AQuA Staff Support Key 103 Christmas Present Appeal for Local Children and Young People

Staff from the North West’s NHS quality improvement organisation, the Advancing Quality Alliance (AQuA), have been helping to spread some Christmas cheer to local children and young people, by supporting Key 103 Radio’s annual ‘Mission Christmas’ fundraising appeal.

AQuA staff support Key 103 Mission Christmas

Staff have been helping to make Christmas a little brighter by buying extra gifts to donate to the appeal, to be given out to disadvantaged youngsters across Greater Manchester.

Mission Christmas helps to raise money and supports local children living in poverty. With an estimated 1 in 3 children living in poverty, last year it raised over £2 million in cash and gifts to help over 51, 500 of the region’s 0-18 year olds.

Improvement Advisor Eleanor Peet, who coordinated the appeal for AQuA, said:

“We’ve had a fantastic response and it’s been really nice to see staff donating their gifts to help make Christmas morning that little bit special for local kids and young people.

“Whilst we work across the North West, we are based in Sale, so we do like to support local causes when we can, and Key 103’s Mission Christmas is a great way we can do our bit to share some festive cheer.”

You can also find out more about Mission Christmas in this video, or follow #MissionChristmas on Twitter for more updates.

AQuA Executive Coaching Opportunities Now Available for Members

The Advancing Quality Alliance (AQuA) is pleased to announce that we are now offering Executive Coaching opportunities to individual senior leaders across our member organisations.

This is an exciting chance for members to work alongside one of our team of highly experienced improvement coaches, and receive support to explore how they can best address their personal performance to lead organisational or local system priorities and challenges.

Open to executives, non-executives and senior leaders, feedback from previous participants has shown that many of our members have appreciated the opportunity to undertake external development with the team.

Other benefits members have gained include:

• Increased confidence and support to lead complex change initiatives that span organizational boundaries 
• Improved relationships with multi-agency partners 
• Better recognition for local or national change programmes 
• Increased team performance

Accessing Our Support

The type of support we are able to offer is flexible and depends on the needs of the individual. However, there are a several conditions before this offer can commence:

• You must work for an AQuA member organisation for the duration of your coaching 
• Before you and your coach commit to a coaching relationship, we will arrange a preliminary meeting or phone call to explore why you want coaching, what you hope to achieve and what you are looking for in a coach. Only if both parties agree that executive leadership coaching is appropriate and that they could work together will the coaching proceed. 
• You and your coach will agree to and sign a coaching contract outlining what you both commit to. 
• As part of the contract you and your coach will agree a set number of coaching sessions, the duration and location of each session and whether the coaching is face to face or virtual. This will vary from client to client. 
• The detail of the coaching conversations will be completely confidential.

Find Out More & Apply

In order to apply for coaching, you must be a senior leader working in an AQuA member organisation for the duration of the agreed period.

If you would like to find out more or apply for this opportunity, please send the following details to Jascinth.Ward@srft.nhs.uk:

• Your name, role, organization and contact details (including office & mobile numbers) 
• An outline of your coaching objectives and what you would like to achieve from this support

Following this, we will then arrange a preliminary meeting or phonecall to explore why you want coaching, and what you hope to achieve from it.

If it agreed coaching support it appropriate for you, both you and your coach will draw up a coaching contract to outline key commitments. This will also cover what type of support best suits your needs, whether this is face-to-face or remote, and the location, duration and how many sessions this will cover.

Details discussed during coaching sessions will be completely confidential.

Our coaches

Below you can find more information about our team of coaches.

Elizabeth Bradbury, Director

Elizabeth is a highly experienced leadership coach, with an established national reputation for coaching across executive and non-executive board and governing body members, senior managers and clinicians. Much of this experience has been in support of leading complex organisational or system transformation, large scale service reconfiguration, and performance improvement.

Her calm, friendly approach combines empathy and constructive challenge, to support participants to effectively develop and analyse strategic priorities and issues, and devise realistic options in keeping with their local context and culture.

By helping to set clear, results-oriented goals to her coaching, Elizabeth has helped a number of participants to further develop their leadership capabilities, increase their presence and strategic impact across multiple partners, and develop their role as effective system leader.

Elizabeth is also a registered nurse with extensive experience across emergency care and hospital management, and holds a Level 7 qualification in Executive Leadership Coaching & Mentorship. She also recently served on the Board of the international Foundation for Integrated Care.

Lesley Massey, Director

Lesley is an accredited ILM Level 7 leadership coach, and leads the expert faculty for AQuA’s Board development programme; supporting senior executive teams to meet challenges around complex change and developing strategic quality improvements.

Starting her career as an Occupational Therapist, Lesley has a wealth of experience gained from roles across frontline clinical specialist care, and operational and strategic management positions.
Throughout her coaching, Lesley has supported a wide range of senior leaders to improve their ability to manage challenging relationships, and deliver action focused, practical outcomes for staff and patients.

Using a combination of reflective listening and goal setting, she encourages participants to challenge their existing thinking and approaches. Her approach works particularly well with those who are new to leadership roles, to help them build teams and organisational forms, manage new relationships across different organisations, and develop their strategic thinking and presence.

Helen Kilgannon, Head of System Transformation

With over ten years’ experience in coaching and mentoring, Helen has completed a range of NW Leadership Academy coaching programmes and CDP, and is currently studying a level 7 qualification in leadership coaching. As a CIPD qualified HR professional, she is also able to support individuals through the NHS Leadership Framework 360 assessment and feedback.

Helen’s approach works well for people looking to improve their personal effectiveness particularly in times of change, take a real practical approach to delivering their goals and manage relationships to maximise personal impact. Her clients have included Directors of Nursing, Consultants, Assistant Directors, and senior operational managers.

She has worked in a range of provider and strategic organisations at Assistant Director level. Previously working as an Assistant Director for Organisational Learning and Development in a mental health and community provider, key areas of work have included leading coaching strategy, cultural development, health and wellbeing, communications, and learning and development.

She has led major programmes of transformational change regionally and operationally, taking programmes from inception to implementation and evaluation. Her role in AQuA as Head of System Transformation is to support systems to develop and implement new models of care, with a strong emphasis on leadership for place/system leadership.

Blog - Smoothing the Flow - David Fillingham

In his latest blog, AQuA Chief Executive David Fillingham shares his thoughts on adapting Lean thinking within health and social care, and how this can be supported through improving Whole System Flow.

AQuA Chief Executive,
David Fillingham CBE

Having had six years seeking to introduce Toyota thinking (where the Lean methodology was created) into healthcare at Bolton Hospital, and another six seeking to apply it more widely through AQuA, I've come to believe that it is definitely a case of needing to adapt not just adopt.

