Innovation Warehouse - Stories
Meridian is a resource for you to be able to share the changes that you have made to the way that you do things that have resulted in improved health outcomes for patients, a more effective way of delivering more for less, an increase in the productivity or just a different way of doing things.  Please use this space to upload the innovations that you wish to share and that others can benefit from.
Thank you.
You are welcome to submit new stories or comment on existing ones

Innovation (Approved)

Overview summary:
In the UK and Western Europe most individuals with Osteoarthritis (OA) are managed in general practice with OA the second most common reason for consulting a general practitioner (GP).

The aim of JIGSAW-E is to implement a new model of supported self-management into general practice pilot sites in 5 European countries and evaluate the impact of this using local audits of quality care for OA. All innovations are designed for adoption and spread at pace and scale beyond pilot evaluation, and opportunistic adoption in developed sites is encouraged.
Challenge identified and actions taken :
JIGSAW-E supports practices in proactively managing patients with OA. The projects aim is to enhance quality of life for adults 45 years and over with joint pain without reverting to surgical treatment for OA unless all other appropriate options have been explored.

NHS England have recognised that given the significance of MSK (musculoskeletal conditions) to the NHS (£4.57 billion & 30% GP consultations) the recommended actions including pan STP collaboration across the pathway, could make a significant contribution to improving the quality of MSK care. NHS England has established MSK health as one of their key priorities.

JIGSAW-E supports general practice in addressing the following challenges:
  • Reducing clincial variation, through successful implementation of an electronic OA template to guide practice
  • Improve uptake of NICE guidance
  • Improve evidence based practice through supporting self management, train the trainer programme, local champions and training on the OA consultation
  • Improve patient satifsfaction and clinical outcomes through practitioner led long term condition clinics and bespoke patient information (OA guidebook)
  • Improving patient safety - reduced reliance on pharmacological/surgical interventions
  • Care pathway - reducing imaging and referrals to Orthopaedics
  • Improving work absense rates
Impacts / outcomes: 
JIGSAW-E addresses the unmet need in the management of OA across 5 European partners focusing on provision of quality non-pharmacological therapy: written patient information; exercise; physical activity; healthy eating and weight management advice. In 2016/2017 JIGSAW-E introduced a new model of supported self-management in general practice pilot sites and evaluated its impacts using audits of OA Quality Indicators collected using the JIGSAW-E e-template and routinely recorded general practice medical records.

JIGSAW-E supports the self-management of OA, providing a model of quality care incorporating four key primary care innovations:
  1. OA Guidebook - written information authored by patients and health professionals
  2. Model OA consultation for primary care
  3. Training for primary healthcare professionals in delivering high quality OA care
  4. Medical record (using e-template) and patient derivied Quality Indicators of OA care

Through EIT Health funding the project has also impacted on
  • the systematic implementation of international guidelines and NICE quality standards for OA at practice level across 5 European countries
  • Citizen and Industry partnerships supporting the scaling up of the this project across additonal EU partner countries

Highlight outcomes of the project so far
  • International Community of Practice for the project which includes key representation from across the 5 partner countries and the health professional groups of GPs, Practice Nurses, Physiotherapists and Patients
  • JIGSAW-E template embedded into clinical systems within practice within the UK. Translated templates are developed for partner countries as a local IT solution
  • OA Guidebook - translated and adapated across all project partners
  • Bespoke training package for GPs, Nurses, Physiotherapists and non-clincial staff. Training packages have been translated and adapted for use in partner countries and currently being converted into online training programmes
  • JIGSAW-E website providing supporting information for both clinicians and patients. Currently in the testing phase
  • Patient App
  • Strong industry links to be developed further in 2018
  • Business model in development
  • Network of clinical and patient champions supporting the effective roll out of the project
  • World leading patient and public involvement and engagement
Which local or national clinical or policy priorities does this innovation address:
NICE: Osteoarthritis: the care and management of osteoarthritis in adults
Supporting quote for the innovation from key stakeholders:
"The JIGSAW project promotes self management of OA amongst patients which encourages them to take a proactive role, understand the fuller implications of living with OA and to feel more ‘in control’ of their symptoms.

It helps to lessen pressure on secondary care services, and reduce the need for preventable surgery in some cases
 
I would strongly encourage other surgeries and multidisciplinary teams to embrace the project as its implementation has demonstrated positive outcomes in terms of improved quality of life; appropriate use of primary and secondary care services and satisfaction amongst health care professionals."

Practice Nurse, Portcullis Surgery, Ludlow, Shropshire
Plans for the future:
The project is now in its third year of funding from EIT Health. During the next 12 months the project will have a large focus on evaluation and the capture of key learning from the implementation across the five European partner countries.  Each project partner site will be developed into a beacon site for the project, supporting the scale up and out of the project.  Creating an business model for the project will be a key consideration to continue the growth of the project following the end of the funding period.

Digital innovations will continue to be built on over the next 12 months following the development of a JIGSAW-E website, online training package and patient app. 
The implementation of the project will continue to grow with new partners engaging in Europe and in the UK continuation of the adoption and spread of the project will take place across the West Midlands and beyond.

Opportunities to engage Industry in the project further will be explored.
Tips for adoption:
  • An understanding of Knowledge Mobilisation, theory and practice
  • Strong project management for effective implementation of the project
  • Phased approach to bringing on sites of implementation within an area
  • Recognising the impact of a pilot site to showcase best practice
  • Recognising the innovations may need to be flexible to meet the needs of different practices / organisations
  • The development of communities of practice to support the implementation of the project has been hugely successful
  • Development of a network of clincial and patient champions has been instrumental in the dissemination of information and encoragement of stakeholder uptake
  • Development of a busines model to support scale up and adoption
Contact for further information:
Nicola Evans
Implementation Project Manager, Impact Accerator Unit, Keele University
n.evans@keele.ac.uk 01782 734868
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Nicola Evans 17/01/2018 - 14:06 Approved
Overview summary:
A new programme in the West Midlands region aims to recognise and support general practices that deliver technology enabled care services (TECS) as their usual care, to ensure that their patients are empowered by their effective delivery. These local networks of digital exemplar practices are expected to lead the way in their STP to accelerate the adoption of TECS at scale, focused on long term condition pathways and the prevention of deterioration of health conditions. 
Challenge identified and actions taken :
Challenges: Currently across the NHS there is an ad hoc approach to digital delivery of care, an over focus on technology rather than its clinical application, an inadequate investment in digital skills/training of the NHS workforce, with solutions that place greater pressure on clinicians rather than enhancing productivity and quality of care.
 
Action: Development of a digital exemplar programme for general practices based on 7 key ‘C’ principles, with resources/training.
 
1. Competence. Practices’/patients’ ability to use/implement TECS.
 
2. Capability. Practices/patients need to adopt best practice using TECS and act on advice/information.
 
3. Capacity. Staff need time/confidence to innovate.
 
4. Confidence. Practices need to be confident of infrastructure. Patients need confidence that technology is integral part of clinical best practice.
 
5. Creativity. Staff using technology need to identify new opportunities.
 
6. Communication. Sharing of documents & communication between team members/settings caring for same patient.
 
7. Continuity. TECS not a quick fix, sharing knowledge/skills is key so that all across general practice teams and interactions with clinicians in other settings are synchronised across long-term condition networks.
Impacts / outcomes: 
Each of the 12 general practices on our exemplar programme is being supported in planning their use of digital technology with clear metrics in place to help them judge the value of their implementation plan. The programme will also help practice teams to understand the time and investment needed to undertake a new digital approach properly and the outcomes that can be achieved or strived for.
 
Development of a network of digital practices.
 
Our learning website, video tutorials, online toolkits and action learning sets are being offered across the region and are already oversubscribed. Practices that are willing to innovate want some recognition for what they are doing and the digital quality mark that we have developed will do just that.
Which local or national clinical or policy priorities does this innovation address:
Enhancing digital literacy, GP Forward View
Supporting quote for the innovation from key stakeholders:
The Programme’s aim is to upskill and support practice teams to match our 7 C’s, which is crucial to wide scale adoption of Technology Enabled Care Services at the front line.
 
By being in the Digital Exemplar programme we hope to consolidate our IT innovations around best practice, improve patient care in a cost-effective manner. Also having the expertise of a AHSN led programme will have solid foundation for clinical governance, social marketing and ability to implement successful projects elsewhere across the STP and further.
Plans for the future:
We believe the West Midlands will become a rich environment for the tech sector to invest their time and ideas for delivery of care and at the same time help address some of the health challenges we face.
 
