These updates and reflections are written by Cleo White, a co-researcher with Q Lab. Co-researchers work alongside the test team to support them to distil and communicate their learning and progress.
“Hello, my name is Cleo and I am the co-researcher assigned to the test team based within the adolescent and young adult rheumatology Department at University College London Hospitals. By day I work as an Innovation Facilitator at University Hospitals Coventry and Warwickshire where I support staff with their innovative ideas, help to solve their complex challenges and work with them to adopt new innovations that better the lives of our staff and/or patients. By night I can be found hand building pottery in my local studio. I wanted to join the Lab as a co-researcher because I am really interested in working on a national problem which affects so many in a collaborative manner. I believe that there is a lot we can learn from others outside of our own environment, whether that be a new process, a new perspective or simply what has worked and what hasn’t. Delays in elective pathways isn’t a new problem, so I am excited to see what innovative solutions the test teams develop. I hope to bring my curiosity and imagination to the programme, encouraging the team to think big and creatively (within reason) but also my understanding towards the difficulties and hurdles that can be experienced when working within the NHS.”
Update about the UCLH Adolescent Rheumatology test team: Engaging the stakeholders
January 2024
The run-up to Christmas saw the UCLH Adolescent Rheumatology and Paediatrics test team in full swing; deepening their knowledge around the problem and strengthening their relationships with their stakeholders.
Deep diving into the problem
The team held an away day where the departments’ clinical team and some of their willing young people came together to further explore and understand the challenges young people face in accessing rheumatology services. Time was taken to create a safe space for all to freely speak, listen, and engage in productive discussions. Drawing upon tools and techniques from previous Q Lab workshops, the group applied the user journey map to explore what the dream rheumatology pathway would look like from the perspective of both the service users and young people. The workshop generated three key areas that the team felt needed attention:
- How can we build continuity and stability for our young people.
- How can we rebuild confidence in the service for our young people.
- How can we rebuild trust in the system for our young people.
In the coming weeks, the team will be prototyping solutions to address these areas of need.
Building and strengthening relationships with stakeholders
The team recognised early on that involving young people who use the rheumatology service was critical to the success of their project and to lead to meaningful change. The team are using their established steering committee, which includes patients, for much-needed insights, collaboration, and co-design. The committee has supported the planning of the engagement events, and input into the project and decisions. This collaborative relationship has strengthened the rapport between the test team and their young people who use their service.
The team also realised that they needed to engage with young people who are not currently accessing their service and are at a high risk of not attending (DNAs). To address this, they developed a strategy in collaboration with the steering committee. They wanted to understand the context and impact of the factors affecting attendance, which were initially flagged through the predictive model aspect of their project.
The team have experienced some obstacles that hindered meaningful collaboration with external stakeholders, where they tried to link their Q Lab project with another project. This experience led them to take a step back, and objectively reflect on the most practical and efficient ways to overcome the challenges. This included managing expectations and setting boundaries, while continuing to collaborate to attain results for their collective mission.
The timeliness of this Lab and its alignment with the wider Trust’s strategy in population health management have garnered favourable support from senior leadership. The predictive modelling aspect of the project generated local evidence that highlighted that a lack of engagement with elective pathways is an issue that requires exploration. The Trust have been hugely supportive towards the predictive model and have supported staff training allowing rapid application. Funding has also been provided to support with evaluating the impact of this project, with a view to using the team’s process and methodology as a blueprint for achieving equity in elective care in other departments.
The team have also engaged with their regional Integrated Care Board and Commissioning team who have shown a keen interest in the project, with plans to share their insights.
Aicha and the team have been working extremely hard to drive this project forward and I am really looking forward to catching up with them to see what progress they have made since we last spoke!
Update: Research and discovery phase
October 2023
Reflections on the first Lab workshop
Test teams, co-researchers and collaborators came together for the first in person workshop of this Q Lab on 21st September. We were welcomed by the Q team, who shared the agenda and vision for the day, to expand our understanding of the causes of delayed care.
Throughout the day, we were introduced to new concepts and exercises to help deepen our knowledge and develop skills that we can put into practice. We had two engaging talks by the Flow Coaching Academy. The first focussed on the theory of flow, where we were encouraged to think about projects as part of a wider system, visualizing the patient journey and identifying demand, value and constraints along their journey. The second focused on working with others within a complex system and engaging effectively with the right people. We discussed practical tips on how we can develop the right relationships to facilitate project success.
Catching up with Dr Aicha Bouraoui, clinical research fellow in adolescent rheumatology post workshop, she commented that: ‘The beauty of Q is being given the opportunity to make really good connections’, which I think is very true reflection of the day and the Q experience so far.
Reflecting on our highlights of the day, we both enjoyed participating in the different activities to reinforce learning. Aicha particularly enjoyed the Conversation Café which required both passive and active listening, and I enjoyed the Troika Consulting exercise, which allowed us to gain a fresh perspective through coaching.
How UCLH Adolescent Rheumatology team understand the problem
Since the workshop, the UCLH Adolescent Rheumatology test team have been hard at work strengthening their network and forming new collaborations. Within the Trust, they have gained support and have received growing interest about the work that they are doing with the Lab. Outside of the Trust, the team have been connecting with other members of the Q community, particularly those who are working on similar projects and learning from their experiences.