Many attempts to use lean in healthcare have floundered because people have a mental model of hospitals as factories, and therefore of patients as the raw material on a production line. And we both know, this cannot be the case...healthcare is the ultimate service industry.

Most of this work has concentrated just on hospitals and has failed to engage adequately with staff working in primary and community areas, in mental health or in social care. Many of the problems currently being experienced in A&E departments are a reflection of challenges outside of hospitals

What's worse, lean initiatives have all too often been about management consultants being employed to foist lean onto a resentful workforce.

In The Challenge and Potential of Whole System Flow, our joint paper with The Health Foundation, we seek to address this in a number of ways:

Defining the Value

Firstly, value (the aim of creating flow) needs to be defined by the customer not the provider. In healthcare this implies a huge shift towards shared decision making with patients, co-production, and asset based approaches to community development. Techniques such as experience based co-design are a valuable way of addressing this in quality improvement work.

Focusing on the Whole System

Secondly, we have emphasised the need to use all of the resources in a community, not just those of the hospital. We have also taken flow to be not solely about the flow of patients through a system (which risks detracting from a patient focused, care giving ethos) but also about the flow of staff, information and resources.

With increasing numbers of frail older people needing support to live independently, we expect there to be increased flows of those components out of hospital and into community settings.

Addressing ‘Failure Demand’

Thirdly, this helps address the lean concept of 'failure demand' which is much more relevant in service sectors than in manufacturing. Many of the patients who 'flow' into hospitals should never need to. The biggest waste in healthcare is avoidable ill health.

Engaging the Frontline

Finally, all of this needs to be done with the deep and genuine engagement of frontline workers across disciplines and across care sectors. What we need are improvement approaches that give them full ownership of designing and delivering new care systems where staff, information, resources and, where necessary patients, flow smoothly without waste, delay, frustration or harm.

Throughout 2016/17, AQuA, supported by The Health Foundation, have held a series of events exploring Whole System Flow in health and social care. For the latest updates, follow @AQuA_NHS or #WholeSystemFlow on Twitter.

AQuA and The Health Foundation Publish Joint Report on Whole System Flow

Click the image to download the report

The Advancing Quality Alliance (AQuA), in partnership with The Health Foundation, are pleased to announce the publication of a joint report on our work exploring Whole System Flow across health and social care systems.

The report, The Challenge and Potential of Whole System Flow: Improving flow across whole health and social care systems, was co-written by AQuA Chief Executive David Fillingham CBE and The Health Foundation’s Bryan Jones and Penny Pereira, and details key findings and research gained from the past 12 months of working on this new programme.

Speaking on its publication, David Fillingham said:

AQuA Chief Executive
David Fillingham

“Understanding and improving Whole System Flow should be a major priority, not just for colleagues working in the NHS, but also those across the wider health and social care landscape.

“Working on this new programme in partnership with The Health Foundation has been a fantastic opportunity. We’ve had a great response to our work so far, and this report is the product of the drive and commitment of our staff and of the many AQuA members and partners who have made such valuable contributions.

“Whilst its findings may not offer the ‘magic bullet’ to solving flow that some may seek, it does offers insights into how we can work together to tackle this complex challenge, and so secure better outcomes for patients.”

Penny Pereira, Deputy Director of Improvement at The Health Foundation, said

“At its heart, improving flow is about tackling the delays and duplication that are frustrating for all those in the health and care system. Getting flow right is critical to the delivery of new service models, improving quality of care and productivity. But it’s the impact it will have on the daily experiences of service users and staff that matters most.

“We need to look well beyond seeking just quick fixes for A&E. Extending work on flow to span whole health and social care economies takes time and investment. If every organisation in each health and social care economy were able and willing to work collaboratively to design services that optimise flow, it could lead to major improvements in patient and service user experience and outcomes, as well as improved productivity. It is for these reasons that flow should be a top priority."

The report also acknowledges the contributions of AQuA staff Wendy Lewis, Andrew Wilson and David Dixon for their work throughout the programme.

Since May, AQuA have held a series of events exploring different aspects of Flow with both our members across the North West, and wider partners working across health and social care.

Download the report in full here.

Wendy Lewis, AQuA’s Whole System Flow Programme Lead, also shared her thoughts on working on this programme in her recent blog, which you can read here.

For latest updates on the programme, follow us on Twitter @AQuA_NHS or via the hashtag #SystemFlow.

AQuA Members Celebrate Leadership Success at North West Leadership Academy Awards

North West Leadership Academy's Managing Director
Deborah Davis opens the Awards

NHS leaders across the North West recently celebrated a night of success at the North West Leadership Academy’s annual Recognition Awards, for which AQuA was one of the sponsors.

The awards, held at the McDonald Kilhey Court Hotel in Standish, recognised the leading individuals and teams across all levels and professions of the NHS in the North West.

Speaking after the awards, Helen Kilgannon, AQuA’s Head of System Transformation, said:

“It was fantastic to join our colleagues at North West Leadership Academy in celebrating some of the region’s current and rising leaders across the NHS.

“These are individuals that have led some truly outstanding improvements to both patients’ health and experience of the NHS, and for the staff and colleagues they work with on a daily basis.

“AQuA work closely with many of these people, and we are really proud to have such a wealth of talent across the North West.”

AQuA members named among the winners included:

• Emerging Leader - Dr Benita Kane, Consultant in Respitory Medicine, University Hospital of South Manchester NHS Foundation Trust
• Inclusive Leader – Karmini McCann, Head of Workforce Futures, University Hospitals of Morecambe Bay NHS Foundation Trust
• Inspirational Leader – Linda Johnstone, Clinical Director, Cheshire & Wirral Partnership NHS Foundation Trust
• Leading and Developing People – Dave Sweeney, Deputy Chief Officer, NHS Halton CCG
• Leading Systems Transformation – Andrew Bennett, Chief Officer & Senior Responsible Officer, Better Care Together (Morecambe Bay Vanguard)
• Living the Values – Dr Neil Smith, GP Lead for Cancer, Pennine Lancashire, NHS East Lancashire & Blackburn with Darwen CCG
• Team Outstanding Achievement - Clinical – Prof. Cheng-Hock Toh, The Royal Liverpool & Broadgreen University Hospitals NHS Trust
• Team Outstanding Achievement – Non Clinical – Organisational Development and Training team, University Hospitals of Central Manchester NHS Foundation Trust

Among the finalists in the Emerging Leader category was Dr Emmanuel Nsetubu, our AQ Clinical Lead for Sepsis, and Consultant Infectious Diseases Physician at The Royal Liverpool & Broadgreen University Hospitals NHS Trust.

AQuA Fellow and Integrated Care Programme Director for Oldham CCG, Kath Wynne-Jones, was also among the finalists in the Leading Systems Transformation category.

