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NIHR CLAHRC Northwest London Blog

Collaboration for Leadership in Applied Health Research and Care

Patient And CLAHRC NWL Fellow Chosen To Teach Master of Public Health Students At Imperial College On ‘Improving Health Services’ Module For The First Time

Cherelle Augustine is a CLAHRC NWL Improvement Leader Fellow, cohort 2015. Cherelle is a Patient Ambassador for sickle cell disease. In 2005 Cherelle, at the age of 19, co-founded a charitable organisation called Broken Silence in loving memory of a friend who passed away due to complications of sickle cell. Broken Silence was founded by young people, champions young people and targets awareness towards young people.

 

openspeechMarch 13th 2017 was the first time the Master of Public Health (MPH) course at Imperial College had a patient teach their students on the ‘Improving Health Services’ module. It was a privilege to be invited by Rachel Matthews, Patient and Public Engagement and Involvement Theme Lead at NIHR CLAHRC NWL, to co-facilitate her session at Imperial. Being part of a milestone of an institution of such a magnitude can be daunting and although I have yet to complete a masters course myself, I knew I had a lot to offer these students.

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Service users such as myself can spend half their life or more in and out of hospitals or primary care services. I was diagnosed with sickle cell disease, the UKs most common genetic condition, at six weeks old. I have grown up with immense pain, had a near death experience at seven and lived with the after effects of childhood strokes, of which I currently have had six, and as a teen have watched a friend pass away from complications of the same illness. Going through this and more, I became self-aware and was raised to self-manage my condition. Even as a child, I have always been at the centre of making big decisions. My self-awareness has countless times saved my life.

 

Unfortunately, this independence and understanding of my needs has not always been well received by healthcare professionals. I shared this truth with the students. I was able to share not only my stories and values as a patient, but skills I had learnt through running a charitable organisation, being involved with an All Party Parliamentary Group, MPs, Lords, NHS England, the Improvement Leader Fellowship, co-producing and being on both sides of research.

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It was an honour to be able to speak to the MPH students and I am hopeful that I was able to change the mindset and self-awareness of at least one individual going into healthcare. I hope I inspired the students to think about patients as not just somebody to fix, but as an individual with the understanding and skills to work together with to impact positive change in their care and the health service. Change starts with the individual and an individual can change the world.074489-simple-red-glossy-icon-alphanumeric-quote-close2

Quality Improvement and…Improvement Science

Although the debate about what exactly constitutes Improvement Science research continues, The Health Foundation, a leading funder, proposed three distinct categories, providing a helpful way of understanding Improvement Science and the research that is being undertaken in this emerging field:

  • Research about improvement science – the study of how improvement work is undertaken;
  • Research using improvement science methods – studies that assess the use of specific quality improvement methods or approaches;
  • Research to create frameworks, models and concepts related to improvement science – the development and exploration of concepts in Improvement Science.

At CLAHRC Northwest London, quality improvement (QI) projects within the local NHS are our vehicles for testing and exploring the use of QI methods and approaches. Data generated from these projects offers CLAHRC Northwest London the unique opportunity to undertaken research across all three areas. Research provides valuable insights into how improvement work is undertaken, the roles of different QI tools, methods and approaches and also the development conceptual frameworks and models to support future improvement endeavours.

At our February research partners meeting we heard from two researchers about Improvement Science research that had been undertaken at CLAHRC Northwest London.

 

Planning Measurement for Improvement: Getting the most out of your data

Yewande Adeleke, from the Public Health and Information Intelligence team, reported on a Health Foundation funded study led by Dr Tom Woodcock. The study aims to create a web-based tool to help healthcare quality improvement teams to effectively plan measurement strategies, which are crucial in supporting and evaluating improvement endeavours. As part of the development of this tool, the team undertook a two-round modified Delphi survey to establish consensus on the content of the tool by engaging experts in the field.

The survey enabled the team to scale back the number of items that were initially identified for inclusion in the tool by one third and identified 5 overarching concepts:

  • The design of measures;
  • Data collection and management;
  • Analysis;
  • Action;
  • Embedding.

Like with many tools designed for use by practitioners, not just researchers, the development of the new tool needs to be carefully balanced, to ensure it is comprehensive but also pragmatic to support use in the field. This tool aims to offer an important contribution to QI planning, especially in supporting improvement teams to develop good measurement plans.