However, this is not a programme that is confined to the West Midlands. We’ve already discussed the approach with likeminded people in other regions as well as with NHS England so it is certainly something that can be replicated elsewhere.
Tips for adoption:
The patient lies at the heart of what we are doing and so long as practices are committed to achieving the 7 key ‘C’ principles, alongside the appropriate resources and training, we believe that there are few limitations as to what they can do to improve the use of a range of modes of digital delivery across primary care in their area.
Contact for further information:
Ruth Chambers - ruth.chambers@stoke.nhs.co.uk
Marc Schmid - marc@redmoorhealth.co.uk
 
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Paula Stather 10/01/2018 - 13:46 Approved
Overview summary:
Working in collaboration with TeleHealth platform developer Dignio, Sykehuset Østfold Hospital in Norway began the pilot project in January 2017.
 
This ground-breaking cancer care pilot project has produced significant results. This is the first trial in the world where patients were empowered to measure their own white blood cells in the comfort of their own home. A small-scale trial has been completed which has shown positive feedback from patients, clinicians and carers. And now the hospital is funding a larger scale clinical trial.
Challenge identified and actions taken :
The side effects of chemotherapy seriously impact cancer patients’ daily lives. Managing them effectively is a long-time concern for doctors and clinicians.
 
The project was initiated and managed by Sykehuset Østfold Hospital’s cancer specialists Elisabet Nilsen Holm and Andreas Stensvold. Working in collaboration with Norway based TeleHealth platform provider Dignio A/S, Sykehuset Østfold Hospital began the project in January 2017.
 
Dignio Prevent is a secure, off-the-shelf, cloud based device agnostic Remote Patient Monitoring and Telehealth Solution. Dignio can be deployed very quickly with no input from, or impact on, current IT structures, software or licensing services. For the project with Sykehuset Østfold Hospital Dignio provided a complete remote patient vital signs monitoring solution which included an innovative, Bluetooth enabled, home based, white blood cell monitoring device.
 
By combining daily Remote Patient Monitoring of vital signs with CBT and frequent home based white blood cell measurement, healthcare providers can follow the patient in real-time and quickly catch any deterioration in the patient’s health and decrease the chance of hospital re-admission. Analysis of the data improves patient outcomes, reduces treatment costs and decreases re-admissions.
Impacts / outcomes: 
“It’s clear from the pilot project that patients are happy to be monitored and managed in this way. They prefer to be at home, they feed more secure, more in control and less stressed. They begin to learn about and understand how they are responding to chemotherapy and begin to manage themselves.”
Elisabet Nilsen Holm, Cancer Specialist, Sykehuset Østfold Hospital
 
“I hadn’t used a tablet before, I don’t even have a smartphone, but the software is very easy to learn and use. When I was asked to join the trial I didn’t have to think twice. It’s interesting and exciting and has reassured me throughout the entire post chemotherapy period.”
Betty Helen Kristiansen, Cancer Patient
 
Combining Remote Patient Monitoring with CBT and home based white blood cell analysis improves patient outcomes, reduces treatment costs and decreases hospital re-admissions.

Our results which have been independently validated by the City of Oslo.
There is an English language version of their report into the effectiveness of Dignio at:
https://www.dignio.com/s/Telehealth-in-Norway-March-2017.pdf
 
As you will see in the report the outcome of using Dignio was:
32% Less hospital admissions
42% Less outpatient consultations
39% Less hospital bed days
59% Less home nursing
Which local or national clinical or policy priorities does this innovation address:
Cancer - increasing diagnostic capacity
Supporting quote for the innovation from key stakeholders:
“The side effects of chemotherapy seriously impact cancer patients’ daily lives. Managing them effectively is a long-time concern for doctors and clinicians.
 
By combining daily remote monitoring of vital signs combined with frequent white blood cell measurement we can follow the patient almost in real-time and quickly catch any deterioration in the patients’ health and decrease the chance of hospital re-admission.”
 
Elisabet Nilsen Holm, Cancer Specialist, Sykehuset Østfold Hospital
Plans for the future:
Sykehuset Østfold Hospital is currently funding a larger scale clinical trial of Dignio Prevent for home based white blood cell monitoring for patients undergoing chemotherapy.
 
This chemotherapy remote patient monitoring solution is now available in the UK via the UK subsidiary Dignio Ltd.
 
Dignio Ltd are actively looking for opportunities to replicate, in the UK, the successful pilot project that has been completed in Norway.
Tips for adoption:
The minimum pilot size to produce meaningful results is 20 patients. The patients have to be trained (it takes about 1 hour) and the nurses have also to be trained on how to care for patients remotely and how to interpret the results. This normally takes around 1 day with ongoing support from our team in Norway (they all speak perfect English). The trial in Norway comprised of patients with the most aggressive cancers where any contra-indication or exascerbation needed very speedy detection and diagnosis.
Contact for further information:
Ken Garner
Director of Business Development
Dignio Ltd
0203 371 9358
Ken.garner@dignio.com
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Ken Garner 08/01/2018 - 14:05 Approved
Overview summary:
All change begins with an idea.

Athlon are an experience design and technology partner who supports organisations and individuals that are bringing about change through digital transformation and innovation. 

With any innovation there are a number of challenges to overcome, such as; developing an idea into a fully formed solution, efficient testing and iteration, developing a brand, gaining support from stakeholders/potential funders and finally encouraging adoption.

We help you to formulate, refine, build and market your ideas.
Challenge identified and actions taken :
NYU - The Human Project - The largest ever long term study of what it means to be human
How do you keep 10,000 New Yorkers engaged in a 10 year study of themselves and the environment they live in? Athlon were chosen to address this challenge through developing an experience around participant onboarding & consent as well as developing the brand and interactive digital platforms.

Motorola Solutions - Empowering public safety professionals
Motorola Solutions partnered with Athlon to assist in designing their public safety enterprise, an ecosystem from where all other applications would be launched. Looking at hardware devices used by emergency first responders we re-imagined how they could be more effective in high pressure situations. We then created marketing materials to gain support as the products were introduced to governments across the world.

Palmtree - Launching a successful startup
Guidant Technology are a start-up seeking to disrupt the way global organisations manage staff compliance. Athlon were appointed to create and brand their new product. Working from an initial idea of wanting to make compliance information more accessible, easier to explore and relevant to large teams we developed a brand and mobile app experience that helped this startup attract it’s crucial first three major clients.
 
Impacts / outcomes: 
The scenarios listed above resulted in successful, well designed, human centred solutions. Our support helped each one demonstrate their ideas and gain the necessary backing required at different stages of their innovation journeys in order to progress to being launched publicly and/or commercially.

The Human Project continues to grow in strength with additional research themes being added, whilst Motorola’s public safety devices have been shipped globally. Palmtree counts tech pioneers such as Apple and Spotify amongst its illustrious clients.
Which local or national clinical or policy priorities does this innovation address:
The UK Gov's £86m pledge to fund the development of new medicines and devices
Supporting quote for the innovation from key stakeholders:
Working with Athlon was a great experience. They partnered with us across our branding, product design and marketing. Their holistic approach, strategic insights and creative thinking helped accelerate our speed to market. I'd happily recommend them.

GARIN BERGMAN, FOUNDER & CEO, PALMTREE
Plans for the future:
Athlon continues to grow its team and capabilities across the UK, Europe and North America, currently expanding our user experience, strategy and marketing resources.

Our innovation lab is currently in development and looks to be an exciting testing ground for new ideas and technologies both for established organisations and startups.

We regularly dedicate time to investigating the most influential technology trends with our latest thought series exploring healthtech - please see our website for more information: https://www.weareathlon.com/collections/healthtech.
 
Tips for adoption:
Teaching organisations to have a ‘design thinking’ mindset is how we help to drive a human centred approach to innovation.

Our workshops provide tools and techniques to disrupt linear thought patterns and help identify creative opportunities. We find this is the best way to help our partners to adopt a holistic approach to thier challenge.
Contact for further information:
Sam Bhatt, Growth Manager - 0203 384 0470 -  sam@weareathlon.com
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Sam Bhatt 30/10/2017 - 11:42 Approved
Overview summary:
Making a difference to people with diabetes aims to make 1,000 positive differences for people with diabetes with 500 difference makers, developing a self-motivating network of change agents to give people the confidence, tools, know-how and enthusiasm to make a change to what they do what they do and improve patient experience and care. 
 
