The Real Birth Online Workshop: addressing the barriers to effective antenatal education (#3043)

Creation
Draft
Initial
Detailed
Accepted
Adoption
Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
Our online workshop helps women from all backgrounds in all demographic areas to access positive, factual information to support their birth choices using evidence-based information that can be updated as and when new guidance is released.
Overview of Innovation:
The Real Birth Company’s mission statements are ‘to provide relevant, up to date, evidence based antenatal information that is delivered with a positive attitude’ and ‘to impart our knowledge with confidence to empower women and their birth partners at this very special time’.

We have achieved this with our RCM accredited antenatal education training programme that has been developed into an online e-learning antenatal resource for women birthing in the UK & is available in several languages. This e-learning resource is a birth physiology workshop full of important information that supports UK practice & enables women to understand the reasons behind their care, whilst supporting them to make informed choices in labour.


Antenatal education is essential to helping women form opinions & make choices in regard to their pregnancy & birth. There are various types of antenatal education. Hospital accessible antenatal education is dependant on resources, demographics & availability of staff to name a few. Lots of these classes use traditional methods of teaching with limited time to discuss at length the physiology.

The Real Birth online workshop is easily updated & uses evidence-based information from NICE, WHO, RCM, RCOG & others. It is holistic, culturally sensitive & can be accessed from anywhere by computer, tablet or mobile phone.

The innovation of creating a multi-lingual online e-learning workshop came from the positive birth results that were consistent with women & their partners who had attended a specifically designed positive birth workshop.

The workshop was created using techniques that help graduate students revise for exams, this learning technique has been integrated into the imparting of positive birth physiology. The use of non-threatening language & positive birth information helps to normalise birth & reduce fear. When fear is reduced in labour the benefits for both mother & baby are both psychological & physiological.

Barriers to effective antenatal education can include:
  • time pressures for antenatal classes
  • finding midwives who feel comfortable giving antenatal education
  • update & training costs
  • availability of classes
  • limited spaces for face to face classes
  • cost of interpreting services/availability of interpreters
  • birth terminology used
  • women being unable to attend for social or demographic reasons
Our online workshop works to address these barriers to help women from all backgrounds in all demographic areas to access positive, factual information.

Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
Similar Content5
Overview summary:
There is a wide disparity between the emphasis on breastfeeding in culture and the support for mothers attempting to breastfeed for the first time.
 
Funding for Health Visitor run baby groups & drop-ins throughout the UK have been cut in past 2 years due to budget constraints, leading to increasing social isolation of new mothers.
 
Young mothers in particular may not have ever encountered another breastfeeding mother, given that the last generation was largely encouraged to bottle-feed.
Challenge identified and actions taken :
Our target - Mothers who may not have access to current research and/or may be unduly influenced by cultural barriers to breastfeeding.
 
c 700,000 newborn babies born in UK each year. A high proportion will be to new mothers with no experience or understanding of breastfeeding.
 
Funded by ACE from 2017-18, ‘Holding Time’ a series of photographic portraits of mothers breastfeeding was shown at Fabrica Gallery, ONCA Gallery and Royal Brompton Hospital in London, in print, video and installation formats, accompanied by talks and workshops. ONCA featured a Breastfeeding Hub where comfortable seating encouraged mothers to stay longer and talk with other mothers.


 
A project website ( www.holdingtime.org), and YouTube channel promoted 5 min Podcast interviews with participating mothers from the photographic series. A BLOG written by Dr Newell explored issues surrounding the cultural barriers to breastfeeding. Facebook promotions and postcard campaigns at GP surgeries drew visitors to the website and exhibitions.
Impacts / outcomes: 
Findings / Outcomes:
  1. Exhibition audience was more mixed in gender and age than anticipated
  2. Workshops and talks were attended by many academic, medical and health researchers/practitioners
  3. The ‘Holding Time’ slideshow drew audience to the Youtube channel
  4. YouTube recommendations helped to attract many thousands of visitors to the channel.
  5. The Breastfeeding Hub resulted in longer visits to exhibition
  6. Interviews/talks/workshops revealed structural barriers within health practice where policy and practice are not meeting.
Exhibitions x 10 days/ 435 visitors
Website: 1,000 users/ +67%
Talks x 2: 70 attendees
Facebook fans 303 posts/+91 fans/ +695 engagement
YouTube Analytics: 36,400 Views/ +6,710/60 Likes/+179 Subscribers
Which local or national clinical or policy priorities does this innovation address:
Public Health England - Health matters: giving every child the best start in life; Public Health England Commissioning Infant Feeding Guidance; NHS Start4Life; UNICEF; Every child matters
Supporting quote for the innovation from key stakeholders:
National Strategy:
Include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact. This includes: obesity, diabetes and cancer reduction; emotional attachment and subsequent school readiness; improved maternal and child mental health; wellbeing in the workplace; and environmental sustainability.