For more information about the awards, please visit the North West Leadership Academy website, or you can follow the coverage from the night on Twitter at #NWawards16.

Applications Open - Developing Patient Safety Leaders Programme

We are currently seeking applications from AQuA members for an exciting programme designed

to develop the essential skills and knowledge to lead improvements to patient safety.

Starting in February, our four-day Developing Patient Safety Leaders programme will give members the opportunity to develop a deeper understanding of patient safety, and learn how they can drive improvements in the quality and safety of care delivered to patients.

Our team of Improvements Advisors will support participants throughout the programme to develop key safety leadership skills, and help them apply this to their individual roles and environments.

Topics covered over the four days will include quality improvement tools, effective patient safety culture, Human Factors, how to measure for sustainable improvements, and safety from a patient perspective.

This opportunity is suitable for a wide range of roles, particularly those looking to have a greater impact on influencing or planning patient safety improvements. However, participants do need to have a basic knowledge and experience of quality improvement.

Participants must also be available to attend all four dates:

• Thursday 2 February 2017 - Bolton
• Wednesday 22 February - Bolton
• Thursday 9 March OR Friday 7 April - AQuA Offices, Sale
• Thursday 5 May - Salford

Further information can be found in the programme plan. To apply, please download the application form and return to Rose.O'Reilly@srft.nhs.uk.

The deadline for applications is Friday 20 January 2017. Successful applications will be contacted a week after the deadline.

If you would like a further discussion about the course, please contact Rose via the email address above.

Blog - To Flow or Not To Flow

Wendy Lewis is the Whole System Flow Programme Lead for the Advancing Quality Alliance (AQuA), and you can follow her on Twitter @ERPwend. Here she shares her thoughts on the current state of play behind Flow, and some things she has discovered throughout AQuA’s journey in understanding this complex issue.

Wendy Lewis, Whole System Flow
Programme Lead

Our Chief Executive David Fillingham recently led a webinar for the UK Improvement Alliance (UKIA) on the subject of Whole System Flow; a subject that we at AQuA have been working quite intensely on with The Health Foundation over the past 12 months.

Having had the opportunity to work on our Flow discovery programme for the past year, I used the webinar to reflect on some of our learning to date. Some of the discussion and questions generated also really helped me to crystallise some key points that the improvement community may want to consider and contribute to.

Our thinking has led me to these main points:

We Still Rarely Talk About Whole Systems

Language is so important when considering flow. By using the title of whole system flow but then describing a patient pathway or service level improvements as the examples, we are pulling the opportunity for learning and line of sight below the system level. This is perfectly understandable, as this is where our energy, effort and money has been spent in trying to ‘fix flow’ through our NHS services.

Throughout our conversations and local discussions about this work, we’ve used the phrase “from a patient’s front door and back again” to loosely describe the system. However, we developed this definition:

The coordination of all resources across a locality to deliver effective, 

efficient, person-centred care, in the right setting, at the right time.

What we have found really important, is that the participants can describe the system they are applying this thinking to and be clear of its boundaries. If the focus for improvement is on an acute hospital pathway or a community based service - describe it as such. Our role as improvement experts is to then support and also challenge that work, and highlight the opportunities for applying whole system thinking.

We Rarely Talk To Whole Systems

Through AQuA’s programme this year, we’ve had the opportunity to work with both a wide variety of our members, as well as partners across health and social care, and asked them to define the current enablers and barriers to flow. The overwhelming response from our first co-design event was “We need the system in the room to talk about it and improve it!” Quite right too! This is a fair challenge and one that we have made efforts to address, but it does remain an issue.

How do NHS soaked improvement organisations engage with system partners from local authority, community groups and charities? When we have new partners in the room but the examples we describe are health-based (and usually centred on acute hospitals); this really doesn’t foster engagement and shared understanding.

We call it Patient Flow!

ARGGGGHHHHHHHHHHH! If only patients did flow as they would want to, and actually as we frequently promise, then they would flow through our pathways!

I’ve become increasingly aware of the language used about the recipients of our services, our patients, our customers within this work on flow. Bed blockers, delayers, usual suspects, frequent flyers… commonplace in our language as well as in the media. How should we lead the change in language that demonstrates respect and outdated, non-paternalistic, approaches to care provision?

Through our work this year we’ve described four elements that have to be understood alongside each other, in order to understand flow through our systems and how we might improve it:

• Patients 
• Workforce 
• Information 
• Finances 

And again, like with not having the system in the room to generate the right level of discussion, by not paying attention to these four elements in parallel throughout flow work, we run the risk of re-shaping a problem, rather than clearly defining and understanding it.

Reality check

The systems and services that we hold dear are under extreme pressure, with improvement priorities coming out of their ears. Where does a new improvement offer add value, not distract from mandated priorities, and support real transformation when capacity to even think about it is occupied? Applying new thinking to a highly reactive and defensive system -a challenge or unhelpful task?

In improvement we teach “go where the energy is”. I think in reality we in the NHS are seeking to fix what’s hurting us the most right now: A&E waits, delayed transfers of care, financial compliance, to name a few. Going where the energy is for improving the system is not the same as following the energy currently being spent on these pernicious problems. How do we support both? How do we create the head space for applying different and new thinking?

We also need to acknowledge how colleagues in our own improvement communities feel about flow. A lot of us have been involved in a whole range of these over recent times; some with support and drive from national structures, and others from local or regional initiatives.

Our differing levels of success and/or sustainability create a new issue; there is frustration, scepticism and even cynicism about creating another offer around improving whole system flow within 'Us Improvers.' However, there are sources of energy and support outside the NHS that could really help us refresh and reframe our thinking.

So – how do we respond to these points? How should we act on them? If we focus for another year on whole system flow - where will we get to?

AQuA Chief Executive David Fillingham CBE, alongside colleagues from The Health Foundation, will shortly be publishing a joint report on Whole System Flow. For more information, please visit the AQuA website or follow @AQuA_NHS on Twitter.

Blog - The Challenge and Potential of Improving Whole System Flow Across Health and Social Care

AQuA Chief Executive,
David Fillingham

In his latest blog, AQuA Chief Executive David Fillingham shares why he thinks a focus on improving Whole System Flow could offer solutions to major challenges currently facing the NHS,

This is ahead of a forthcoming report alongside The Health Foundation, looking at the challenges and potential of flow in the health and social care sector.

What does whole system flow within health care mean?

Anyone who’s been a patient, or had an elderly relative go through the health care system, will know what a lack of flow looks like: frustrating delays and wasted resources. Sometimes patients and families can feel like they are the only people pulling the different parts of the system together. That absence of a smooth effective flow of patients, information, resources and staff has big knock on implications for patient experience, but also for safety, outcomes, and productivity.