Challenge identified and actions taken :
Diabetes expenditure is approximately 10% of the NHS budget, with the West Midlands spending £94million on diabetes prescriptions between April 2012 and March 2013. There is also a wide variation in the achievement of good clinical outcomes. Only 16% of patients who are prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need. In primary care, around £300million per year of medicines are wasted (likely to be a conservative estimate), of which £150 million is avoidable. NHS England has a priority on medicines optimisation, which aims to deliver improved patient outcomes through a patient-centred approach. 
 
 
Impacts / outcomes: 
Difference maker: Emma Innes, Matron in Diabetes, in conjunction with the In-Patient Diabetes Nurses
Project outline: Redesigned the in-patient pathway at Worcestershire Royal Hospital by proactively seeing all patients on the Acute Medical Unit who were high risk: newly diagnosed diabetes, admitted with hypoglycaemia <4 or hyperglycaemia >11 mmols or use Insulin. The aim was to be able to review and intervene in diabetes management before the effects of acute illness, poor oral intake and non-specialist management could cause any adverse events with the diabetes control.
Difference made:
  • Over nine months after the service change, the diabetes errors on the Acute Medical Unit reduced to 0 from 10 errors recorded over the nine months prior
  • Increased number of patients seen by the DSN team initially, but this is balanced by the fact that patients on the medical wards are more stable due to the early intervention.  

Difference maker: Dr Andrew Askey, GP, Walsall CCG
Project outline: To improve screening for renal complications in people with diabetes by ensuring they have annual urinary albumen:creatinine ratio performed. An EMIS prompt was designed to alert clinicians when ACR screening was due, and further refined to advise on READ coding microalbuminuria or proteinuria and prescribing appropriate medication (ACEi, or AiiR blocker).
Difference made: In 2014, 469 people with diabetes had ACR screen in my practice, increasing to 613 in 2015 with an increase of 144 people screened.  In addition, 55 patients were coded with microalbuminuria or proteinuria, and 28 were started on ACEi medication.


Difference maker: Sat Kotecha, community pharmacist and Chair, Local Pharmacy Network, West Midlands
Supporters: I involved my pharmacy team, patients and the Health Trainer that works from my pharmacy. I also engaged with other pharmacies, a consultant and the company that make the disposable HBA1c tests - the LPC is currently putting a business case together for commissioners to consider.
Project outline: I believe that the person who can make the biggest difference to their diabetes is the patient themselves. However, as diabetes is a 'silent condition', people have no idea if the changes they make are making a difference. I wanted to give people an objective measure to motivate them to make a difference for themselves by measuring HBA1c at baseline and the patient receiving advice on medicines adherence, diet and exercise. There was then a series of follow ups to measure the impact and motivate the individual.
Difference made:
  • 18 patients participated in the service, 10 completed all four consultations, while the rest stopped at various intervals.
  • A range of HBA1c reduction from 3mmol/mol to 14mmol/mol
  • All 18 patients reported changes to diet and increases in physical activity
  • 11 patients reported improved adherence to medication/changes to timing etc
  • Eight patients stopped home BGT as they felt it was unnecessary
  • All 18 patients would recommend to friends and family. 

Difference maker: Julie Taylor, Diabetes Specialist Podiatrist, Staffordshire and Stoke-on-Trent Partnership NHS Trust
Supporters: podiatry line manager, professional leads for podiatry and physiotherapy, statistical support, non-medical prescribing lead, West Midlands Diabetic Foot Network, four GPs in four practices and diabetes consultant, Staffordshire University
Project outline: I wanted to improve timeliness of access to prescriptions for individuals with diabetic foot problems. Current processes cause delays that can have a negative impact on patient and carer experience and clinical outcomes. I wanted to make supplementary prescribing work in my community setting. 
Difference made:
  • My supplementary prescribing increased from 0 to 50 prescriptions, by developing clinical management plans with five independent prescribers (four co-located GP practices who had not experienced supplementary prescribing previously and diabetes consultant)
  • On these 50 occasions, times to prescription improved from minutes to 1 -14 days (from the GP practice)
  • My prescribing prevented at least one hospital admission
  • Nine prescriptions for antibiotics were provided during consultation (commonly delayed by days with existing process and often not in line with local guidance for foot infection)
  • 19 prescriptions for wound dressings/offloading devices that are often incorrectly prescribed due to similar names of products (which require additional prescriptions and associated delayed commencement of appropriate care plans) with a potential saving of >£150 and associated frustrations
  • More importantly, the patient and carer feedback has been very positive, notably regarding convenience and reducing anxiety.
Which local or national clinical or policy priorities does this innovation address:
Long Term Conditions, Quality improvement
Supporting quote for the innovation from key stakeholders:
 “WMAHSN are really good at promoting these great things, and the medicines optimisation programme has this drive behind it that engages people".
Plans for the future:
The initial group of people that made a difference have since gone on to do other joint working projects together and have created an energy and enthusiasm for having a go to make positive change happen.  The legacy of the programme is that the individuals involved have continued to pursue further changes and have made significant achievements at a personal and organisational level. 
Tips for adoption:
This programme is about driving improvement in diabetes and medicines optimisation without dictating how the difference makers achieve their goals. Instead, it has given people time to think and a framework to think differently, with some projects having wide impacts. There were some challenges during the programme which provide constructive lessons for the future. While the aim of identifying 500 difference makers to make 1000 differences was not achieved, the programme showed a rich experience of how a few people can make changes which impact the lives of many thousands of people with diabetes. 

Support for the difference makers included:
  • Two days training around change thinking
  • follow up half day
  • Teleconferences
  • Half day training on ‘Measurement for Improvement’
  • ‘Buddy system to provide support, challenge thinking and identify resources needed.
Contact for further information:
For more information, contact Lucy Chatwin, Business Manager at WMAHSN, on 0121 371 8061 or email lucy.chatwin@wmahsn.org  
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Lucy Chatwin 29/09/2017 - 14:19 Approved
Overview summary:
Many patients who are newly diagnosed with long term conditions(LTCs) or need active clinical management, are anxious and seek information and support from various sources, some of which are unreliable. To ensure that local patients were provided with appropriate support and reliable electronic information, we created three Facebook pages for general information, and three ‘closed’ Facebook groups to which clinicians invited patients to sign up. 
Challenge identified and actions taken :
Patients with the selected LTCs often have problems accepting their new circumstances after diagnosis. Adherence to treatment regimes can then be poor, yet it is crucial that they follow the advice given to them, if they are to manage their condition adequately. By having a peer group and health professional advice they are much more likely to change their behaviour appropriately.

Three general Facebook pages were set up, one for each of the conditions targeted, so information was presented to a wide public using videos and written posts. Three associated closed Facebook groups were established. Health professionals in relevant teams were trained to support the sites, intervene as appropriate in any peer to peer online discussions or inappropriate joiner’s contribution (e.g. commercial advertising) and regularly load interesting and relevant information pertaining to condition management and wellbeing.
 
The aims of using Facebook was education about patients’ condition, and support, especially for newly diagnosed patients. Thus, content might include highlights from research or updated approaches to management. Closed groups were created to enable patients to feel safe seeking advice from their peers, and discuss aspects of their treatment. Questions were loaded on each site to learn more of patients’ experiences.
Impacts / outcomes: 
These three closed Facebook groups now (1.8.17) have 451 users in total. The responses by the wider public to the general information videos filmed for the general Facebook pages has been extraordinary. One video by the consultant cardiologist for AF received 20,000 views. Videos of other cardiologists and cardiac rehabilitation patients have each been viewed between 300 and 13,000 times.
 
Members of closed Facebook groups are very active. As at 1.8.17 there are 120 members in the AF closed group; 110 in the cardiac rehabilitation closed group; and 221 in the MS closed group. The online discussions provide support for several hundred members who are able to discuss concerns with peers and interact with expert health professionals overseeing the site.
Questions posed via each Facebook site eliciting views of patients about the services produced positive responses:
  • 88% felt use of Facebook had improved their knowledge of their condition;
  • 93% said that Facebook had provided them with increased support;
  • 97% would recommend the service to their friends;
  • 50% reported that using Facebook had helped them make beneficial lifestyle changes.
Comments from patients valued the peer support:
 ‘Seeing other people’s experiences and identifying with them yourself’; others welcomed input from clinical staff: ‘Being able to get fast, accurate information without wading through the switch board and waiting for call backs. Also, being able to access support at a time that suits me rather than in office hours.’
 