Although the next step for the team is the creation of the web-based tool, this has also provided an opportunity to reflect on the rigorous measurement planning approach CLAHRC Northwest London has developed over the last 8 years. The CLAHRC approach to working with NHS staff to support them to engage with improvement data, especially through the use of the Web Improvement Support for Healthcare (WISH), could provide some real insight that may be useful in developing the tool.

Future plans include testing the tool with current improvement projects that CLAHRC Northwest London support, introducing a further level of rigour to data collection and analysis and providing an opportunity to gather feedback about its utility.

Furthermore, there may also be future opportunities to influence how organisations collect data for QI, which is currently achieved predominantly through CQUIN (Commissioning for Quality and Innovation) or NCA (National Clinical Audit) mechanisms.

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Exploring the use of Process Mapping in practice in the healthcare sector

Dr Grazia Antonacci, from the Quality Improvement and Improvement Science team, presented on the work she recently undertook at CLAHRC Northwest London for her PhD that was supervised by Dr Julie Reed and Professor James Barlow in collaboration with the University of Rome Tor Vergata. Dr Antonacci’s work explored the role of process mapping in healthcare, first through a systematic review, then followed by a qualitative study of QI project in the NHS that are supported by CLAHRC Northwest London.

Process mapping can be defined as a methodology to analyse and better understand the systems and processes in which improvement interventions may be introduced. The origins of process mapping can be ascribed to Frank Gilbreth (American Society of Mechanical Engineers – 1921). The use of mapping techniques then rapidly increased in the manufacturing field as well as in service industries and included application in many domains (quality improvement, business engineering, development of information technologies etc.). The popularity of the use of process mapping in healthcare is undoubtedly linked to the need for an approach to share knowledge and experience of processes across a wide range of stakeholders, especially in increasingly complex healthcare systems. Despite the widespread use of process mapping there are no systematic reviews of its use in healthcare, as such Dr Antonacci identified and reviewed more than 60 empirical studies that used process mapping in healthcare, of which nearly two thirds were published since 2010.  This review offers a novel contribution to the literature on process mapping and identified several deficiencies, especially related to the poor involvement of stakeholders (particularly patients) and poor training in process mapping techniques.

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The findings of the systematic review were subsequently used to inform a qualitative study to explore the use of process mapping by QI projects supported by CLAHRC Northwest London. Interviews were undertaken with NHS staff and identified that process mapping was undertaken in a wide variety of settings for numerous reasons, with a particular emphasis on the need to:

  • Improve communication between different professional groups or organisations;
  • Develop consensus and a shared understanding of how processes actually occur in complex systems;
  • Promote patient-centred care by supporting dialogue between healthcare professionals, patients, and their families.

As this study outlines, whilst there is no single consistent approach to process mapping, the need to involve stakeholders across professional and organisational boundaries are crucial and often require leadership to achieve this. So despite the potential benefits of using process mapping, a more structured and informed approach is required.

Both researchers eloquently outlined the need for Improvement Science research. CLAHRC Northwest London recognises that despite the wide use of many QI methods and approaches, such as process mapping and measurement strategies, there are still gaps in our understanding of how these methods are currently used and what contribution they make to improvements. Furthermore, it is necessary to identify ways in which the methods and tools can be enhanced to be more effective whilst remaining practical.

March Newsletter 2017: Nutrition and Exercise

Many of the improvement programmes at CLAHRC Northwest London centre around the principles of preventative medicine and care. As we all know the most basic preventative care is to maintain a healthy eating and exercise regime.

Current projects that make this goal measurably easier include iHydrate, which ensures the adequate water intake and hydration of care home residents. Dehydration is a significant problem among older people, which has adverse effects on their health and can result in admission to hospital.  I-Hydrate aims to optimise the hydration of residents and increase the number of residents consuming their daily target fluid intake.

Another project which emphasizes the maintenance of healthy habits is SHINE, now in its second round, which promotes both physical and mental wellbeing. Most people will have a range of health needs spanning both mental and physical wellbeing. Unfortunately, health services are often provided in a way that does not recognise the inter relationships between physical and mental health.