There have been many attempts to improve flow, but projects have tended to focus on only one part of the system and usually on hospitals, particularly emergency departments. When we talk about ‘whole system flow’ we mean something broader. We need to start looking at what’s going on in other parts of the health and social care system, and to improve things using all the resources in a community. It’s a much bigger challenge.

How can focusing on whole system flow help with improving care quality and reducing costs?

At the moment people in England are busy working on their Sustainability and Transformation Plans (STPs) and developing new models of care. But none of this will deliver results unless we find a way to move patients and resources around the system in a more effective way. I feel really strongly that tackling whole system flow provides the underlying principles for developing new models of care more effectively.

There are three huge benefits to improving flow:

1. Patients get a better experience and outcome. If an older person with a number of long-term conditions can’t get to see their GP, they may deteriorate and need to be taken to A&E. Before you know it they've spent hours waiting to be admitted, and then they’re in hospital weeks or months longer than necessary because they can’t get discharged. That’s a very poor experience.
2. High-quality care is delivered using fewer resources. Had we got the right intervention in place at home much earlier for that person they would never have been in hospital in the first place. This is often called failure demand, which represents a big part of the pressures on our services, as we explore in the report (to be launched soon).
3. Better flow leads to happier staff. Patients aren't the only ones who feel frustrated by bits of the system not joining up properly, it really impacts on staff as well.

How does change happen in complex systems and how can improving flow help?

We've found there are a number of quite hard-edged things we need to do to get systems to work together effectively, including developing supportive financial incentives, information systems and service design. But there are also ‘softer’ things around leadership, culture and relationships which are absolutely crucial.

Some of the Health Foundation’s work through their Flow Cost Quality programme in Sheffield really helped us learn about how you can engage frontline staff in improving flow, and they got some great results.

The Wigan Deal is also particularly interesting. Wigan Council led a programme to reform care and wellbeing services. Appreciating that they were dealing with a complex system, they invested in training large numbers of staff in the principles of the deal, giving them permission to think differently and work in a different way with local residents. They’ve now developed a number of new care and support packages in the community that are more person-centred, much less expensive, and better meet residents’ needs. This has helped them identify over £8m in permanent revenue savings so far.

Wigan has now created an integrated care partnership organisation, bringing health and social care providers together. It’s definitely an area to watch.

The NHS in Scotland and Wales are also looking at improving whole system flow, so it’s been great to work with colleagues from across the border on this. Find out more in our forthcoming report, which will include case studies on their work, as well as examples from further afield.

Where should people start if they want to improve whole system flow?

People often just think about the patient journey. This is the right place to start, but on its own it doesn’t show a full picture. You also need to think about how the people working in each of the services along that patient journey will be equipped with the skills and support to bring about improvements. And if you want to have a wide and sustained impact you have to work at system level too. That’s about engaging senior leaders, so they understand how parts of the system need to work together and can tackle the big barriers they have the power to influence.

In our report we will set out a model for whole system flow, which shows that we need to be taking action on four different levels:

• Patient
• Frontline team
• Local health and social care economy
• The national system

Is current national policy supportive of improved whole system flow?

In England, we’re seeing a very healthy direction of travel on this through things like the sustainability and transformation planning framework, and the new single oversight framework from NHS Improvement and CQC. It’s all encouraging a more integrated system.

I have two big worries though. 

Firstly, the basic funding shortfall in the NHS, which is enormous. People are spending so much time firefighting. The second thing is social care funding, because while there is a squeeze on the NHS, it’s been much tighter for longer on local authorities. Social care can’t play their part if the money just isn’t there.

This sort of whole system transformation takes time. Is there enough patience around for this kind of approach, bearing in mind the NHS’s current financial situation and other big challenges?

Changing senior leadership is often seen as the solution in places with large deficits and big performance problems. That makes whole system transformation hard, as it disrupts relationships within the local community, and new leaders will naturally focus on quick fixes.

However, I am a relentless optimist. Places like Wigan, that have been allowed to build a constancy of purpose and consistency of leadership over a longer period of time, are really starting to prove that agencies can work together effectively with impactful results. Their results show that a two year timescale is long enough to start to demonstrate initial results.

What we need to do is drive that forward, and help people demonstrate their success. This will then become a model for work in other parts of the health and social care system.

This blog was originally published on The Health Foundation website. For the latest updates and activity on Whole System Flow, please follow #WholeSystemFlow on Twitter.

Safety Measuring & Monitoring Framework Workshop for Acute and Mental Health Members

Waseem Munir

The Advancing Quality Alliance (AQuA) would like to invite members working across Acute and Mental Health settings to an exciting workshop designed to improve patient safety.

Taking place on 19 January 2017 at the Imperial War Museum North, this one-day event forms part of our work on implementing the Safety Measuring & Monitoring Framework, alongside The Health Foundation.

Waseem Munir, Safety & Mortality Improvement Lead, said:

“Through our work alongside The Health Foundation, we’ve made amazing progress with several of our members in implementing the Framework. This event forms our next phase of work, in which we hope to widen the understanding and implantation of this across our members.

“At this event we’re looking forward to showcasing how our members across Acute and Mental health can use the Framework to think differently about safety, and how it can support them to provide a more holistic view for patients.”

The Safety Measuring & Monitoring Framework was drawn up by Professor Charles Vincent and colleagues from the Imperial College. It provides a platform for discussions on exactly what ‘safety’ means, how it can be best managed, and what needs to be considered when planning safety improvements.

Further information about the framework can be found on the HowSafeIsOurCare website.

For more information about or to book your place on the event, please visit the event website page.

Multimedia Recap - IHI Accelerated Patient Safety Programme

Earlier this month, the Institute for Healthcare Improvement (IHI) and AQuA welcomed over 50 delegates to an exciting four day event, designed to support organisations to develop and implement safer health and social care systems.

Taking place at Hotel Football, Manchester, our expert faculty guided delegates through the vital skills and knowledge needed to apply improvements to their individual roles and environments.

We've put together a multimedia recap of the best tweets, photos and videos from across the four days. For full information about the course, please visit www.AQuAnw.nhs.uk/IHI

AQuA Staff Latest to Join the Health Foundation Q Community

Advancing Quality Alliance (AQuA) staff are among the latest to join an exciting new community from The Health Foundation, designed to support continuous improvements in the quality of care for patients.

From left - AQuA staff Emma Walker, Amanda Huddleston, Liz Kanwar & Elizabeth Bradbury

Elizabeth Bradbury, Emma Walker, Amanda Huddleston, and Liz Kanwar were recently invited to join the Q Community, which brings together improvement practitioners from across healthcare management, commissioning, research and policy, to share ideas, skills and collaborate on improvement projects.

Speaking of the announcement, AQuA Chief Executive David Fillingham said:

“I’m delighted to see my colleagues join the Q community, alongside our Safety and Mortality Lead Andrea McGuinness, who was among the founding members.