Clinical staff have also commented that they have had far less telephone calls from patients worried about new medications: ‘They can discuss new treatments with other patients who are on them, so they don’t bother to contact us as they are reassured about side effects they are experiencing.’
The MS team have been awarded the MS Society Award 2017 in the MS Professional category. 
Which local or national clinical or policy priorities does this innovation address:
- Care and Quality - Health and Well Being - Drive to efficient and productive workforce
Supporting quote for the innovation from key stakeholders:
From patients –what is good?:
‘It’s comforting to know we can ask a question without it going public.’
‘Sharing experiences learning of different medications and things people do to alleviate symptoms.  The knowledge that there is someone to listen and get expert advice if needed.’
‘This group is great for interacting with other people with MS, I don’t feel so out of it alone.’
‘This group is great for having someone else there who understands what I am going through and can give advice.’
Patients from Stoke-on-Trent and Stafford                                                                          
From clinicians -insights:
‘Because it’s professionally monitored, we can correct false or negative information.  It takes the burden off the family too, as patients help each other to be more positive.  We’ve involved the MS Society; we promote local activities, and have got more volunteers that way.  It’s a partnership with them.’
MS Specialist Nurse
 
‘Initially we felt we needed to answer questions.  Now patients have often answered it themselves.  We are more relaxed – it’s now a support group.  They are very clued up about medication, and share tips, which we wouldn’t necessarily think of, intricacies of what makes life better for them.’
 
‘Take chest discomfort – initially we gave wordy answers to make sure we covered all possibilities.  Now, if we need to, we ask them to message us through a private inbox, giving their unit number, and we can look through their notes before replying, or give them a phone call.’
                                                                                                                       
Physio, Cardiac Rehabilitation
 
Please click on the link to view a video of Matt Berrisford, Exercise Physiologist, Cardiac Rehabilitation, University Hospital of North Midlands:
https://vimeo.com/203200412
Plans for the future:
WMAHSN support has enabled the pilot of the Facebook programme and dealt with organisational challenges such as NHS branding, governance etc. The success of the programme has resulted in national awards, where the excellence of these services has been recognised. This pilot proves the case for widescale adoption of Facebook for those with other LTCs in all health settings across UK and beyond; and optimise the links between trusted health Facebook sites, such as those piloted with local general practice Facebook sites.  Adopting other simple technologies such as Skype and text messaging are envisaged as additional ways of improving workforce efficiency. 
Tips for adoption:
  1. NHS reluctance to initiate Facebook sites can be overcome when health professionals and managers realise the low quality and unreliable information that is provided on unregulated sites to which patients gravitate if they are not given a suitable local or trusted outlet.
  2. Closed Facebook groups advocated by the NHS need to be monitored regularly by clinicians. But although this takes relatively little time, the material uploaded to a site does require regular oversight.
  3. The local nature of the Facebook group is important. There may be variations in treatment in different parts of the UK, and patients feel reassured by knowing that it is their clinicians who monitor the information displayed.
  4. Patients should be given details of the Facebook site at their initial diagnosis, because it is at this point that they will seek to supplement whatever information they have been given. To be directed to a local, trustworthy, informative and supportive network of patients is preferable to randomly finding unregulated and inaccurate sites elsewhere on the Internet. 
Contact for further information:
Marc Schmid
Project Lead
marc@redmoorhealth.co.uk
07736 008380
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Sue Wood 01/09/2017 - 08:40 Approved
Overview summary:
North Staffordshire and Stoke-on-Trent CCGs, with the support of the WMAHSN LTC Network and social enterprise company Redmoor Health, have been supporting their GP practices to use social media to engage with their patients.  As a result of the programme, over 2/3rds of the practices are now regularly using social media, the most popular being Facebook.  The topics discussed range from simple health messages to the publications of DNA data and consultations on appointment and telephone systems.
 
Challenge identified and actions taken :
The challenge is convincing general practice teams that it is in their best interests to have their own official Facebook landing page providing accurate and useful patient information individualised to the practice. Otherwise an unofficial page may be generated by the public (not necessarily registered patients) who access Facebook on their own devices and create a profile for the practice.  These publicly created pages are then unmoderated by practices, usually containing negative unpleasant comments about the practice services, which the practice is unable to control.  Unofficial pages can also be used to relay content not related to the practice, i.e. advertising businesses, which gives the mistaken impression that the advertisement has been endorsed by the practice.
Impacts / outcomes: 
Once practices realised that an unofficial Facebook page had been set up they were keen to develop an official Facebook page. By owning an official page (or claiming an unofficial one) practices can increase the likelihood that their patients reach their official site which are listed higher than unofficial pages in searches. Establishment of Facebook has enabled general practices to increase engagement with their patient population by sharing useful patient information including opening times, services etc. 
 
The practices engaged have also developed an effective communication channel.  This was highlighted in the 2017 cyber attack which affected practices throughout the country – telephone lines were down, websites couldn’t operate and online bookings were also affected.  Those practices with Facebook could send out information quickly to their patients with instructions to share across  personal networks.  As services came back online practice staff were accessing their practice’s Facebook page from home and posting updates to their patients.
 
When a video produced by the stroke team at University Hospitals North Midlands (UHNM) was posted across practice Facebook pages it received over 20,000 views in one weekend. A poster advertising a drop-in heart screening programme for young adults reached over 45,000 people in one weekend and sessions were fully booked within two days. A typical practice page engages around 200-1500 patients in a week, but this increases dramatically with posts that trigger significant patient interest.
 
Facebook is also now being used to recruit new members to practice Patient Participation Groups to enable those with difficulty in attending face to face meetings to become involved in more effective ways.
 
Some practices have also set up closed private Facebook groups for specific cohorts of patients who are able to discuss concerns with peers.
 
The review undertaken by the medical student has been accepted for publication by BJGP Online.
Which local or national clinical or policy priorities does this innovation address:
This should list the NHSE priority areas that the project addresses. These will be used to ensure the case study is easily searchable on Atlas: - Care and Quality - Health and Well Being
Supporting quote for the innovation from key stakeholders:
Seema Gater, Practice Manager Apsley Surgery, Stoke-on-Trent
“As a forward thinking practice we are keen to use social media to give patients a different way to interact with us. We wanted to provoke reaction and engagement and we have started to successfully tap into this by highlighting our monthly breakdown of DNA statistics to our patients though Facebook.”
 
Jane Cope, Practice Manager Goldenhill Surgery, Stoke-on-Trent
"We use Facebook as an opportunity to advertise and educate patients on seasonal topics, i.e. influenza vaccines in the winter, holiday vaccinations in the summer etc. and also other information that would be of benefit to patients."
 
As technology develops and more patients use the web to communicate, as a forward thinking practice, we see Facebook as a new innovative tool to communicate and educate patients."
 
A video has also been produced in which two PPG chairs discuss how they benefit from using social media: https://vimeo.com/digitalhealthsot/socialmediappgs
 
The following articles have been published regarding social media:
 
https://www.pcc-cic.org.uk/article/stoke-practices-engage-social-media
 
http://practicebusiness.co.uk/the-seven-cs-to-creating-a-digital-practice/?platform=hootsuite%E2%80%AC
 
http://www.pulsetoday.co.uk/your-practice/dilemmas/how-should-we-respond-to-negative-comments-on-social-media/20032472.article
Plans for the future:
As well as continuing to expand the network of Facebook practices, the pages that exist are being used to promote CCGs’ priority health messages and programmes. This includes signing patients up to Patient Online and engaging new parents on the future of maternity services in Staffordshire. By inviting parents to join a closed Facebook group, the CCGs have recruited 144 people to the engagement programme.
 
The North Midlands Breast Cancer Screening team is now using practice Facebook pages to promote their service and interact with patients to explore how the service can be improved and how non-attendance can be tackled.
Tips for adoption:
Embedding the use of Facebook into health and care engagement can have a huge impact on spreading positive messages and helping shape behaviour. It is not without risk though so there are some important considerations that need to be made:
  1. Training and support for frontline NHS staff
  2. Adoption of trustworthy, safe protocols
  3. Dedicated clinical time set aside to manage the regular engagement with patients
Once these are in place, the toolkits and support packages that have been developed in the West Midlands will support any frontline staff use social media to engage with patients.  Click on the link below to access the Social Media Toolkit:
https://redmoorhealth.co.uk/wp-content/uploads/gp-social-media-toolkit-redmoor.pdf    
Contact for further information:
Marc Schmid
Project Lead
marc@redmoorhealth.co.uk
07736 008380
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Sue Wood 01/09/2017 - 08:30 Approved
Overview summary:
This initiative aimed to improve understanding of the challenges pharmacies face in the adoption of technology enabled care services (TECS) focussing on efficient medicines utilisation and adherence.  
 