Priorities
Good practice guidance identifies that breast milk is considered the physiological norm of nutrition for infants and can provide wider benefits to further promote the bond between mother and baby. Some of the key evidence based benefits of breastfeeding are summarised below:

Baby
• Children who are breastfed for longer periods have lower infectious morbidity (including diarrhoea and vomiting) and lower risk of infant mortality
• Less risk of constipation
• Reduced likelihood of becoming obese or developing type 2 diabetes or other obesity related conditions later in life

Mother
• Reduced risk of developing breast and ovarian cancer
• Reduced risk of diabetes
• Develops stronger relationship bonds through skin touch between mother and baby
• It is a free resource and readily available
To gain the maximum benefits of breastfeeding the World Health Organization recommends an exclusive breastfeeding period for the first six months of life and continuing to breastfeed for at least two years.

West Midlands
• Breastfeeding initiation is significantly lower in the West Midlands compared to the England averages between 2010 and 2015
• Initiation rates between Local Authorities within West Midlands range from 48% to 77% out of all maternities during 2014/15

Key risks of lower breastfeeding uptake:
• Younger age of mother with those aged under 20 years the least likely to breastfeed.
• Mothers who are from a white ethnic background.
• Mothers who have never worked or employed in a routine or manual occupation (classified as lower socio-economic status).
• Younger age left full time education with mothers who left at or before 16 years least likely to breastfeed.
• Mothers in the most deprived quintile of society (classified as being in quintile 1 of the Index of Multiple Deprivation IMD calculation).

Patterns and associations of breastfeeding prevalence:
• Breastfeeding prevalence rates in England in 2010 were higher for each risk factor group compared to 2005 data for each reported period from time of birth to nine months.
• Breastfeeding prevalence dropped at an increased rate after two weeks from birth for all key risk indicator groups. At six months, roughly one third of mothers were still breastfeeding.
• The largest difference in breastfeeding prevalence is associated with age of the mother followed by age the mother left full time education and then socio-economic status and deprivation respectively.

Awareness of health benefits of breastfeeding:
• An inverse association is demonstrated between awareness of the health benefits of breastfeeding and younger age of mother, mothers classified as Asian or black, those in a lower socio-economic status and mothers who were intending to only formula feed or who had not yet made a decision.
• Mothers from a white ethnic background reported the most awareness but are the highest ethnic risk group to not breastfeed.

Information sharing:
• The groups least likely to receive information about the health benefits of breastfeeding include mothers aged under 20 years and those who have never worked.
• There is no significant difference between ethnicity and receipt of breastfeeding information.
• For all groups there are a low proportion of women who reported attending antenatal classes where infant feeding was discussed.

Please see https://www.youtube.com/watch?v=DjCeenfwBxQ
A film made by rb&hArts – the Charitable trust an partner at Royal Brompton Hospital.
Plans for the future:
Proposal: 
A three year campaign of exhibitions/web content creation/printed book to stimulate and curate conversations around breastfeeding between the public and medical professions addressing the discrepancy between research and practice in order to inform research communities and the general public.