“This is a real testament to their knowledge and experience in improving the health and quality of care, not just with our members in the North West, but also with our partners across the country and beyond.

“AQuA work closely with The Health Foundation across a number of initiatives, and I look forward to seeing our staff work alongside some of the leading individuals from across the health and social care landscape.”

Amanda Huddleston, Quality Improvement Lead for Safety & Mortality, said:

“Being invited by The Health Foundation to join the Q community is a real privilege. This is a great initiative to help grow and invest in quality improvement skills and expertise, and I’m looking forward to working with so many talented colleagues from across health and social care.”

Q is also supported by NHS Improvement, which was established in April to oversee and support NHS Trusts across England.

Staff join a community of 261 improvement experts from across the UK, and The Health Foundation hope to grow this number with further opportunities over the course of the next 12 months.

For more information about Q, please visit The Health Foundation website, or follow updates on Twitter @theQcommunity.

Expressions of Interest: AQuA Board Member Vacancies

The Advancing Quality Alliance (AQuA) are now seeking expressions of interest from experienced leaders to join the AQuA Board.

AQuA Chief Executive
David Fillingham

AQuA’s Board is made up of five Directors from AQuA membership across the North West, as well as four external independent Directors.

We are looking to appoint two new Directors from across AQuA membership, following the departure of Michael Gregory and Gary Doherty, who are stepping down after taking up new roles outside the region.

To help ensure a balance of expertise across our Board, we are particularly interested in applications from members with financial backgrounds, as well as those with experience across primary care and/or commissioning.

AQuA Chief Executive David Fillingham said:

“Our Board members bring a wealth of experience and perspectives to their role in setting and scrutinising AQuA’s work and overall vision.

“Michael and Gary have played a vital role in this during their time with us, and we wish them the best of luck with their new roles.

“We’re now looking for two new Directors, to help ensure we continue meet the changing needs of our members, and provide them with the best possible support we can to address their aims and challenges across health and social care.”

For more information about the role, please download the role description.

To apply, please send a short CV and covering letter, detailing why you would like to join the Board and how you meet the role’s requirements, to carole.maloney@srft.nhs.uk.

If you would like to arrange a further discussion about the role, please contact us on the email above, or call 0161 206 8938.

The deadline for applications is the end of Friday 4 November 2016.

Publication of Advancing Quality (AQ) 2015/16 Clinical Intervention Measure Results

Nadine Boczkowski,
AQ Programme Director

The Advancing Quality Alliance’s (AQuA) flagship reliability of care programme, Advancing Quality (AQ), has recently published 2015/16 clinical intervention measure results for its NHS member organisations across the North West.

The AQ programme, which was founded in 2008, supports partners to improve the consistency and quality of clinical care across a number of Clinical Focus Areas (CFAs) such as; Acute Kidney Injury, Hip and Knee Replacement, Sepsis and Early Intervention Psychosis.

For each of these areas, a set of core quality measures are identified and agreed by local clinical experts across the region, aligned to national standard guidelines. Working to ensure every eligible patient receives the standard care every time, according to each measure has proven to positively impact outcomes; not only helping to save lives but reduce re-admissions, complications and length of hospital stay.

Nadine Boczkowski, Director for the AQ Programme said:

“We know that people’s health in the North West is generally worse than the England average. In part this is due to the high levels of deprivation seen across the region compared to other areas of England. The AQ programme provides an approach to measure and evidence base the delivery of consistent quality practices in prevalent conditions across the North West.

“Although there has been decline in results in some areas, impacted by changes to measure definitions and thresholds, it is encouraging to see such positive and increasing results in critical areas such as sepsis, AMI and Diabetes . The ongoing commitment of member organisations and their staff to continuously improve and sustain the quality of clinical care is unfounded. 2015/16 continued to identify and spread the scope and scale of best practice by coming together as a collaborative community, sharing knowledge and learning to drive innovation and improvement.’’

The results, which are featured in full on www.advancingqualitynw.nhs.uk can be viewed by hospital or locality. Hospitals included in the published results are commissioned to participate in the programme as part of their local contracts. Some participating organisation’s data may not be published if they do not meet the data quality / completeness threshold for public reporting.

The Clinical Focus Areas included in the 2015/16 results are:

• Acute Kidney Injury
• Alcohol Related Liver Disease
• Chronic Obstructive Pulmonary Disease
• Dementia
• Diabetes 
• Heart Attack
• Heart Bypass
• Heart Failure
• Hip Fracture
• Hip or Knee Replacement Surgery
• Pneumonia
• Psychosis
• Sepsis

The Trusts with 2015/16 results being published today are:

Acute Trusts

• Aintree University Hospital NHS Foundation Trust
• Countess of Chester Hospital NHS Foundation Trust
• East Cheshire NHS Trust
• East Lancashire Hospitals NHS Trust
• Lancashire Teaching Hospitals NHS Foundation Trust
• Liverpool Heart and Chest Hospital NHS Foundation Trust
• Mid Cheshire Hospitals NHS Foundation Trust
• Pennine Acute Hospitals NHS Trust
• Royal Liverpool and Broadgreen University Hospitals NHS Trust
• Salford Royal NHS Foundation Trust
• Southport and Ormskirk Hospital NHS Trust
• St Helen’s and Knowsley Teaching Hospital NHS Trust
• Stockport NHS Foundation Trust
• Tameside Hospital NHS Foundation Trust
• University Hospitals of Morecambe Bay NHS Foundation Trust
• Warrington and Halton Hospitals NHS Foundation Trust
• Wirral University Teaching Hospital NHS Foundation Trust

Mental Health and Care Trusts

• 5 Boroughs Partnership NHS Foundation Trust
• Cheshire and Wirral Partnership NHS Foundation Trust
• Greater Manchester West Mental Health NHS Foundation Trust
• Lancashire Care NHS Foundation Trust
• Mersey Care NHS Foundation Trust
• Pennine Care NHS Foundation Trust

Independent sector providers

• BMI Healthcare - The Alexandra Hospital
• Ramsay Healthcare UK - Euxton Hall Hospital
• Ramsay Healthcare UK - Fulwood Hall Hospital
• Ramsay Healthcare UK - Renacres Hospital

Patients should be at centre of decisions about their care, says NICE

NICE - the National Institute for Health and Care Excellence - has joined forces with a wide range of leading health care organisations to help get patients more involved in decisions about their care.

SDM can improve relationships
between patients and clinicians

NICE, alongside NHS England, the General Medical Council, universities and other organisations have come together to form the ‘Shared Decision Making Collaborative’.

The collaborative hopes to promote a move away from ‘top-down’ medicine, towards a culture where clinicians and health care professionals work together with their patients to choose the most appropriate tests, treatments and support packages.

