 2025 | Open-access in-person and digital learning event (Q network welcome!) |
1 Jun 2025 | Final reflections, appetite and feasibility of phase 2 (non-NHS organisations) |
Comments
Mandy Westcott 29 Feb 2024
Sounds like this has significant potential for cross organisational and shared working. Its focus on improving patient experience, and collaboration between and across organisations in a system thinking approach is noticeable.
Be interested to know what engagement activity you have already done.
Claire Appleton 12 Mar 2024
Hi Mandy,
Thanks for your positive response to our idea. We're lucky to have some existing peer networks in NHS Wales for quality and safety so feel we are starting from a good place.
We've also initiated 'stakeholder engagement' for this proposal and have had a really enthusiastic response, with representation confirmed by the national quality & safety team, 6 out of the 7 Health Boards in Wales as well as our national ambulance trust and involvement from our national team for patient safety software.
Everyone is really keen to explore the benefits of systems based approaches and working beyond the constraints of organisational boundaries/governance and we believe this funding would enable us to overcome some of the practical obstacles to doing so (workforce capacity & skill, digital solutions).
As the project initiators, we want to ensure that the project itself is undertaken in the same collaborative spirit as the work we'll be exploring so we're producing the full proposal as a national group with input from each organisation. This has shown up already in our conversations about who should be the 'lead organisation' - we can't decide as we really want to promote shared ownership!
We'd really welcome any additional ideas you have for how we can make this experience as positive and productive as possible for all those who have already engaged with us.
Thanks again for sharing your thoughts.
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