NIHR CLAHRC NWL has also funded My Medication Passport (MMP), a patient-held record of medicines, designed by patients, for patients. It is available as a pocket-sized booklet and as a smartphone app originally designed to help patients to make a record of their own medicines list and any medication changes in order to improve communication about medicines between patients, carers and healthcare professionals. While nutrition and exercise should always be the cornerstones of a healthy lifestyle, some long-term conditions require more medical influence and it is important to keep the facts and details of that care in one easily accessed location.

Improvement programmes like these, and more in our latest round of funding, make it easy and manageable to make good choices regarding daily food and exercise choices. Even when we all do our best sometimes we need a helping hand.

February Newsletter 2017: Health Economics

While it has always been important to spend allotments for health services wisely, maintaining an awareness and record of efficiency is now both effective and beneficial for the improvement of the quality of services and care.

In the last year NIHR CLAHRC NWL have developed an independent eLearning resource called QI4U as part of an effort to build capacity in a systematic approach to quality improvement for front-line NHS staff and service users.  QI4U is available for anybody who has an interest in effective quality improvement of healthcare services for the benefit of patients. QI4U is targeted towards but not limited to front-line clinicians, academics, patients and service users.

QI4U plays a big part in CLAHRC NWL’s ambition to empower and build capacity within Northwest London in the systematic approach to quality improvement

As part of the National Institute for Health Research, CLAHRC NWL have been front runners in  developing, collaborating and delivering high quality research projects to find new ways of improving healthcare. CLAHRC NWL utilises the skills, knowledge and expertise of researchers, health and social care professionals, managers, commissioners and patients with the aim to ensure the results of the research are translated quickly and effectively into benefits for patients, the wider NHS and social care.

QI4U has proven to be a transparent and easy way to accomplish this goal.

SHINE Wins CNWL’s Project of The Year Award

The Central and North West London (CNWL) Annual Gem and Long Service Awards took place on Thursday 26 January 2017. SHINE, a CLAHRC NWL funded research driven improvement project, won the Project of The Year award.

“As a member of the SHINE Project Team since its beginning in 2014, I have seen many changes in the way the team members interact with each other and also with the Danube ward team. As a service user I found that working with ‘professionals’ as an equal valid member of the team has benefited the project as a whole and has been a real learning curve for all. To win the CNWL Project of the Year has for me been an affirmation of how everyone works together in a very important project dealing with physical health needs for people with severe mental health problems.” Jenny Trite, Project Team Member and Service User.

“This award is hugely important for the team as we reflect on what we have achieved so far and roll out our work more widely. It is great to have this recognition and appreciation of what we have done – or started to do – to improve our patient’s physical health, which has become a huge passion for me since I have been working on the project. I am so glad to work with all the members of the SHINE team, although I particular want to thank Bill Tiplady who first asked me to be involved, our service user colleagues – without whose constant hard work none of our interventions would have been helpful or meaningful – and the Danube ward team who are so committed to quality of care despite working in an acute, busy environment”. – Ed Beveridge, Project Clinical Lead and Consultant Psychiatrist at CNWL NHS Foundation Trust.

Continue reading “SHINE Wins CNWL’s Project of The Year Award”

Leading Pharmacists Discuss The Deprescribing Debate In New A Themed Journal Issue

In 2016, Barry Jubraj and Nina Barnett were guest editors for the EJHP BMJ ‘most read’ themed journal issue devoted to ‘deprescribing‘.

“Our themed issue provides an introduction to the deprescribing debate, with articles ranging from reviews by international experts on the current problems surrounding deprescribing, to a description of practical tools to support the process.”

This journal brings together influential articles, commentaries and case studies written by international experts such as Dr Polly Duncan, GP and NIHR Academic Clinical Research Fellow, UK, Professor Doron Garfinkel, specialist in Internal Medicine and Geriatrics, USA and Professor Ian Scott, Chief Investigator, Polypharmacy Stream Lead, Australia.

For more information visit here.


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January Newsletter 2017: Supporting Self-Care

Asthma is one of the most common long-term conditions in the UK. An estimated 75% of hospital admissions are avoidable and 90% of deaths from Asthma are preventable.