A set of intentions and commitments, which will help make shared decisions about care a reality in everyday clinical practice, has been set out by the collaborative in their consensus statement and action plan.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said:
“When health care professionals work together with patients, research shows that more appropriate decisions are made about their care. This can lead to improved patient safety, better patient satisfaction and more efficient use of resources.

“It’s important that a culture of shared decision making is embedded into clinical practice. NICE, through our collaboration with other leading health care organisations, will make sure that patient centred care becomes an everyday reality in our health service.”

Emma Walker, AQuA

Emma Walker, Portfolio Lead for Shared Decision Making at the Advancing Quality Alliance (AQuA), said:
“We are delighted to be involved with the National Shared Decision Making Consensus Statement. We are looking forward to working with a range of national partners to support the embedding of SDM into practice; drawing on AQuA’s experience of working with teams and organisations in practice and sharing a range of resources, tools and case studies that we have developed over the past 4 years.”

As part of the collaborative, NICE has pledged to:

• raise awareness and promote shared decision making at a local and national level through a series of case studies
• work with NHS England to ensure that shared decision making tools are embedded within guidance and pathways
• look at existing ways to measure shared decision making in clinical practice through its indicators programme
• advocate for research funding to look into the effectiveness and cost-effectiveness of shared decision making

Other leading health care bodies have also pledged their intentions and ambitions in the action plan. These include:

• NHS England to make sure that involving patients in decisions about their care is rooted in ongoing work programmes
• Healthwatch England to help support shared decision making on a local level
• The General Medical Council to incorporate shared decision making within its Generic professional capabilities framework, which sets out the knowledge, skills and behaviours which doctors need.

To find out more about NICE, please visit their website or follow them on Twitter @NICEComms.

AQuA Showcase Work on Shared Decision Making at NHS Expo 2016

Last week the Advancing Quality Alliance (AQuA), the North West’s leading organisation in quality improvement, joined thousands of colleagues from across the NHS, to showcase our work at the Health and Care Innovation Expo (NHS Expo) in Manchester.

Emma Walker, who leads our work on Shared Decision Making (SDM), joined partners at the NHS Right Care’s dedicated zone to lead presentations on AQuA’s work on SDM, as part of the national Ask 3 Questions campaign.

Speaking after the event, Emma said:

“Being at Expo with the Rightcare Team was an excellent opportunity not only to link with some amazing thought leaders on ‘Person and Community Centred Care’, of which Shared Decision Making and Self-Management Support (SMS) are aspects of this approach, but also to speak to a range of members and NHS colleagues about what AQuA can offer in support.

“I was delighted to give two presentations on our work. The first with Dr Alf Collins, Dr Al Mulley and Professor Matthew Cripps, looked at closing the Perception Gap in relation to SDM, with my section focusing on AQuA’s expertise and experience in putting the theory into practice.

“In the second we discussed some of our top tips for embedding SDM into practice, focusing on our experience from the past 5 years of working with teams to embed SDM and SMS at both team and organisational level.”

The aim of NHS Expo is to bring clinicians and managers from across the NHS to explore how to innovate and use technology to improve care and treatment to patients.

This year’s conference continued to explore the latest developments in health and care and the continued vision behind the NHS Five Year Forward View, with keynote speeches from NHS England boss Simon Stevens, Sir Bruce Keogh, and Health Secretary Jeremy Hunt.

The two-day event was a great opportunity for the AQuA team to talk about their work with members and wider colleagues across the NHS, and patients to discuss how SDM can help improve their relationships with clinicians and experience of care.

We look forward to attending NHS Expo once again in 2017. For more information about our work on Shared Decision Making, including individual case studies, please visit our website.

Advanced Improvement Practitioner - Applications Now Open

We are now welcoming applications from members to take part in the next round of our Advanced Improvement Practitioner (AIP) programme.

Running from November to May 2017, this in-depth course is designed to support senior staff to develop their skills and capabilities to lead and facilitate improvements across their organisations, and health and care systems.

The programme is ideal for members who are leading services or tasked with service transformation, including roles in quality, assurance, improvement, or even organisational development.

Participants will take part in modules on:

• Quality improvement theory and practice -  including key policy contexts, models and methodologies for improvement, systems thinking and organisational strategies, person-centred transformation, and developing theories for large-scale change
• Approaches and execution of change and engagement - models and principles for successful change, testing and implementation, improvement culture, how to build engagement, and managing and engaging people, communities and stakeholders
• The role of an improvement leader - covering the key habits of improvers, how to create conditions for learning and improvement, resilience, and system leadership

Full information about the programme is available in our information pack. 

To apply, please complete our application form and return to lucy.davies@srft.nhs.uk by 12pm on Wednesday 12 October.

Applicants must have the support of an Executive Sponsor or their line manager in order to apply.

If you would like a further discussion about the programme, please contact liz.twelves@srft.nhs.uk.

Learning to Improve - Getting the Right Kind of Practice - David Fillingham

How do we learn? Two examples spring to mind from my experiences this summer.

The first: my four year old grandson kicking a football in his back garden, being coached by his ever patient Dad to get more power and accuracy so that the ball landed in the back of the net at least some of the time. After an afternoon’s practice, some gentle praise and constructive feedback he was getting it between the posts more often than the England football team; maybe a ray of hope for the 2032 World Cup?

The second: it’s Olympic year and watching titans such as Andy Murray and Jessica Ennis-Hill turning in medal winning performances made me think of their own countless hours of diligent practice.

Practice is critical to learning. Yet it’s not necessarily true that all practice makes perfect. Recent research into the neurophysiology of learning has demonstrated that it requires the right kind of practice to get good at something – whether it’s kicking a ball, an Olympic event or improving healthcare. You need to practice not only frequently but also correctly. You need to practice with lots of supportive feedback so you learn from your mistakes and don’t hard-wire self-defeating habits into your attitudes and behaviours.

As it is for grandsons and Olympians, is it also true for health care systems? After two decades of striving to apply improvement method to the NHS are we getting any better at it? And what constructive feedback might help us to improve the way we improve? My own perspective is that of someone who has made many mistakes and not always sufficiently learned from them.

We have had a succession of national bodies leading improvement in the NHS in England: the NHS Modernisation Agency, then the NHS Institute for Innovation and Improvement, followed by NHS Improving Quality, and now, after the coming together of Monitor and the Trust Development Authority, NHS Improvement. I was privileged to lead the first of those bodies, the NHS Modernisation Agency, from 2001 to 2004 and I have worked closely in support of each of the successor organisations.

The NHS has never been more in need of effective national leadership for improvement than it is right now. Overwhelming service and financial pressures are placing a tremendous strain on front line staff and in many places standards of care are beginning to slip.