The team have also spent time developing a value stream map of a young person’s journey, from appointment booking to clinical consultation. Rhea, one of the patient collaborators, detailed their journey, highlighting issues and barriers along the way. Using this, and the outputs from the co-design workshops previously held, the team identified two main sets of barriers that prevent engagement with the service:
- those within patient control, such as health behaviour, and
- those outside patient control, including wider systemic barriers.
Using the knowledge and skills gained from the in-person workshop, the team have made meaningful connections, allowing them to learn through shared knowledge and learnings and progress the project. They have also been generating attention and support from within their Trust, which no doubt will be extremely helpful going forward.
Introducing the University College London Hospitals, Paediatric Department
September 2023
The team
The test team that I have been assigned to is the Adolescent Rheumatology Department at University College London Hospitals. Leading the team is Dr Aicha Bouraoui (a Clinical Research Fellow) supported by Sophia Mavrommatis (Adolescent Rheumatology Clinical Specialist Physiotherapist) and Ruth Harvey senior QI facilitator and QI coach at UCLH.
Dr Aicha Bouraoui is a clinical research fellow in adolescent rheumatology, an accredited health coach and a senior registrar in rheumatology and general internal medicine. Aicha has an interest in quality improvement, coaching, system thinking and co-production. She took part in a prestigious leadership programme, Darzi fellowship, and enrolled in a coaching fellowship in leadership and organising for change programme, with the Institute of Health Improvement (IHI). She led a number of QI projects over the years and is a pioneer of embedding health coaching and social determinants of health as part of routine clinical care. She is a content advisor for medical care, driving change at the RCP.
Sophia Mavrommatis is a physiotherapist and joined the adult rheumatology service as an advanced physiotherapy practitioner in 2004. In 2016, she took the position of therapy lead with the Adolescent & Young Adult (AYA) rheumatology service. Sophia has extensive experience in long-term musculoskeletal conditions, leadership, and quality improvement. She was the clinical lead of the AYA service between 2018 to 2022 and the South Camden MSK Clinical Assessment & Treatment pilot service between 2007 to 2010. Sophia has a range of pathway improvement projects under her belt including the UCLH adult rheumatology Carpal Tunnel (2005- 2008) and Hypermobility pathways (2013-2016). In her quality improvement trust-wide roles, Sophia has worked on implementing enhanced recovery elective surgery pathways and clinical commissioning for quality and innovation projects (2010 – 2016). Sophia is currently working on two Health Foundation projects and the BSR sponsored Juvenile Idiopathic Arthritis Learning Collaborative.
Ruth Harvey-Regan is a Senior Improvement Facilitator at UCLH. She is an accredited coach with a PgCert in Healthcare Leadership and an MA in Social Sculpture: the art of transforming information into action for social change. Prior to working in the NHS, Ruth ran her own company coaching A ‘Level and college students. She also learnt the power of health coaching through personal experience applying the TGROW mindset and framework to her own debilitating long-term health condition with transformative results. Joining the NHS in 2010, working as Head of Patient Experience at BCPFT from 2016 and moving into QI/Improvement in 2020, she has consistently applied the principles of coaching, co-production, systems thinking and collaborative approaches to problem-solving to build the capability and confidence of those closest to the problem to make and sustain change for themselves.
The challenge
The challenge that Aicha and Sophia are exploring is ‘how can we improve patient engagement with our service and the wider healthcare system?’
Addressing poor patient engagement is a critical challenge, as it is a problem felt throughout the NHS. Clinic non-attendance for example can have significant consequences, including delays in care for urgent patients and increased workload for staff, often leading to burnout as they overbook clinics to prioritise urgent cases. As a department, the test team want to become more proactive in supporting their patients in a more holistic and efficient way and to do so, want to understand the underlying factors and to develop engagement strategies to overcome them.
To achieve this, the team are working collaboratively with their young people and are deep diving into identifying barriers. Previous local machine learning efforts have identified that inequality factors, such as socioeconomic status and geography, contribute to high clinic non-attendance. Additionally, a recent workshop run by the department revealed that some of these barriers overlap with barriers faced when accessing education.
Over the next 9 months, the test team will engage and work with their young people to understand the reasons for poor engagement. Co-discovery sessions utilising different research methods will be used to capture this data and once analysed, Aicha and Sophia plan to work collaboratively with various stakeholders, including the young people themselves, healthcare providers, and external organisations, to develop an effective engagement strategy, with the goal of overcoming barriers and improving patient engagement.
This is such an exciting project to be a co-researcher on as Aicha, Sophia and the team are committed to understanding the root cause of why their patients aren’t engaging in the first place, which is often overlooked. Through initial research, they’ve identified that inequality factors contribute to the challenge and are dedicated to being proactive in addressing them throughout the project. Additionally, their drive to develop something in collaboration with their patients for their patients (and staff), with their desire to try something new with constant reflection and improvement, isn’t often found within the NHS. I think the work that they are doing is going to be invaluable to not only their department but others who face similar challenges, and it’s going to be interesting to see how this project develops over time.
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