20 pharmacies from North Staffordshire were approached with 17 agreeing and 5 remaining through to completion.  The patient cohort was defined as those with prescriptions for COPD, asthma, diabetes type 2, diuretics, NSAIDs or back pain with protocols developed by the WMAHSN LTC Network.

Further details on the study can be accessed here
Challenge identified and actions taken :
The challenge was how pharmacists might utilise TECS to add value to the delivery of the New Medicine Service (NMS) and Medicines Use Review (MUR) and Prescription Intervention Service at the point of dispensing, in the integrated care of patients. 

The aim was to improve patient convenience, experience and increase understanding of their conditions and thus improve patient participation in self care with subsequent clinical benefits and associated cost benefit in medication usage. 

The project focussed on:
  • Recruitment of community pharmacies then agreeing a Memorandum of Understanding (MoU) detailing expectations under the project.  The MoU included a bursary of £500 for participation in training, identification and recruitment of patients, data capture and evaluation (Appendix 1);
  • Training to pharmacists followed by the licensing of pharmacies for Florence simple telehealth with ongoing on site support from local clinical telehealth facilitators and the Local Pharmaceutical Committee (LPC);
  • Protocols in the specified LTC's providing TECS introduction pathways (Appendix 2)
  • Florence and Manage Your Health aide memoirs
  • Baseline survey of participating pharmacies at project inception and a post participation survey (Appendix 3)
  • Patient feedback on Florence 
  • Patient feedback on the Manage your health app 
Impacts / outcomes: 
This was designed and delivered as a discovery project. As a consequence, the impacts and outcomes are limited to learning.  Based on critical reflection and consideration of the evaluation and surveys completed as project actions the project team identified where the project could have been more impactful in terms of retaining the participation of those pharmacies that expressed an interest. Then better retention and participation rates could have secured higher incidence of TECS adoption from the cohort of patients covered by the project.  These conclusions and the resulting recommendations recognise the small numbers involved and that further exemplar projects would be required before at scale roll out could be considered.
 
17 community pharmacies expressed an interest and progressed to training and receipt of the MoU and were deemed to be fit to participate – five of these accredited pharmacies went on to complete the project.  The number of interactions (contacts with patients) reached 88 realising 93 incidences of patients becoming engaged with or interested in TECS (patients could elect for either / both Florence and the Manage Your Health app).  The demographics of the patients reached during the project shows 5.7% (5) to be children (<20years old) and 19.3% (17) to be older adults (> 59 years old).  With an even distribution of participation by gender (42M / 46F) and by condition the willingness of patients to consider TECS when introduced by the pharmacist could be considered high as the 88 patients – based on participation data collected at the pharmacy – converted or stated an intention to convert to simple telehealth or an app.
 
The conversion rate supported the hypothesis that community pharmacies are in a position to introduce and generate adoption of TECS during their participation in a single patient focussed care plan.  However, if the project was to be replicated more attention would be required in the recruitment and preparation of the participating community pharmacy teams.
 
  • The MoU in itself was helpful for recording and agreeing the basis of participation but it could have contained more on the objectives and outcomes expected from participating pharmacies;
  • Experience showed that while the strategic involvement of the pharmacist(s) was fundamental to placing the project in context for the pharmacy the pharmacy staff (including counter staff) were better placed to manage the interactions with patients on the practicalities of enrolling with Florence or the downloading and then utilisation of the Manage Your Health app;
  • Training for the pharmacy team would be better delivered out of hours or by remote delivery (e.g. skype) as the day to day operations of the pharmacy made the delivery of training during opening hours problematic with frequent breaks in the training being required and on some occasions the training could not be completed within the time slot allotted for it;
  • The community pharmacies without exception had sufficient private space in which to interact with patients but they would benefit from more mobile IT to improve the content and value of the interactions e.g. by demonstrating TECS on an iPad to an interested customer;
  • In project planning, more could be done in helping community pharmacies understand patient flows and when this type of activity might best be done – during the project more than 40% of activity took place on a Friday with 20% on a Wednesday;
  • Survey at inception showed a healthy degree of scepticism on behalf of pharmacists as to the demand TECS would make on their colleagues but that TECS was an important and legitimate part of the pharmacy role. They agreed that the introduction of TECS into patient care was desirable and likely to improve their outcomes – the post participation survey illustrated that pharmacist time with patients was the key factor in patients adopting TECS (within the constraints of the project offer) and that TECS should be part of the pharmacy menu of services; and
  • Future initiatives would benefit from a much closer link with the outcome responsibilities placed on community pharmacies for NMS, MUR and the prescription intervention service as the project did not provide any causal link from the pharmacy activity to medication utilisation, adherence of cost effectiveness in prescribing.
 
It is worth noting that the demographics of the patient cohort recruited suggested significant levels of participation by older age groups generally considered to be ‘digitally excluded’. However, in the post participation telephone survey – albeit for small numbers – pharmacists reported patients not having a mobile phone (telehealth) or a smart phone or tablet (Manage Your Health app) as only occasional incidental occurrences.
Which local or national clinical or policy priorities does this innovation address:
Care and Quality Health and Well Being Health Education England’s Building a Digital Ready Workforce. https://hee.nhs.uk/our-work/developing-our-workforce/building-digital-re...
Supporting quote for the innovation from key stakeholders:
During the post participation survey the following comments were noted based on conversations with the participating pharmacists and pharmacy teams:
 
“Patients felt that the info on the Apps was reliable rather than just looking on the internet”
 
“I can see the benefits of using technology ………… new launches always take time, cannot expect new service to be instantly successful.  Once established and embedded expect it to be more successful”
 
“It would be good to have a self-service portal (in the pharmacy) i.e. tablet/lap top for patients to use to become familiar/comfortable”
 
“Pharmacist would have liked more telephone support”
 
“Delivering healthcare technology is easier than pharmacists believe …..”
 
“(The) Service is easy to sign up to but (I) just haven’t got the time. …….. apologies for lack of participation but owners not prepared to commit to staffing required”
 
“Try to link patients’ info and needs with the pharmacy from GPs.  Create better awareness – leaflets, posters, media and promotional material – poster/leaflet to encourage patient/customers and make aware
 
Please note:  These references are from notes taken during the post participation telephone survey and have been presented out of the context of that survey and the individual discussions that took place and, in some instances, represent multiple responses on the same or similar themes.
Plans for the future:
The learning from the initiative was substantial and consequently there would need to be significant redesign before it was run again.  There was much to commend the project recognising that it ran for a short time and yet the take up or conversion rate to the TECs offer was in itself significant and therefore of value in the context of what the project hoped to achieve.
 
The case for another initiative involving pharmacies and pharmacy teams is strong providing there is a greater emphasis placed on how their investment of time in introducing TECs impacts positively on pharmacy relative and important outcomes.  There is a valid argument for developing and introducing a currency for this work that is of value to pharmacies.
 
Since this initiative, Healthy Living Champions have been introduced into all pharmacies in Northern Staffordshire and it would make good sense to have them involved in this type of initiative in the future. Healthy Living Champions have a role to promote Public Health messages.
Tips for adoption:
The initiative brought home the importance of securing senior pharmacy managers support for the community pharmacists’ wider role, recognising that they need protected time to be effective.

Community pharmacists are motivated to use their knowledge to help patients, and projects like this one should capitalise on this.

If locations, such as pharmacies, are to be the focal point of introducing TECs to patients and the public promotion and support material for use on site is important.
 
Much is assumed about the digital awareness of professionals and employees in health and health care services – the initiative identified that greater digital awareness created by other programmes may help the future recruitment of willing participants from within clinical and healthcare teams and from the public and patients.
Contact for further information:
Tania Cork
Chief Operating Officer
North Staffs & Stoke LPC
taniacork@northstaffslpc.co.uk 
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Sue Wood 01/09/2017 - 08:21 Approved
Overview summary:
This tool has been developed by a team at UHCW, headed up by Professor Meghana Pandit, Chief Medical Officer & Deputy CEO.