The formation of NHS Improvement gives me hope. Its new leadership, Ed Smith (Chair), and Jim Mackey (Chief Executive), are on record as saying that they want to see a step increase in investment in improvement method as a response to the challenges we face.

So, if we are to go through another cycle of ‘practice’ – with a new national improvement strategy due in the Autumn of 2016 – how can we make sure it is the ‘right kind of practice’? What sort of reflection might help us to avoid some of the mistakes of the past?

Here are four suggestions based on my own experience. Why not use the comments function below to say what your list would look like?

1. The NHS Modernisation Agency was successful at engaging clinicians in its work but it was much less effective at engaging boards and senior leaders. Investment in strengthening the ability of NHS boards’ to lead quality and safety improvement should be given the highest priority. Without it improvement won’t take hold in a sustainable way.
2. The Department of Health, NHS and other national bodies may provide funding and set overall direction, but it is NHS organisations and front line staff who are the real ‘customer’ for improvement support. We need to generate buy in and give all NHS organisations a genuine stake in being part of an ‘improvement movement’.
3. The wicked problems we face can’t be solved by organisations working in isolation. The ‘Sustainability and Transformation Plans’ in England create an ideal opportunity to develop improvement capability across whole systems of care not just in institutions.
4. If national improvement organisations attempt to deliver all improvement support themselves they pull talented people with good improvement experience away from front line delivery. I’d like to see NHS Improvement keep its core team relatively small and for them to work through a variety of regionally based partners. The aim should be to keep improvement practitioners close to the action, and to network them together in a vibrant learning community. 

The UK Improvement Alliance is made up of organisations whose mission it is to improve health and the quality of healthcare and who are seeking to learn and apply the lessons of the past. We aim to be a strong partner to NHS Improvement in England and its equivalents in Scotland, Wales and Northern Ireland.

Meeting the extraordinary challenges which the NHS faces is a daunting task. To succeed we’ll need to be on top of our game. Let’s commit ourselves to the ‘right kind of practice’ that which is imbued with the spirit of humility, reflection and learning.

This blog was orignally published by the UK Improvement Alliance (UKIA). To find out more about their work, please visit their website, or follow them on Twitter @theUKIA. 

iNetwork Innovation Awards 2016 Now Open for Nominations

The Advancing Quality Alliance (AQuA) is encouraging members to enter the iNetwork’s Innovation Awards, by nominating their projects or services for the dedicated Health Award.

Celebrating the best in public sector innovation, the awards are seeking entries that have designed or delivered exceptional projects or services to patients and service users.

Helen Kilgannon, Head of System Transformation, said:

“Working with our members, we see first-hand some of the brilliant improvements and innovations made by staff on a daily basis across teams, projects and services.

“As the North West partner for iNetwork, we want see as many AQuA members as possible to celebrate their efforts by nominating themselves for the awards.

“With this year’s awards boasting a brand new category for Health, this is a great recognition of their success and achievements in improving outcomes and services for patients.”

Other categories open to members include:

• ·         Outstanding Contribution Award
• ·         Innovative Access to Public Services (IAPS)
• ·         Effective Service Redesign and Reform
• ·         Excellence in Information Sharing and Security
• ·         Connected Procurement
• ·         iStandUK (electronic data standards)
• ·         Supplier Excellence

iNetwork help support public sector organisations to improve local services, by encouraging collaboration and sharing best practise. Members can access their events and training for free through AQuA membership.

Entries for nominations close on Tuesday 27 September before being put out to a public vote on 30 September.

Nominations with the most votes will then be reviewed by a judging panel and announced in October, with finalists invited to attend the awards ceremony and dinner at iNetwork’s winter conference on 16 November in Manchester.

Entries will be judged on their evidence of making an impact, innovative nature of the work, and potential to be adopted by others.

Members can submit their nominations here, or visit the iNetwork website for further information on individual categories.

For more information about iNetwork, including events and training, please visit the iNetwork website. 

Blog: How do we intentionally develop the integrated workforce? - Elizabeth Bradbury

Elizabeth Bradbury, Director

This blog is about intentionality. We intend to improve integrated care for local people – and improvement can be anywhere on the spectrum of small local change, to radical new models of care to transform population health outcomes – and we intend to invest time, energy and resources in doing this.

But just how intentional are we about equipping our combined health and care workforce with the knowledge and skills to lead and implement transformational change? Our experience at the Advancing Quality Alliance (AQuA) is that intentionality varies across the UK, and global delegates at this year’s International Congress for Integrated Care in Barcelona had a similar view.

AQuA's Change Model for Complex Systems

In Constructive Comfort The Health Foundation emphasise the importance of investment in workforce skills including leadership, change management and quality improvement in order to accelerate and build the system-wide capability to sustain large scale change. In recent years inspirational stories have illustrated intentional skill-building as part of transformation plans in NHS Highland, South Central Foundation in Alaska, Kaiser Permanente, USA and the Canterbury system in New Zealand to name just a few. So the big question is…how do you get started?

Intentionality: getting started

If you’ve asked yourself how intentional your approach is to equipping the local workforce with the capability to drive change, and the answer is ‘not very’ or ‘there’s scope to improve’, I offer five questions to help frame your discussion:

1. What skills and knowledge do you require to implement integrated care at scale?
2. At what scale is the skill and knowledge needed and how can this be achieved locally?
3. What change models and improvement methods are suitable for your complex environment?
4. What resources are available to support implementation of the changes in the local strategic plan? This includes the role of local leadership, improvement and innovation agencies.
5. How can multiple simultaneous priority work streams be co-ordinated and the learning spread?

Ideas on how to intentionally build workforce capability to underpin integration

AQuA recently shared its intentional approach to large-scale workforce capability building in Leading in Complex Systems: 10 learning points for developing multi-agency leadership teams. We advocate a change model (see diagram) that blends approaches to make best use of staff time and resources, and underpin this with a facilitated peer learning community and team coaching.

We condensed learning from our work with local health and care systems across the UK into ten points with the aim of helping others design programmes for system leaders:

Design and Planning

• Blend theory and methodology
• Intentionally design system leadership support into transformation programmes
• Model collaboration in the provision of system leadership support delivery
• Teams learn to lead together
• Develop distributed system leadership capability
• Sustain support to leaders
• Tailor support for senior and executive leaders
  

Skills in the wider workforce

• Support relationship development at all levels
• Embed improvement expertise in leadership teams

Enablers

• Think measurement – what is feasible?

We’d really like to hear your thoughts on this topic, and invite you to share examples of how you are intentionally developing integrated workforce capability via Twitter @IFICinfo or #ICIC16.

This blog was originally published on by the International Foundation for Integrated Care IFIC. To find out more about the Foundation, please visit their website.

Elizabeth Bradbury is a Director at AQuA and Board member for IFIC from 2014-16.

