Q Exchange
Working together for seamless perinatal services in Yorkshire and Humber
- 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?
There is a global and cross sector growing evidence base that when work is carried out in complex interdependent environments, how we relate and coordinate the work together impact important outcomes for that work. This has been shown to be the case in health and care, and is particularly relevant where risk is high, work is time sensitive and inherently unpredictable such as multidisciplinary work across health and care settings and organisational boundaries.
A reliable and valid measurement of perceptions around the way we relate and coordinate – relational coordination (RC) -shows that clinically important outcomes are improved where there is high RC – and that where systems and teams intentionally improve RC, the outcomes improve as well.
What does your project aim to achieve?
Perinatal Mental Health care in Yorkshire and Humber will be managed by a Provider Collaborative , led by LYPFT, from April 2024. The collaborative will be collectively accountable for:
· Flow into and out of the inpatient resource in Leeds
· Having clear and functioning safe pathways for this
· Co-creating learning and continuous shared improvement across the system
· Structure of quality control and assurance ensuring good system governance across partners
RC evidence also shows the role of systems leaders in to ensuring both they are working in a way that supports RC and that they work to produce environments that support people to work in this way – with structures, processes and cultures that support frequent accurate and timely communication, a shared knowledge of the work the system is undertaking together and how all the roles needed fit together producing environments of mutual respect and shared problem solving.
How will the project be delivered?
1. A work process is agreed that makes sense to the leadership group.
For illustrative purposes a draft work process identified is:
Working together for seamless perinatal services in Yorkshire and Humber
2. Measurement of Relational Coordination
3. Sharing the report and sense making
4. Carrying through interventions
5. Learning and measuring impact
6. Collective decisions about repeat measures and use of RC at other levels.
The potential exist to use RC as a real time quality control system at the point of admission (or alternative to admission) and discharge to ensure that the teams around a service user and their family is good enough for good outcomes. This could include measures from the service user and family as equal partners in the care.
How is your project going to share learning?
To support the evaluation and shared learning from this work we will work together in collaboration with Advancing Quality Alliance (Aqua)to share the results nationally to develop blogs and publications which will include:
- High level, anonymised results from relational coordination survey;
- Improvement interventions
- Learning
How you can contribute
- The networker - to share the results and impact that RC can have on transforming relationship that support high quality, safe care.
- The critical friend - members of the Q community to share ideas on the types of RC interventions - to support collaborative working across wide geographical area.
Plan timeline
| 16 Apr 2024 | Meeting to discuss RC survey results |
|---|---|
| 3 Jun 2024 | Workshop to agree RC interventions |
| 1 Jul 2024 | RC intervention work |
| 29 Jul 2024 | Monitoring/ understanding impact of RC interventions - iterations and ongoing improvements |
| 1 Oct 2024 | RC survey with patients/ lived experience group - focus on SDM |
| 1 Dec 2024 | Review results from patient RC survey |
| 10 Feb 2025 | RC patient survey - workshop - including patients |
| 19 Oct 2025 | Date TBC - RC roundtable event |
Comments
Amanda Huddleston 5 Mar 2024
Excellent proposal - using person centred and system level approaches could really be a game changer in bringing about effective, sustained improvement.
claire kenwood 19 Mar 2024
Thanks Amanda - we hope to move from building the collaborative, to working along care pathways and then (depending on how we go!) moving to include service users and families at key points to ensure that there is enough relational coordination for safe transition across care boundaries
As with all of this work, an iterative approach is needed!
Elizabeth Bradbury 27 Feb 2024
Sounds interesting....just wondering how you'd connect this with the multiple maternity improvement initiatives underway at present to avoid improvement fatigue? It sounds aligned to changing behaviours, and we know that's imperative for cultural change (ref Shook, Schein and many others....)
Also - how will women and families be involved, it would be wonderful to see co-design and coproduction of the proposal and planned work.
Do you have an example you could include about measurable impact, I think this would help the proposal become more tangible, it sounds a little theoretical at present.
Good luck!
claire kenwood 19 Mar 2024
Thanks for your comments!
As this is internal to secondary mental health, the work in general maternity does not have such an impact. This work is more concerned with how you build leadership collaboratives over large geographic areas knowing that relationships are key - and that often the times people talk service to service are at times of disagreement rather than agreement - and these times are reasonably infrequent given the nature of the service.
The first step for us is building the identity and relationships of the shared leadership - second would be ensuring team to team pathways are working relationally (using a SOP that already exists but needs relationships to work!)
As with all of this work, the iterative nature for the group means we cannot be sure if we will get the the third stage - for me the most exciting. Here we plan to have real time quality control of an RC measure for a team around a service user at the point of transition including the service users and their family. Care is essentially co-created at this individual level, and a fragmented care team is a risk that is sometimes easier for those who need a service to see than those who are (with good intent) trying to deliver it.
We know that clinical outcomes are better when care is delivered by relationally integrated teams - and that geographical distributed teams working across boundaries have less natural ability to form these networks. The impact we are looking for would be safer services across boundaries - a real issue for all of mental health if you read incident reports. This is where we would hope tp see impact - and will have a chance to better define that in stage 2. We also know that the clinical teams have more chance of connecting if the leadership team is relationally coordinated - and that this correlates to clinical outcomes. So, that is where we are starting!
Emma Walker 27 Feb 2024
I think this will be really useful learning as we work to deliver more services across systems, places and provider collaboratives - we know from recent maternity services reviews that it is the relationships that can create challenges so this approach would be generate some very useful and widely applicable learning to other settings too.
claire kenwood 19 Mar 2024
thanks for your interest and comments!
Jessica Anderson 27 Feb 2024
Sounds like an interesting project and an area close to me heart. I was in the Mother and Baby Unit in Leeds after having severe postnatal depression. I lived in Leeds so my care as an inpatient and in the community all came under LYPFT, so the co-ordination between the different elements, but speaking to other women in the MBU who came from other places, this wasn't always the case, so really do think this is an area that could be improved
I'd be really keen to learn more about the interventions you plan to introduce to improve RC
claire kenwood 19 Mar 2024
thanks for your thoughts - it would be great to connect and hear more from you
If you have the time I am easy to contact on nhs.net
best wishes
Claire
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