Thursday, February 25, 2016

Report from Commission for Acute Adult Psychiatric Care Peer Reviewed by AQuA

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Julie Cullen, Head of Mental Health
Last month the Royal College of Psychiatrists' Commission for Acute Adult Psychiatric Care published their recommendations for improvements in adult psychiatric care.

The report, 'Old Problems, New Solutions: Improving acute psychiatric care for adults in England' was written by Lord Nigel Crisp, and calls for urgent action to be taken to reduce harm and improve acute care for adults.

Peer-reviewed by AQuA's Head of Mental Health, Julie Cullen, the report also highlights our work with members in reducing incidences of self-harm across the North West.

You can read the full report here as well as find more information about the work of the Commission on their website.

Tuesday, February 16, 2016

BLOG: Hacking the NHS

By Cathy Sloan, Improvement Advisor, Advancing Quality Alliance (AQuA)


Cathy Sloan, Improvement Advisor
What the heck is a hackathon you might ask? I did too a couple of weeks ago when I volunteered for Hackathon Facilitator Training in London with NHS England's Sustainable Development Team ahead of the NHS Transformathon. I'd heard the odd thing about Hacks being used in healthcare and was intrigued to find out what all the fuss was about.
For those who don't know, Hacks started in the IT as a way of bringing together programmers and developers to intensively collaborate on a project. These marathon sessions generally last 24 hours (fuelled by vast quantities of pizza, energy and beer!) as open, creative events with no ideas off the table. I was particularly interested in what facilitation skills are needed to run a good Hack and how this differs from facilitating regular health improvement event.

Hackathons are increasingly being used outside IT to bring a diverse range of people together to develop ideas, improve and solve issues in a fast-paced, creative environment. However they're still typically structured around a rough theme, e.g. improving flow, and are broken down into a number of smaller sprints:

  • Sprint 1: Describe the ideal situation - how will you know when you're there? What will you see, feel, know and do?
  • Sprint 2: What gets in the way now?
  • Sprint 3: Mini group hacks to creatively achieve the ideal, gather ideas, suggestions, and creative solutions
  • Sprint 4: Clustering the mini hacks to build these ideas, aggregate thinking and develop creative ways forward
For the NHS Transformathon NHS South Cheshire and Vale Royal CCGs held their own 24 hour Hackathon across two days. This examined the problems with their current health and care model as they look to shift care from hospitals to the community, particularly with moving money around the system whilst maintaining performance.

On day one attendees were given a brief outline of these issues and were asked to form teams to devise potential solutions. Feedback from the day was really positive and it was great to see such a diverse mix of people present; from service users, local industry (including luxury car manufacturer Bentley), the fire service, as well as people from across the whole of the NHS and social services. Whilst many were sceptical to start off with, most were quickly won over; with a number of key ideas emerging and commenting on how much energy there was in the room!


On day two I was ready to put my newly-acquired facilitator skills to use and was raring to go for an early start (that first cup of tea was much needed), as were a number of participants who had stayed over at the venue. As things got going teams were asked to pitch ideas from day one to a dragons’ den-style panel. The winning pitch would then be supported by the North West Coast Academic Health Science Network (NWC AHSN) to take the idea forward.


Among my teammates it was apparent there were a number of local and national system issues that were causing them problems, making it tough to ready a pitch against the clock. Whilst a few more people on the team without a vested interest might have provided a bit more perspective, reflecting on my role as facilitator I probably should have recognised this (and will do on my next Hack).


With a bit of a push and a quick overview of the 30, 60, 90 methodology, the team quickly developed a pitch which was ably delivered by one of our GP teammates. As the whole Hack came together to pitch, this was a really interesting process and was taken very seriously. A total of 4 pitches were delivered to the panel of senior leaders. After their lunchtime deliberations, to our amazement (given the speed we'd pulled together our pitch) our team won!


Looking back at my Hathathon experience, particularly the Central Cheshire Hack, this was such a good event full of energy and enthusiasm. I was really surprised how different the pitches were; from a life course wellbeing app encouraging and enabling self-management, to a collaborative approach to medicines management and budgeting.


The hack process definitely encourages people to think creatively and collaborate to solve problems. Speaking to other participants after the event, one of the things they seemed to value the most was having the time away from the day-to-day to be able to think and create with new people. One attendee in particular loved how some of the non-NHS people were also able to hold a mirror up to existing systems and processes and really challenge the way things are done in the NHS.


I really enjoyed my first experiences of a hack and am keen to give it another go. They bring a real spark of creativity by doing things differently and may well bring some of the different solutions needed in the NHS.


You can watch the full video from NHS South Cheshire & Vale Royal’s Hack here.


Wednesday, February 3, 2016

BLOG: A&E Crisis and Patient Flow - Why are we waiting?

By David Fillingham, Chief Executive, Advancing Quality Alliance (AQuA)

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David Fillingham, Chief Executive
Accident and Emergency Departments are busy places. This winter in particular has been a difficult one for many hospitals, with queues of ambulances forming outside at peak periods and lengthening waits for patients to be treated or admitted to a bed.  Indeed, across England as a whole the performance of Emergency Departments has not struggled so much for over a decade.  The reasons for this are complicated. 

Anyone who has themselves needed emergency care, or has had a relative cared for, will know that it is a highly complex system. GPs, ambulance services, hospitals, community services, care homes, social care, and in particular mental health services, all have a vital part to play.  If the way they work together isn't carefully coordinated, then it’s all too easy for the system to become “blocked”.

Bottlenecks develop so that patients have long waits to see a GP, or to be admitted to hospital, or to be discharged from hospital, or to receive the kind of the care they need to live independently in the community.

The evidence shows that problems in achieving an effective and smooth flow of patients across the whole system can have very damaging consequences. The experience of the patients and staff working in the system can be a poor one.  The outcomes of care are worse, the costs of running the system can be much higher, and in the worst cases there could be even be deaths which could have been avoided.

Work on improving patient flow has tended to focus inside hospitals, and mainly on emergency care, particularly the role of A&E Departments and Admissions Units. AQuA believes that to bring about large and sustainable benefits we need to widen our thinking to consider all aspects of care and how they can be connected together more effectively. 

AQuA is currently carrying out a “scoping review” to identify how we can best support our members to improve whole system patient flow during 2016/17. We are working closely on this with other organisations, such as the Emergency Care Intensive Support Team and the North West Utilisation Management Team, and are also receiving support from the Health Foundation.

We will be looking at the latest evidence base, considering best practice elsewhere, and seeking to identify change principles and interventions that will improve the flow of patients across the whole health and social care system.

We are keen to hear the ideas and suggestions of AQuA members, and in particular to know about any initiatives which are already seeking to address this difficult challenge.

Please do get in touch with your thoughts and comments via aqua@srft.nhs.uk or tweet us @AQuA_NHS.