Outputs:
  • 10 new exhibitions of Holding Time at community, health and art centres, birthing units and hospitals across the country.
  • 10 x Postcard campaigns of 1000- 1500 (e.g. 25 cards x 50 surgeries per exhibition) leading public to online content
  • 20 mother stories Podcasts
  • Expansion of Mother Stories section of website
  • Transcripts/closed caption subtitles for all Podcasts
  • 20 guest BLOG posts: Academics/medical researchers to write on subjects raised by women in workshops and interviews e.g. the struggle to feed in the early stages, the establishment of lactation, post partum care, expressing, breastfeeding in public, looking at how current research can help parents make informed choices in these areas.
  • 10 Podcasts with Academics/medical researchers/health professionals
  •  Facebook Q&A sessions with guest researchers/practitioners and participating mothers
  • Breastfeeding Hubs/workshops/talks where possible/appropriate delivered by Dr Lucila Newell and Lisa Creagh
  • Facebook/Instagram channels to promote the above.
A limited edition book featuring Holding Time with an introduction by Dr Debra Bick, essay by Ruth Stirton/Lucila Newell/Erin Barnett. Schilt publishers have confirmed they will produce and distribute this book across Europe and North America using their existing channels.
Tips for adoption:
Any Community health space can host the exhibition, promote the exhibition using the tested method of GPs surgeries locally and linking to the online content. They can also suggest researchers and mothers to interview or write BLOG posts. I have applied to Wellcome for a budget to cover ten exhibitions in areas with low breastfeeding rates nationally.
Contact for further information:
For more information please contact Lisa Creagh
Project Web: www.holdingtime.org
Artist site: www.lisacreagh.com
Email: lccreagh@icloud.com
Tel: 07816 577140
See additional 'Links' document attached
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Innovation 'Elevator Pitch':
Good quality maternity information is essential to provide safe care. We will evaluate the Mother’s Information Application (MiApp), a personalised electronic, fully interoperable version of the Perinatal Institute’s hand-held notes. 
Overview of Innovation:
Currently hand-held paper notes are the primary record for maternity. The Perinatal Institute’s maternity notes have become the standard, used in approx 60% of pregnancies in England -https://www.perinatal.org.uk/News/Perinatal_Newsletter_Spring_2016.pdf

The Perinatal Institute have been successful in combining the utility of a standardised, evidence based record for clinicians, with details on the care the mother should expect at the various stages of pregnancy, outlining her choices as well as essential information and key messages to ensure best possible maternal engagement in her care.

The hand-held notes are the master record allowing complete inter-operability with all care providers, but require double or triple entry of data to ensure electronic systems are up to date. With increasing development of information systems, electronic records are starting to become the principal maternity record, which takes information and control away from the mother. Instead they carry either:
  • Print outs of certain aspects of care (being paper heavy and complicated to navigate) or
  • Minimal information in the form of a summary ‘co-op card’ or appointment card.
This results in a lack of routine pregnancy information being given to women, an absence of specific information available to the mother about her own pregnancy, and a lack of inter- operability between the systems used at different facilities meaning other care providers do not have access to the mother’s record if required.
The Mother’s Information Application (MiApp) is a personalised, electronic, fully interoperable version of the Perinatal Institute’s hand-held notes available on smart phones, tablets or desktop computers. It returns control of the health record to the mother, and allows her to make her maternity healthcare record available to her designated care providers, directly or through integration with local information systems.
MiApp is able to:
  • Provide expectant and new mothers with relevant information about their pregnancy, explaining what to expect at each stage and listing options to allow informed choices.
  • Act as the master document for recording and updating details about the care received,
    including results of screening tests, investigations, risk assessments, referrals, and management plans.
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
MiApp is able to:
  • Provide expectant and new mothers with relevant information about their pregnancy, explaining what to expect at each stage and listing options to allow informed choices.
  • Act as the master document for recording and updating details about the care received, including results of screening tests, investigations, risk assessments, referrals, and management plans.
  • Give mothers control over their data with complete national inter-operability (using industry standard HL7 messaging) allowing her various care providers to access details and include additional information as appropriate.
  • Avoid the need for double entry of data, reducing the administrative burden on clinicians and administrators and thus increasing time for clinical care.
  • Provide high quality data for clinical care as well as for secondary uses, and support evidence based commissioning, service planning and performance monitoring.
  • Increased cost savings because of reduced double entry of data, reduced clinical coding time, reduced litigation costs and reduced clinical time spent on record keeping (a separate cost benefit analysis will be provided).
  • Integrated messaging system between patients and clinicians as well as between clinicians, which reduces unnecessary appointments and enhances quality of care.
Online Discussion Rating
5.86 (7 ratings)
Initial Review Rating
3.80 (1 ratings)
Benefit to WM population:
There are a number of health and weatlth benefits to the West Midlands population, including:
  • Good quality data produced from MiApp will support commissioners to tailor services according to local needs.
  • Individual NHS Trusts can use the data produced to benchmark their services and therefore recognise areas for further improvement. 
  • Clinical risks are greatly recuded through the interoperability, as the West Midlands population will be able to move between healthcare providers with a fully accessible, complete healthcare record.
  • In recognition of the diverse West Midlands population, the record incorporates translation into 18 languages along with information in video format. The aim is that families from all backgrounds and of all capabilities have access to information that they can understand and use appropriately to improve their health.
  • MiApp enables access to the wider health and social care system by highlighting services that are available to all, empoweing women to take control of their own health.
  • Promotes standardised care for the West Midlands population in line with national guidelines.