AQ Listening Exercise: Share your views on the Advancing Quality (AQ) programme

Over the next three months we’re asking members to share their views on the Advancing Quality (AQ) programme; AQuAs flagship reliability of care offer.

After almost a decade of successful collaboration with North West healthcare organisations, AQ has delivered demonstrable improvements in the quality, reliability and outcomes of clinical care.

To ensure members continue to gain the most value from an effective reliability offer we would like members to help shape our 2017-18 priorities for AQ by taking part in our online survey, a short phonecall or face-to-face meeting.

Nadine Boczkowski, AQuA Programme Director for AQ & Analytics said: “Your valuable input into the listening exercise will help us to shape services and develop new offers tailored to your needs, offering support in the right areas to drive up the quality and safety of care and deliver consistently high standards.”

The Listening Exercise is open to staff across all members currently participating in AQ, as well as those who have previously taken part in the programme (please note AQuA and AQ membership are separate).

The short survey should only take approximately 10 minutes to complete, and you can take part by following the link below.

Click here to take the survey

Alternatively, if you would like to arrange a short meeting or telephone interview then please email: advancing.quality@nhs.net to arrange.

For more information about the Listening Exercise, you can download the flyer. If you would like to find out more about Advancing Quality, please visit the website.

Please note the online survey will close for feedback on Friday 30th September.

Expression of Interest: Shared Decision Making Mini Collaborative Programme

We are currently seeking expressions of interest from members to participate in a new mini collaborative programme, as part of our ongoing Shared Decision Making and Self-Management Support offers.

We will be holding an initial half-day sharing and learning event on Wednesday 9 November at our offices in Sale, and will encourage teams to continue working together throughout the programme. Applications are open to all clinical teams from across our member organisations.

Increasing collaboration between patients and practitioners forms a crucial element of the NHS Five Year Forward View, and both Shared Decision Making and Self-Management Support feature prominently in the NHS Operating Framework. This programme will provide support over a six month period to enable teams to embed these practices in their services.

Fully involving patients in the decisions about their own care and treatment has also been shown to improve outcomes, increase patient satisfaction, and make more effective use of NHS resources.

Further information about the programme can be found in the application form, or by downloading the SDM programme flyer.

The deadline for applications is 12pm Friday 9 September, and completed forms should be returned to Hannah.Towler-Lord@srft.nhs.uk.

Members will be contacted with the result of their application by Friday 16 September.

If you would like a further discussion about this opportunity, please contact either Brook Howells on Brook.Howells@srft.nhs.uk, or Rachel Bryers on Rachel.Bryers@srft.nhs.uk.

Blog: REsTRAIN YOURSELF - Implementing a restraint reduction approach in mental health - Paul Greenwood

After a fantastic final event last month for the close of The Health Foundation funded REsTRAIN YOURSELF project, I felt it was a great opportunity to share with you some of my thoughts from working on programme.

The aim of REsTRAIN YOURSELF was to reduce physical restraint in mental health inpatient settings through an evidence-based approach.

Despite only meant as a ‘last resort’, physical restraint is a coercive intervention that is commonly used in mental health services. There have been increasing serious concerns over a number of years about its overuse and significant adverse effects on patients.

Over the course of this two-year programme, I’ve had the chance to work closely with a number of teams in ward environments across the North West, to offer training and support the implementation of the restraint reduction approach.

Members who have participated in the programme include:

• 5 Boroughs Partnership NHS Foundation Trust
• Cheshire and Wirral Partnership NHS Foundation Trust
• Cumbria Partnership NHS Foundation Trust
• Lancashire Care NHS Foundation Trust
• Manchester Mental Health and Social Care NHS Trust
• Mersey Care NHS Foundation Trust
• Pennine Care Foundation Trust

Having the opportunity to work alongside staff has been such a positive fulfilling experience. Having spent a number of years as a mental health nurse myself, it wasn’t easy for me to stand back and observe things on extremely busy acute mental health wards; especially when the nurse in me wants to help and get involve

From this work over the past two years we now have a strong body of evidence on restraint reductions, and here are some of my findings:

Teams

The teams faced many challenges to enable change to occur: from juggling with staffing levels, high levels of acutely unwell patients, and always struggling to find a bed. Both staff and patients have really engaged with the project and implemented a range of approaches to dealing with violence on the wards.

Staff focus on trauma-informed care has shifted from a task-orientated ‘them and us’ dynamic, to more reflective, person-centred approach to patient care.

Having been based on wards on a weekly basis, engaging with staff during those moments of violence and aggression, and trying to help them approach situations differently has been a real challenge.

Often, the adrenaline has kicked in and it is hard for staff to pull back from rushing to restrain rather than de-escalate.

However, one of the biggest efforts by teams has been their work to improve care around self-harm, and working with patients, rather than trying to control them with restraint.

This is a very sensitive area of practice in mental health which staff do struggle with. But coaching has allowed them to be more open and stand back, take their time, and work with the patient, to see better outcomes for patients and their team.

This approach has also seen better communication in shift handovers, more formal staff and patient debriefs, more meaningful activities for patients, and the development of sensory rooms.

Patients 

Working with patients directly we also aimed to develop individual safety plans; a self-management tool that helps both staff and patients focus on what triggers violence, and strategies to help calm and de-escalate. After testing these through the Plan, Do, Study, Act (PDSA) process, these plans have been a huge positive for both parties.

To help improve communication between staff and patients, we also developed weather symbols to use in patient community meetings. This helped them to talk about violent incidents and the general mood of the ward in a safe managed environment, using language that all can connect with (Sunny, cloudy and stormy days).

Patients now comment upon their discharge about how they enjoyed the sunny days on the ward; reinforcing to the teams the importance of focusing on working with patients to make sure there are many sunny days on the ward.

A consistent theme for staff is how they now focus more on the potential impact of restraint on patients, rather than the technique, and how this can avoid trauma to both patients and their colleagues. For me, this is a big cultural shift, which I believe over time will improve team cohesiveness and ultimately lead to safer patient care.

Throughout the two years, all the wards we have worked with have made great progress 

and have seen noticeable reductions in restraint. With The Health Foundation-funded programme now at an end, we hope to continue to build on this learning as we commence the AQuA Restraint Reduction programme throughout 2016/17.

I’m really looking forward to working with many of the Trusts who participated in REsTRAIN YOURSELF, and it’s great to also welcome Greater Manchester West NHS Foundation Trust on board for our new programme.

In October we’ll also be sharing the final evaluation report for REsTRAIN YOURSELF will be published by The Health Foundation, which will be available on our website and other communications.

Paul Greenwood is AQuA’s Improvement Advisor for Mental Health. You can contact him on paul.greenwood@srft.nhs.uk, or follow him on Twitter @PaulG_AQuA.