This is a digital tool that will enable tracking of all post-surgical complications / morbidity by surgeon for each patient. It will enable learning and help reduce complication rates and identify trends in complications and morbidity.
Challenge identified and actions taken :
This innovation is a surgical morbidity scorecard developed at UHCW. It allows capture of theatre details and complications from two different systems onto a scorecard. The idea being that each month, surgical teams can review their performance as a team or as individual suegons and analyse the data. The indicators include generic surgical morbidity measures such as length of stay, readmissions, heamorrhage, DVT, PE, wound infection, return to theatre and unexpected admission to ITU. With this data available for each surgeon and each patient, surgeons will be able to iddentify need for change in practice and equally will be able to counsel / consent patients before surgery with their own morbidity / complication rates. 
 

This information is sufficiently robust to enable identification of trends in morbidity, allow in depth review when concerns are highlighted.  Such morbidity data, when appropriately actioned can be utilised to improve quality of patient care. 

The morbidity scorecard demonstrates that it is possible to establish an automated system capable of identifying trends in outcome. Accurate recording and reporting of surgical outcomes, in particular morbidity figures, is important in maintaining and improving surgical practice and perioperative care.
Impacts / outcomes: 
This innovation has a clear benefit to patient care and to the NHS. It will improve an understanding of surgical morbidity prospectively enabling surgeons to change practice when rquired. It also enables reduction of complications through learning therby reducing cost to the NHS. Furthermore, patients will benefit from improved counselling and consenting process.
Which local or national clinical or policy priorities does this innovation address:
NHS England guidance on the review and monitoring or morbidity rates.
Supporting quote for the innovation from key stakeholders:
In Healthy Measures: A UK gynaecologist’s plan to improve hysterectomy outcomes led her to develop a Surgical Scorecard that can be used in all surgical specialties. 
Plans for the future:
In terms of the development of the system itself, we plan to increase the number of indicators on the scorecard. These will be speciality specific bespoke indicators.

We are also hoping that this may be taken up throughout the region and the wider NHS and would welcome enquiries about assisting other organisations in doing so, either licensing the materials that we have develoed here at UHCW, or passing on knowledge to enable similar systems to be developed in-house elsewhere.
Tips for adoption:
As above, we would be happy to have a discussion with you regarding implementing this in your organisation. Please see the contact details below.
Contact for further information:
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Meghana Pandit 15/07/2017 - 13:13 Approved
Overview summary:
The Sutton Coldfield Unplanned Admission Avoidance in the Elderly Project involved six General Practices working together to design and implement a method of improving unplanned care for their patients over the age of 70.

Objective results showed a 20.0% reduction in hospital mortality for ACE project patients (p=0.014, ChiSq Test) with no comparable reduction for other local practices not in the project.

Approaching the project in a structured manner and learning service redesign skills maximised the potential for impact and positive outcomes.
Challenge identified and actions taken :
Experienced community nurses were employed to undertake urgent assessment and intervention in patients at risk of imminent admission and of all patients soon after discharge to reduce readmissions. A later additional work stream facilitated earlier safe discharge for inpatients, the ‘pull system’, with active monitoring via a live software feed with real-time details of admitted patients. Relationships between hospital and community medical and social teams were formed and strengthened and new pathway models planned and implemented.

Data collection was both subjective and objective.

The subjective data of ‘crisis’ admission avoidance indicated that 75% of interventions had a significant impact on reducing the likelihood of admission for a relatively low number of interventions each month. For post-discharge reviews this level of impact was much lower at 15%, but for a much larger number of contacts. Early safe discharge intervention demonstrated a moderate or more level of impact for at least 60% of up to 230 interventions each month.
Impacts / outcomes: 
​Objective results showed a 20.0% reduction in hospital mortality for ACE project patients (p=0.014, ChiSq Test) with no comparable reduction for other local practices not in the project.
There were significant reductions in both average length of stay and cost of admission. A system-wide change in average length of stay and cost was observed but the project practices saw greater reductions compared to the other local practices, and we estimate that we achieved an additional cost saving of £324,000 over 2 years.
Which local or national clinical or policy priorities does this innovation address:
Patient Safety, Unscheduled Care, Primary Care.
Supporting quote for the innovation from key stakeholders:
In conclusion, approaching the project in a structured manner and learning service redesign skills maximised the potential for impact and positive outcomes. The observed reduction in hospital mortality, in particular, points towards a significant improvement in patient safety. Reductions in cost and average length of stay also occurred but, as clinicians, nothing compensates for the significant time and effort involved in changing how our National Health Service functions better than the knowledge that patients are now less likely to be harmed.
Plans for the future:
Share the message and continue delivering and improving the service.  
Tips for adoption:
Invest up front in the Improvement Science Foundation training and support before attempting to replicate this elsewhere. 
Contact for further information:
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Simon Dodds 28/06/2017 - 09:41 Approved
Overview summary:
For three years now, dedicated staff in Birmingham Children’s Hospital have been using Appreciative Inquiry as the method for a programme called Learning from Excellence, and the WMAHSN has had such good reports of their work and such interest from its members that they have decided to support its rollout across the region.
Challenge identified and actions taken :
We all have a strong tendency to reflect on things that haven’t worked well, but Appreciative Inquiry helps us understand that we can learn much more from things that go well. It’s an idea that’s catching on in the mainstream, too. Increasingly, it’s an idea being used in sports psychology, where teams who review their good performance are shown to improve more than teams who review the things that didn’t go well.

Traditionally, safety in healthcare has focused on avoiding harm by learning from error, but this approach may miss opportunities to learn from excellent practice. Excellence in healthcare is highly prevalent, but there is no formal system to capture it.
Impacts / outcomes: 
When we learn from our good practice, morale and resilience is improved and our psyche is in a better position to learn. It’s called Learning from Excellence.

A series of introductory talks have ran called Where did it all go right? and then asked interested people to sign up for a two-day AI training course run by Appreciating People. We’ve been asked to provide five of these two-day courses, and they’ve all been fully booked. The participants on them have been amazing – dedicated, talented and really interested in using Appreciative Inquiry to take another approach to learning and enhancing safety.

The participants we worked with at WMAHSN really responded to using AI to create positive education, and work on their Quality Improvement. It helped them build resilience, as they were focusing on the things they were good at, and celebrated their successes.
Which local or national clinical or policy priorities does this innovation address:
Learning from Excellence - Patient Safety
Supporting quote for the innovation from key stakeholders:
In Learning from Excellence [learningfromexcellence.com/], Adrian Plunkett says: We tend to regard excellence as something to gratefully accept, rather than something to study and understand. Our preoccupation with avoiding error and harm in healthcare has resulted in the rise of rules and rigidity, which in turn has cultivated a culture of fear and stifled innovation. It’s time to redress the balance. We believe that studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale.'

Quote from a participant of AI training: ‘The Appreciative Inquiry training will help me to run round table meetings exploring episodes of excellence better. But it will also be useful for my everyday practice, where I will use its strength-based methodology to help me get the best out of the theatre teams I work in.’
Plans for the future:
Studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale. The plan is to continue to study excellence and create more opportunities for learning.

Also aim to get other health organisations in the region to begin to adopt Learning from Excellence and Appreciating Inquiry in their work of practice. 