 
Current and planned activity: 
The Perinatal Institute is a national not-for-profit organisation set up to enhance the safety and quality of maternity care. It is a qualified provider of
maternity support services, including education and training in standardised maternity records, fetal growth assessment and perinatal audit.

The Perinatal Institute has won numerous national awards including most recently the 2016 Queens Award for Enterprise, the 2015 BMJ Award for clinical leaership and the 2015 Patient Safety Award for IT and Technology

The conduct of a quantitative and qualitative evaluation of the MiApp system in comparison to current systems.
What is the intellectual property status of your innovation?:
The intellectual property belongs to the Perinatal Institute
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
Co-Authors:
Regional Scalability:
The service can be scaled rapidly and efficiently across the region. Our business case means it is likely to be cost-efficent in a very short space of time making it an attractive proposition for commissioners.
 
A robust evaluation of MiApp will establish the feasibility of using this type of solution and provide a measure of it’s transferability to maternity care across the region and ultimately the UK. 

 
Measures:
The project will consist of a quantitative and qualitative evaluation of the MiApp system in comparison to current systems. This evaluation includes a:
  1. Structured survey and semi-structured interviews to explore existing maternity systems with expectant mothers and clinicians.
  2. Structured survey and semi-structured interviews to explore the experience of expectant mothers and clinicians using MiApp. This will include using the principles of user testing to evaluate the mother’s ability to retain and assimilate information held on MiApp.
  3. Economic evaluation of MiApp in relation to time spent on administration in comparison to current systems
Key Deliverables
  • Report on current range of systems available in the West Midlands and their perceived effectiveness in providing mothers and clinicians the information needed for safe maternity care
  • Qualitative and quantitative assessment of user experience of current systems and MiApp.
  • Cost benefit analysis with implications for service delivery in the West Midlands and nationally
  • MiApp is in the process of being rolled out at two sites in the UK but to date there has been no formal evaluation of the effectiveness of MiApp for clinicians and mothers.
  • Proposed outcome measures for women include:
  • Satisfaction with care
  • Retention and assimilation of information
  • Engagement in pregnancy
Inclusion criteria
A number of characteristics can influence the ability to find and understand information in an IT application (including age, educational attainment, inability to speak/read English and deprivation). To help ensure that our cohort reflects this range of characteristics, we will purposively select women from a variety of backgrounds and ensuring the survey is available in multiple languages. 
Adoption target:
The conduct of an evaluation is predicated on the adoption of the device within selected settings. This would be the the first stage of a controlled roll-out, one where we will precisely measure the benefits it provides to encourage its adoption across the region and beyond. 
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Innovation 'Elevator Pitch':
This project uses art to inspire and inform, targeting geographical areas of social disadvantage where breastfeeding rates are low/ mothers may not have access to current research and may be unduly influenced by cultural barriers to breastfeeding.
Overview of Innovation:
Funded by ACE from 2017-18, the series of twenty-three photographic portraits of mothers breastfeeding by Lisa Creagh (Artist Practitioner) was animated into a film and exhibition-ready prints in January 2018. From January – May ‘Holding Time’ was shown at Fabrica Gallery, ONCA Gallery and Royal Brompton Hospital in London, in print, video and installation formats, accompanied by talks and workshops. ONCA featured a Breastfeeding Hub where comfortable seating encouraged mothers to stay longer and talk with other mothers. 
 
A dedicated website (www.the-parlour.org), was set up to broadcast interviews using Lisa Creagh’s YouTube channel. Here interviews by Lisa Creagh and Lucila Newell with participating mothers were posted as 5minute Podcasts. A Facebook promotion and postcard campaign drew visitors to the website, where a BLOG written by Sociologist Lucila Newell explored issues surrounding the cultural barriers to breastfeeding and an events page directed them to exhibitions and workshops/talks.  
 
Findings:
  1. Responses from audience at exhibitions was more mixed in gender and age than anticipated
  2. Workshops and talks were attended by more academic, medical and health researchers/practitioners than expected
  3. Online sharing of ‘Holding Time’ slideshow brought a large proportion of the audience to Podcasts 
  4. ‘The Parlour’ was not needed as a separate brand identity for the website: numbers of direct visitors were less significant than online sharing and YouTube recommendations. 
  5. The Breastfeeding Hub resulted in longer visits to exhibition
  6. Interviews/talks/workshops revealed structural barriers within health practice.
 