People with asthma have an elevated incidence of anxiety/depression and effective treatment of these conditions reduces the use of health care resources by asthma sufferers as well as improving their quality of life. The asthma self-help project has focused on co-producing a self-management programme to integrate the physical care of those with asthma in primary, community and secondary care with the psychological treatment available from Westminster IAPT service (a national NHS resource for psychological treatment).

As part of the project, the team have developed a 7 part self-help manual for adult patients with asthma which integrates an overall asthma management plan with cognitive-behavioural techniques for controlling anxiety and panic, with the aim of improving their ability to self-manage their condition and symptoms without the need to use acute services. The 7 sessions of the treatment resource are interaction between asthma, anxiety and panic; cognitive behavioural therapy model and relaxation; worry management tools; behavioural activation; negative thoughts and social anxiety; managing panic attacks; maintaining wellbeing and good holistic asthma control.

The project now plans to use the learning gained through this project to implement a similar structured, integrated service within Hillingdon in an attempt to further improve services for patients in north West London.

For more information contact: d.matthew@imperial.ac.uk

A Look Back at the CLAHRC NWL AutumnCollaborative Learning Event

On the 3rd of November 2016, CLAHRC NWL held their Autumn Collaborative Learning Event at the Royal College of Obstetricians and Gynaecologists, 27 Sussex Pl, London NW1 4RG, United Kingdom.

The day was opened by Professor Derek Bell and unloaded a day filled with global sharing on quality improvement methods and how to utilise them efficiently. The video below shows the first Plenary Session presented by Professor Danny Keenan, cardiac surgeon and Medical Director of Central Manchester University Hospitals NHS Foundation Trust.

The preliminary Sessions were dynamic, informative and embodied the collaboration ethos of NIHR CLAHRC NWL. The Sessions included, Working With Patients and Carers, Closing the Translation Gap, Introduction to Measuring for Improvement and Impact of Design in Healthcare  Service Improvement.

The following tweets highlight some of the visitor feedback and thoughts on some of the sessions:

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Closing The Translation Gap
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Working With Patients and Carers

The afternoon kicked off with an excellent array of judged presentations from the CLAHRC NWL’s Round 6 Research Driven Improvement Projects’ leads grouped under the subject matter of Quality Improvement In Action.

Dr James Williamson, Medical Director of Sir Charles Gairdner Hospital in Australia hosted an interactive talk about Choices, Chances and Changes highlighting quality improvement from an Australian perspective.

His ‘Death by Dashboard’ concept resonated with the audience including CLAHRC NWL’s own Public Health and Information Intelligence Co-Lead, Dr Tom Woodcock.

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Video below captures his session and advice.

 

Quality Improvement In Action was continued with a representation from CLAHRC NWL’s Round 7 Research Driven Improvement Projects’ leads, where they gave highlights on their projects.

The afternoon continued with further quality improvement idea sharing and a reveal of the winners of the award for the Research Driven Improvement Project presentations.

The winning project teams were:

  • i-hyrate (Round 6)
  • Risk Assessment Model in Pregnancy of Unknown Origin also known as RAMP (Round 7)
  • Hounslow Community Atrial Fibrillation Screening Project (Round 7)

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The research projects were creatively captured by artist Eleanor Beer on the night.

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The next NIHR CLAHRC NWL Collaborative Learning Event will be on the 2nd February 2017. Be sure to register and join us! More Information here.

#CLAHRCEvent

Winter Collaborative Learning Event: Accelerating & Sustaining Quality Improvement

NIHR CLAHRC NWL invites you to register for our CLAHRC Winter Collaborative Learning Event

2nd Feb 2017 | 8:30 – 16:30 | Congress Centre | 28 Great Russell St | London WC1B 3LS
Directions

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Registration is now open for the NIHR CLAHRC NWL Winter Collaborative Learning Event onAccelerating and Sustaining Quality Improvement”.

Book your place and register now.

Our winter event will be a tremendous opportunity to learn from experts on quality improvement and hear from project teams currently undertaking quality improvement projects within Northwest London.

Please forward this invitation to other members of your project teams and encourage them to attend as well.

Guest speakers include: Professor Theresa Murphy, Laura Lennox, Ganesh Sathyamoorth.
Click here to view the PROGRAMME

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