 
Contact for further information:
Helen Hunt: helen.hunt@wmahsn.org 
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Manish Patel 02/06/2017 - 09:22 Approved
Overview summary:
The Safer Provision and Caring Excellence (SPACE) Programme has been developed by the West Midlands Patient Safety Collaborative (WMPSC), and is being designed and delivered in collaboration with Walsall Clinical Commissioning Group (CCG) and Wolverhampton CCG. It will run in 35 care homes across Walsall and Wolverhampton (all of which provide both residential services and nursing care) over 24 months.  The programme is being evaluated by the NIHR Collaboration for leadership in applied health research and care (NIHR CLAHRC).  
Challenge identified and actions taken :
Improving safety in care homes is becoming increasingly important. Care home residents typically have multiple physical and/or cognitive impairments, and adverse events like falls often lead to hospital attendance or admission. Developing a safety culture is associated with beneficial impacts on safety outcomes, but the complex needs of care home residents, coupled with staffing pressures in the sector, pose challenges for positive safety practices to become embedded at the individual and organisational levels. Staff training and education can positively enforce safety culture and reduce the incidence of harms, but improvement initiatives are often short lived and thorough evaluation is uncommon. The programme will train staff and managers in service improvement techniques, with the aim of strengthening safety culture and reducing adverse
safety event rates. The evaluation will use a pre-post design with mixed methods. Quantitative data will focus on:care home manager and staff surveys administered at several time points and analysis of adverse event rates. Data
on hospital activity by residents at participating care homes will be compared to matched controls. 
Impacts / outcomes: 
This mixed methods evaluation of a large-scale care home improvement programme will allow a substantial amount of qualitative and quantitative data to be collected. This will enable an assessment of the extent to which care home staff training can effectively improve safety culture, lower the incidence of adverse safety.
events such as falls and pressure ulcers, and potentially reduce care home resident’s use of acute services.
Which local or national clinical or policy priorities does this innovation address:
Patient Safety, Improved Quality of care, Prevention of adverse events, Improved staff morale, Improved Dementia Care
Supporting quote for the innovation from key stakeholders:
"Giving the Care Sector a voice"
"supporting each other to provide a positive safety culture"
Plans for the future:
Evaluation to be published in 15 months time 
Regional Care Home Conference in October 17 in the north of the Midlands 
Contact for further information:
Helen Hunt 
Assistant Programme Manager - PSC 
0121 371 8057
Helen.Hunt@wmahsn.org
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Helen Hunt 02/06/2017 - 09:15 Approved
Overview summary:
The Long Term Conditions (LTC) Network has delivered a stream of programmes to encourage uptake of remote delivery of care for LTCs and adverse lifestyle habits. These include options for delivery of care such as Flo simple telehealth, video consultation, Closed Facebook Groups, apps and aid to diagnosis.
Challenge identified and actions taken :
Lack of clinicians’ awareness of viable options for TEC; competence and confidence in their usage:
  • good practical examples described and signposted in LTC Network bulletin to clinicians
  • publications in national journals
  • support for development & launch of national training module 
Lack of patients’ awareness of viable options for TEC;competence and confidence in their usage
  • good practical examples described for patients 
  • pilot upskilling course for patients 
  • support set up and usage of health professional supervised Closed Facebook Groups by three specialties in acute healthcare settings (and a few local Patient Participation Groups (PPGs) in practices
  • support medical students Year 5 to encourage patients to sign up to Patient Online to access their own records 
  • write article for citizen readership in the North Staffordshire Sentinel newspaper 
Confusion about universal approach to shared management of care of LTCs between providers of care and different modes of remote delivery of care:
  • Create LTC shared management website, with clinician and patient sections; 
Lack of leadership across health economies in relation to synchrony/sharing of remoted modes of delivery of care
  • create example interaction across Staffordshire in relation to videoconsultation for clinical consultations
  • shared learning of usage of TECs 
Impacts / outcomes: 
Facebook:
UHNM closed Facebook groups – a total of 354 members, MS (168), AF (91) and cardiac rehab (95)
Public pages – AF – 895 reach per month/498 post engagements per month; Cardiac rehab – 2099 reach per month/791 post engagements per month
 
Twitter: Over 97,000 accounts reached from tweets
 
Manage your Health App: 330 users
 
Flo Simple Telehealth: 652 protocols registered across the West Midlands region
 
Telehealth E-learning course: Since December 2016 when the RCGP CPD course went live there has been 236 registrations with 42 people having completed the course.  Users have rated the course 4.3 out of 5 stars.
 
Publications:
‘Digital Healthcare: The essential guide’, (Authors: Chambers R, Schmid M, Birch-Jones J), 2016
http://www.otmoorpublishing.com/publications/digitalhealthcare
‘Clinicians rise to the social media challenge’ – Primary Care Commissioning CIC
https://www.pcc-cic.org.uk/sites/default/files/comm_excellence_june_2016_aw_web.pdf
‘How video consultations can benefit patients’ – GP Online
http://www.gponline.com/video-consultations-benefit-patients-nhs/article/1401346
‘How to set up a Skype consultation service’ – Medeconomics
http://www.medeconomics.co.uk/article/1401405/set-skype-consultation-service
‘GPs launch Skype to care homes project in Staffordshire’ – Fabsnhsstuff
http://fabnhsstuff.net/2016/06/26/gps-launch-skype-care-home-project-staffordshire/
‘How should we respond to negative comments on social media’ (Authors: Ruth Chambers, Marc Schmid):
http://www.pulsetoday.co.uk/your-practice/dilemmas/how-should-we-respond-to-negative-comments-on-social-media/20032472.article
‘How a Skype trolley saves GP time’ (Authors: Ruth Chambers, Marc Schmid)
http://www.pulsetoday.co.uk/your-practice/focus-on/how-a-skype-trolley-saves-gp-time/20032834.article
Evaluation report, Autographer plus Flo (Authors: Sue Molesworth, Lisa Sharrock)
http://www.simple.uk.net/home/casestudies/casestudiescontent/mental-health-memory-support-for-mild-cognitive-impairment-or-mild-to-moderate-dementia
Stoke and North Staffordshire leading the way in hi-tech help for patients:
http://www.leek-news.co.uk/8203-stoke-and-north-staffordshire-leading-the-way-in-hi-tech-help- for-patients/story-29733613-detail/story.html
‘Revamp your website to reduce demand’ (Authors: Ruth Chambers, Marc Schmid)
http://pulse-learning.co.uk/practice-business-finance-modules/practice-business-finance/revamp-website-reduce-demand
‘Helping the elderly take tablets’ (Authors: John Marszal, Aoife Donnelly, Ruth Chambers)
http://www.health21.org.uk/2016/11/01/old-people-will-use-tech-if-clinicians-let-them/ 
‘Promoting best practice in COPD management’ (Authors: Rosie Piggott, Elaine Cook, Faye Foster, Alwyn Ralphs, Lucy Teece, Roger Beech)
https://www.bjpcn.com/browse/editorial/item/1943-promoting-best-practice-in-copd-management.html
Video: ‘COPD patient avoids A&E and acute admissions through self-management with Flo’ (Author: Ann Hughes)
https://sites.google.com/a/simple.uk.net/community/home/casestudies/casestudiescontent/copd-patient-avoids-a-e-and-acute-admissions-through-self-management-with-flo
The Health Foundation - The Power of People
Video: Introducing Flo: Telehealth with a human touch
http://healthfdn.org.uk/4Y2-4MPPC-35ITUGKE86/cr.aspx
E-Learning: Telehealth, telemedicine and telecare: an introduction to “TECS” (Technology Enabled Care Services)
http://elearning.rcgp.org.uk/mod/page/view.php?id=4117#register
BMJ – Link to back pain article (STarT Back Tool)
http://www.bmj.com/content/356/bmj.i6748
Year 5 Medical Students x 4 Patient Online Initiative – North Staffordshire & Stoke-on-Trent CCG newsletter publication –
www.stokeccg.nhs.uk/news/staffordshire-students-help-patients-to-log-on-to-gp-services-online-4028/<http://nhs.us6.list-manage.com/track/click?u=ef12432f7b285a04d0bfe1494&id=21f44def52&e=33cdefcc95>
Video: https://vimeo.com/206196885/4a38152bac
WMAHSN LTC Network Newsletter – Publication commenced in January 2017 to 500+, the database has now increased to c.750.
Staffordshire Sentinel – weekly ‘Ask the Doctor’ health articles:
http://www.stokesentinel.co.uk/search/search.html?searchType=&searchPhrase=Ruth+Chambers&where=
‘GP praises Endoscope-i’: https://vimeo.com/191810628?ref=em-share
 
Conferences:
Person Centred Care Conference held in Birmingham on 6th May 2016 – 60 delegates
 
‘Making Change Happen with Simple Telehealth and Florence’ held in Stoke-on-Trent on 25th January 2017 – sharing success and best practice with breakout sessions for Acute, Community and Primary Care – 82 delegates
 
Which local or national clinical or policy priorities does this innovation address:
GP Forward View (New models of care/patient empowerment) Underpin delivery - clinical management of key LTCs: Asthma, COPD, diabetes, hypertension, AF
Supporting quote for the innovation from key stakeholders:
Marc Schmid – Digital Expert, Redmoor Communications:
“The programme has brought patient networks together around MS, cardiac rehab and AF and stroke, providing peer to peer support and regular information from clinicians. The introduction of video consultations has enhanced the care available as well as improving the efficiency of service delivery”.