Figures (Jan-May 2018) 
 
Exhibitions x 10 days/ 435 visitors
Website: 1,000 users/ +67%
Talks x 2: 70 attendees
Facebook fans 303 posts/+91 fans/ +695 engagement
Instagram: +87 posts/+346 followers/ +1.4k engagement 
Twitter: 155 Tweets/+55 Followers/+25 engagements 
YouTube Analytics: 8,907 Views/ +6,710/60 Likes/+63 Subscribers
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Education, training and future workforce / Innovation and adoption / Person centred care
Benefit to NHS:
There is a wide disparity between the emphasis on breastfeeding in culture and the support for mothers attempting to breastfeed for the first time. There are approximately 700,000 newborn babies in the UK each year. Of these, a high proportion will be to new mothers with no experience or understanding of breastfeeding. Much funding for Health Visitor run baby groups and drop-ins throughout the country have been cut in the past two years due to budget constraints, leading to increasing social isolation of new mothers. Young mothers in particular may not have ever encountered another breastfeeding mother, given that the last generation was largely encouraged to bottle-feed. 

Holding Time is a project designed to address inequality and lack of opportunity. We know from a huge body of evidence that breastfed babies have better short and long term physical and emotional health outcomes.[1]But drop out rates in breastfeeding are still perilously high. Currently young women from disadvantaged backgrounds have breastfeeding rates of less than 29%[2]. But until cultural attitudes towards breastfeeding change, it is unlikely that this will be improved. 
 
One of the greatest challenges new mothers face is overcoming the dominant negative attitude towards breastfeeding in public[3]. The Infant Feeding Survey 2010 shows that In Brighton, breastfeeding rates are higher than the national average, but these statistics hide inequalities. 

The nature of this work is discursive,opening dialogues around breastfeeding between not only women, but also genders and generations where arguably there can be wide disparities in opinion. 

Using social media, a local postcard campaign to GPs, and a YouTube channel, the project uses the exhibition in a local community space as an opportunity to engage and invite the public to engage in multiple ways.
 
[1]Department of Health. Breastfeeding and the NHS Priorities and Planning Framework 2003-2007 (modified February 2007). London: Department of Health. www.dh.gov.uk/  
[2]https://www.jfhc.co.uk/Who_wants_to_eat_in_a_toilet_20947.aspx: “The prevalence of initiation of breast-feeding varies between neighbourhoods from 28% to 80.6%.”
[3]45% of mothers reported that they felt uncomfortable breastfeeding in front of other people, and this was most acute in public places (43%) http://www.hscic.gov.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf
Benefit to WM population:
Looking at the Public Health England Statistical findings of 2017/18 Quarter 3: the latest data on breastfeeding prevalence at 6-8 weeks after birth, areas such as Stoke on Trent, Sandwell and Nottinghamshire have particularly low rates of breastfeeding (31.8%, 37.2% and 39.5% respectively) for example but again these statistics represent take up, which would drop considerably within a couple of months. Given that the WHO has recently defended its position of the benefits of breastfeeding for at least two years, the challenge is to inspire this minority of mothers who do take up breastfeeding to continue for longer and to inspire more mothers to try, particularly young women who seem to struggle with the public face of breastfeeding. 
Current and planned activity: 
Next Stage:
 
  • Stimulate and curate conversations around breastfeeding to the public 
  • Dr Debra Bick (Expert)/Lisa Creagh to approach medical and academic researchers in the field of breastfeeding for content and collaboration
  • Podcast interviews with medical researchers, Paediatricians, midwives and heath practitioners to inform and integrate research with opinion, capitalising on the wide reach of YouTube platform. 
  • BLOG to comprise of guest posts by medical researchers focusing on issues raised by women in workshops and interviews e.g. the struggle to feed in the early stages, the establishment of lactation, post partum care, expressing, breastfeeding in public, etc
  • Tour of Holding Time to locations across the UK with low breastfeeding rates, including Breastfeeding Hubs where possible/appropriate
  • Facebook/Instagram channels to promote the exhibitions and web content above 
  • Accessibility expanded through transcripts/closed caption subtitles 
What is the intellectual property status of your innovation?:
Copyright of all images is held by Lead Artist Lisa Creagh
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
3 years +
Ease of scalability: 
Simple
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Overview of Innovation:
Caring for Carers Project
Background
With the increase in birth rates, staff shortages and negative organisational cultures, midwives often experience unexpected feelings of stress and can lose their passion for their role. As a newly qualified midwife, I saw how morale and resilience can be affected in maternity care and the impact that this can have on the care of women and families.  I wanted to help them by raising morale and reinvigorating their passion for midwifery by developing a culture of “positivity” in the maternity unit which would help midwives feel better and in turn l provide a good maternity experience for women, and their families.
The Project
The aim of my project was to provide maternity staff with skills to help them cope with the stresses of working within maternity  in order for them to re-establish their passion in midwifery. The project highlights some of the work we have done within the Trust to improve staff morale and demonstrate the positive achievements of a set of interventions. My personal hope is that by supporting midwives, we support women and their experience of maternity care will improve and in turn this will improve outcomes for mothers and babies. The project has successfully ran 2 conferences which was supported by midwives from around the country and we attracted many high profile speakers to the events. To follow on from the conferences, we have created a monthly wellbeing cafe with massages and aromotherapy which maternity staff can use to recharge their batteries. The from our swellbeing intervention have been shared nationally. By sharing our new knowledge and by working alongside the RCM’s new campaign 'Caring for You' then we are positive that we can improve maternity care locally and nationally. My hope is that these tools will help develop midwives who are positive about their role, positive about birth, positive about the NHS and positive about providing personalised care for women and families. This will have a big impact on maternity care and could be measured by the family and friends test results received from families who use our maternity service. The effect of this project could be seen not only by women and families but also midwifery students who are the future of midwifery, by being role models who demonstrate positivity, resilience and good morale then this could be infectious to students and hopefully give them the skills to develop resilience when joining the NHS.
 
 
Initial Review Rating
3.00 (1 ratings)
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Innovation 'Elevator Pitch':
Whose Shoes? uses a range of scenarios and topics to help staff explore the concerns, challenges and opportunities facing different groups. So you can walk in their shoes understand the process and issuses associaed with making (an informed) decision
Overview of Innovation:
Whose Shoes? is a popular approach to co-production within the NHS, endorsed and actively supported by the Patient Experience team at NHS England and the Transformation team within NHS Improving Quality, as well as local authorities, universities and other public services. It is a flexible tool that can be adapted (through bespoke partnerships) to a wide range of topics and challenges. The original board game, launched in 2008, explored issues around the emerging personalisation agenda.
A person-centred and values-based focus remains central to all development.
New material is being developed through strong collaborations with passionate people, fired by a very strong social media presence and networking capability. Whose Shoes looks at issues from different perspectives and triggers crucial conversations, with real ‘light-bulb moments’ as participants come together as ‘people’ rather than roles and work together to find solutions to the issues that matter to them. Getting as wide a range of participants as possible around the table cuts across boundaries and flattens hierarchy.
The relaxed approach creates the conditions for ‘service users’ to contribute as equals in a relaxed environment which is conducive to open, honest exchanges. People are empowered to lead rather than simply contribute. There is a strong focus on action and sharing good practice widely, with participants encouraged to make pledges and to share good practice through stories and case studies and to promote these through social media. Graphic recording of Whose Shoes workshops is very popular with hospitals using the records as action plans.
The maternity version of Whose Shoes? has been developed in partnership with the London Strategic Clinical Network and NHS England. It was piloted in five London hospitals. Workshops are now spreading – including other London hospitals, Guernsey, Leeds, Cumbria and Manchester.
Whose Shoes? material to improve communications between children and young people, their parents and healthcare professionals has been co-produced with Great Ormond Street and HENCEL.
Scenarios to promote dementia-friendly communities and understanding by NHS staff of the challenges of living with dementia have been produced through partnerships with Skills for Health and an Age UK consortium. Integration scenarios are used in the Darzi programme. Bespoke scenarios around other areas of patient experience (e.g operating theatres) is being trialled with Kingston Hospital
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Wealth creation / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
“ Whose Shoes brings people together to have conversations that matter, the resources stimulate thoughts whichlead to new insights & importantly to actions through the power of human connection & the use of narrative. ..... The energy generated is tangible .......it’s sustained long after as the creativity of both the public and professionals in unleashed. I’d really recommend the approach as a vehicle for any service committed to ongoing improvement
#Hellomynameis… Kath Evans, Experience of Care Lead (Maternity, Infants, Children and Young People), NHS England
 