Luke Bracegirdle – Head of Digital & Business Analytics, Keele University School of Pharmacy:
“West Midlands Academic Science Network part funded a development project to extend work on the Manage Your Health app, to include additional content on long term conditions. Prof Ruth Chambers (Clinical lead Long Term Conditions Network, WMAHSN) has been very supportive and used the network to connect our development team with partners with complementary skills as well as link to further initiatives in the region to promote patient information resources in the area of Atrial Fibrillation”.

Phil O’Connell – Chairman & Chief Innovation Officer, simple.uk.net:
"The WMASHN Long Term Conditions (LTC) Network has provided invaluable support for clinical teams, helping to raise awareness of practical and pragmatic remote delivery of care options.  The LTC Network has worked with us, encouraging evidence based uptake through clinical peer to peer sharing of case studies and evaluation across traditional organisational boundaries of the techniques and methods used by our members to address LTCs and adverse lifestyle habits.
International dissemination of the learning, evaluation and case studies developed through the 'Simple Telehealth' programme of work including Florence in the UK, has been greatly assisted by the practical clinical applications and evaluation made possible by the WMAHSN.  The techniques and methods evaluated have achieved replicable positive clinical and productivity outcomes that are now being studied for implementation in Ireland, USA and Australia."

Jodie Williams – Stroke Prevention Clinical Nurse Specialist, University Hospitals of North Midlands NHS Trust:
“The AHSN has widely supported the AF Stroke Prevention Team over the last 2 years.
It has supported the provision for expert advisory for Atrial Fibrillation, its education and management throughout both Primary and Secondary Care.  It has supported the promotion of an online GP Masterclass for Atrial Fibrillation to GPs in Primary Care to continue education and evidence based management for AF patients reducing the risk of AF related stroke. The AHSN has supported the AF stroke prevention team in becoming champions within both Primary and Secondary Care enhancing self care management, reducing major disabling strokes with a positive impact to the Local Health Economy”.
Plans for the future:
  • Continue with pan-Staffordshire rollout of video-consultation option for clinician/patient follow up interaction in all healthcare settings; extend to social care settings as appropriate; share learning and urge adoption across the region
  • Promote the impact/how to overcome inertia to remote options for delivery of care at all levels of NHS across West Midlands and beyond via events, conferences (e.g. focus on CVD and diabetes 10.5.17; quality improvement 13.6.17), publications, LTC Network bulletin, Twitter, etc.
  • Evaluation of Trust-wide rollout of Flo Simple telehealth Sandwell & West Birmingham Trust; county-wide rollout of videoconsultation; use of Facebook in general practices
  • Develop online learning resources and simple course for citizens to use to enhance their confidence and competence in personal use of TEC for their own LTC(s)
  • Promote or develop online learning resources for clinicians to enhance their competence & confidence in adoption of TEC
Tips for adoption:
  1. Inertia is common in the NHS in relation to any new way of working – persist in engaging all those who are vital in making change happen.
  2. Don’t keep what you’ve learnt about the adoption of an innovation to yourself - evaluate, promote, disseminate it. 
Contact for further information:
Ruth Chambers - LTC Network Clinical Lead 
Ruth.Chambers@stoke.nhs.uk

Sue Wood - LTC Network Project Manager 
Sue.wood@wmahsn.org

Marc Schmid - Digital Expert, Redmoor Communications Social Media
Marcgs72@gmail.com

Luke Bracegirdle - Head of Digital & Business Analytics, Keele University School of Pharmacy - Manage Your Health app
l.bracegirdle@keele.ac.uk

Chris Chambers - Telehealthcare Facilitator, Stoke-on-Trent and North Staffordshire CCGs - Flo telehealth
chris.chambers@stoke.nhs.uk
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Sue Wood 23/05/2017 - 07:29 Approved
Overview summary:
Health innovations and ideas frequently require robust research evidence to demonstrate clinical and cost efficiency, or structured real-world trials to support scale and speed of adoption. WFC provide a range of specialist support services in regulatory affairs. 

An example of the services that we can provide is illustrated through the case study of how WFC supported Electromedical Products International, Inc (EPII), to gain real world-data for the adoption of an innovative medical device at scale.
Challenge identified and actions taken :
EPII and the UK distributor The Microcurrent Site (MCS) offer the Alpha-Stim AID medical device. Alpha-Stim AID is proven to be clinically safe and effective in the alleviation of anxiety, insomnia and depression.

To enable EPII and MCS to offer the Alpha-Stim AID to patients in the NHS, research data was required to be submitted to the National Institute for Clinical Excellence (NICE) to evidence the clinical and cost effectiveness of the device when used in an NHS setting. Neither EPII nor MCS had any experience of designing and submitting research studies in the UK.

WFC took a protocol outline and developed it into a full clinical trial protocol with essential documentation following engagement with all stakeholders.

Regulatory submissions were made to the Health Research Authority (HRA) for approval (inclusive of ethical favourable opinion), to the National Institute for Health Research (NIHR) for inclusion onto their portfolio, and to an NHS Improving Access to Psychological Therapies (IAPT) service in the East Midlands.

WFC designed a site initiation training package which was attended by over 60 members of the IAPT team over 2 days to ensure successful and compliant trial delivery.

All aspects of design and delivery were undertaken on behalf of EPII and MCS who were provided with regular progress reports.
Impacts / outcomes: 
The clinical trial, which had been planned for many years, was designed and initiated in just 15 days of WFC consultancy time, enabling EPII and MCS to gather the valuable clinical and cost effectiveness data sooner than expected.

EPII and MCS were able to delegate all aspects of set-up to WFC with confidence, thus reducing the burden upon their teams.

Extensive initiation training ensured a prompt start to recruitment and rapid generation of data.

Strong working relationships with all stakeholders ensured a well-designed study which quickly processed through regulatory approvals. WFC were also able to facilitate conversations with the relevant Clinical Commissioning Groups (CCGs) and patient advocacy groups, with the result that real-world data collection is near completion and ready for submission for adoption of the device in the NHS. 
Which local or national clinical or policy priorities does this innovation address:
NHS IAPT services are committed to initiating treatment for 75% of people within 6 weeks of referral, and 95% within 18 weeks of referral, a clinical target formalised in policy framework Achieving Better Access to Mental Health Services by 2020. Alpha-Stim AID provides a maintenance therapy for people whilst on the waiting list following referral, thus enabling the target to be achieved. Additionally, a significant proportion of people using Alpha-Stim AID achieve full recovery, and so do not require further individualised treatment from NHS IAPT. This represents a considerable saving, and is in line with the NHS Mandate 2017/18 priority to balance the NHS budget and improve efficiency and productivity. WFC support clients to meet the national requirement for a technology appraisal from NICE, which is based upon clinical and economic data. The NHS is legally obliged to fund and resource treatments recommended by NICE’s technology appraisals within three months, as reflected in the NHS Constitution. As such, WFC are experts in navigating local and national priorities and processes. 
Supporting quote for the innovation from key stakeholders:
“Everything was great and highly professional”: Steve Hutchinson, MCS Managing Director. 
Plans for the future:
EPII and MCS will shortly be submitting the clinical trial data to NICE for technology appraisal. Recommmendation for use in the NHS is anticipated due to the high-quality clinical and economic data gathered, working relationships built with clinicians, NHS IAPT service managers, and Clinical Commissioning Group leads, in addition to support from patient groups.

WFC are ready and available to support other users of the Meridian platform to navigate regulatory affairs issues.
Contact for further information:
Mark Terry, Senior Consultant: mark@wendyfisherconsulting.co.uk
Luke Brewer, Senior Consultant: luke@wendyfisherconsulting.co.uk
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Mark Terry 10/05/2017 - 09:32 Approved
Overview summary:
"Let's talk about anticoagulation" video gives information that can be shared with patients who need to consider having anticoagulation therapy.
 
Challenge identified and actions taken :
To support a consultation with a clinician.  The video shows the reasons for anticoagulation therapy, the choices available, including the risks and benefits of the different types.
Impacts / outcomes: 
Gives a simple clear understanding of anticoagulation options for patients and their carers.
Which local or national clinical or policy priorities does this innovation address:
WMAHSN reducing unwarranted clinical variation in AF
Plans for the future:
This video will be included as part of the toolkit of resources the WMAHSN is producing to support AF detection and treatment,
Tips for adoption:
To be used as part of a consultation.
Contact for further information:
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Karen Morrey 03/05/2017 - 12:50 Approved

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