“ ‘Whose Shoes’ has been an incredible catalyst in Maternity care. Having set up 5 pilot workshops with the London maternity strategic clinical network there has been a tremendous ripple out to hold further workshops in other Trusts as well as the phenomenal change platform that is #MatExp.
The actions are far to numerous to list here, some examples: a  graffiti board …to give live feedback on services, decorating the maternity theatre ceilings to improve the environment for women undergoing Caesarean section (CS), optimal cord clamping ……. midwifery workshop to explore better collaborative working - the list is endless.
We have also used ‘Whose shoes’ in other areas of the hospital with success #KHFTWhoseshoes, improving  staff attitude & environment and patient experience in our main operating theatres & having a drop in session on administration at our Trust Open Day”.

Florence Wilcock, Consultant Obstetrician Kingston Hospital NHS Foundation Trust, Chair of the London Maternity Strategic Clinical Network maternity experience subgroup.
 
"Whose Shoes is a creative opportunity to engage staff, women and patients in a process of improvement and enlightenment, The #MatExp social movement for change ... used in our failing maternity service to better understand the experiences of women, their birth partners & our staff.  The creative energy & ideas generated during our session were directly developed into practical actions & we have subsequently used the model of engagement in other clinical areas.  Whose Shoes played an important part in our improvement journey & is having a direct impact on outcomes for women, birth partners and staff"
At the time of engaging with Whose Shoes, Steve Hams ex-Interim Dir. of Clinical Governance & Chief Nurse for the Health and Social Services Department at the States of Guernsey, now Interim Dir. of Clinical Performance & Delivery, NHS Surrey Downs CCG
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
t feels currently as though the West Midlands is largely missing out on what is now a popular, proven improvement methodology being adopted rapidly in other parts of the UK and now reaching out internationally. This tool is very different from the ‘same old’ , traditional ‘top-down’ consultation models. It is about real staff and patient engagement leading to rapid improvements – and people find it fun too!

The NHS benefits would be similar to other parts of the country but it would be easier and cheaper (travel, accommodation) to work in partnership with West Midlands (ie local) NHS Trusts / CCGs.

Also New Possibilities, the recommended graphic facilitators, with whom we work as very close business associates, are based in Birmingham.

Thus greater adoption in addition to helping, patients and helcare providers it would also allow our regionally based company to grow and develop new specialised products as well exporting this delivery process overseas e.g Currently exploring taking 'Whose Shoes Maternity' approach to Uganda.

Currently Adopted / Procured by:
  • NHS England: North region; East Midlands
  • Hospital Trusts include:
    • Kingston, Guy’s and St Thomas’s, Lewisham & Greenwich, King’s College, UCLH, Leeds, Croydon, Maidstone & Tunbridge Wells, Stockport, Manchester, NHS Cumbria, North Cumbria
  • Cheshire & Wirrall Partnership Trust
  • Guernsey HSSD
  • Great Ormond Street (partnership - CYPMeFirst masterclasses)
  • CCGs include: West Leicester, West Kent, Leeds
  • AHSN / Area Team: Wessex, Thames Valley
  • International workshops and talks delivered: Australia, Malta, France; Puerto Rico
See: www.nutshellcomms.co.uk for 'Case Studies' and other information.
Current and planned activity: 
  • Building on 5 pilot workshops (& Train the Facilitator session) carried out with NHS Eng. & the London Strategic Clinical Network supporting the new maternity experience; now spreading to hospital trusts across the UK
  • 12 Whose Shoes #dementiachallengers in March 2016 workshops across Kent, Surrey and Sussex, run by Age UK consortium, commissioned by HEEKSS
  • On-going partnership with Great Ormond Street Hospital to use bespoke scenarios in #CYPMeFirst masterclasses for multi-disciplinary health professionals working in paediatric services from many hospitals; the first 20 ‘Communications Champions, who are taking this into their own organisations; more being recruited (up to 100)  
Required activity
  • Procurement / Adoption of Whose Shoes? -  Across the W Midlands NHS Trusts, via workshops or via purchase of online/board game versions of Whose Shoes?
  • Collaborative work to personalise Whose Shoes? For particular projects or departments
What is the intellectual property status of your innovation?:
Design registered. UK Registration Design No. 4009563; Trade Mark (Whose Shoes): No. 2502651
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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