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.
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Innovation (Approved)

Overview summary:
Adrenal incidentalomas (AI) are lesions found whilst patients undergo radiological scans for other conditions. Most are benign and hormonally non-functional. However, 20% are malignant and/or produce excess hormones. Malignant lesions require rapid treatment as tumours can be aggressive and life-threatening.

This project based at University Hospitals of North Midlands and University Hospital of South Manchester aimed to establish effective management of patients with AIs, minimising delays in diagnosis/treatment and reducing patient distress.
Challenge identified and actions taken :
  1. We did not develop consensus guidelines - these became redundant following publication of 2016 guidelines.
     
  2. How to make the system utilisable with different centres IT systems within our pilot work’s limited budget.
     
  3. We identified the importance of incorporating an MDT outcome letter into eAIMS to save time and reduce errors. Ultimately, this will positively impact on uptake by other centres.
Actions:
  1. The system is aligned with the newly published European Guidelines for AI (2016).
     
  2. In collaboration with Trust IT, we developed a web-based embedded electronic management system (the electronic Adrenal Incidentaloma Management System; “eAIMS”). Use of a web-based system improves ability of other centres to uptake eAIMS, even if they utilise different IT systems.
     
  3. The system captures key information on AI cases and generates a pre-populated MDT outcome letter, saving clinical and administrative time whilst ensuring timely management with enhanced safety (reduced need to re-dictate and type results, minimising transcription errors). We also developed a prioritisation strategy, in collaboration with MDT members, which ensured that high risk individuals are prioritised for prompt discussion and decisions.
     
Impacts / outcomes: 

There are many positives outcomes from the eAIMS project. It has made a positive impact within the healthcare industry and helped to improve patient safety, reduced the time from AI identification to MDT decision and much more. The impact that eAIMS has made is discussed in more detail below:
  1. By using the newly published European guidelines, we developed a novel, web-based eAIMS that links the clinical, biochemical and radiological data necessary for assessing and managing AI patients.
     
  2. Implementation of eAIMS, along with improvements in the prioritisation strategy, resulted in:
    • A 78% reduction in the time from AI identification to MDT decision (vs. our original primary objective of 20%). This significantly reduced delay, which will result in less patient anxiety.
       
    • A 49% reduction in staff hands-on time.
       
    • Improved patient safety:
      • A reduction in the risk of transcription errors, given the in-built error validation of entered data and the automatic generation of the MDT outcome letter as opposed to repeated human-instigated steps.
         
      • Our analysis identified that 70% of AIs were not being followed-up, and hence we are now developing the next stage of the programme to proactively identify all new AI cases, thereby avoiding missing cases (work in progress).
         
    • A 28% reduction in costs (from an independent health economics analysis).
       
  3. Links outside UHNM: Built-in the project is the partnership with UHSM to explore the generalisability and utility of the system. The system was conceived as web-based from the outset to facilitate wider adoption. We have also established dialogue with the Association of British Clinical Diabetologists to showcase our work.
Which local or national clinical or policy priorities does this innovation address:
Firstly, the eAIMS system has improved the prioritisation strategy of AI patients, which has led to a reduction in the time from AI identification to MDT decisions. It has optimised the likelihood of tumour treatments from earlier identification and enhanced digital health. • The eAIMS system is already in place and has become the default at UHNM (University Hospitals of North Midlands). • The web-based system has also already been adopted by University Hospital of South Manchester and is fully functional. This will demonstrate the adoptability by other Trusts.
Plans for the future:
Our plan for the future is to spread the innovation:
  • One of the ways we will spread the innovation is by offering the system to selected Trusts across the UK. By doing this we hope that the system will be adopted by other Trusts.
     
  • We also would like to further develop the eAIMS system to ensure that it is more user-friendly and less time-consuming (e.g. a paper form to be scanned to allow data entry).
     
  • Furthermore, another plan for us is that the data management infra-structure (e.g. system administrator) to manage the core system, ensuring data quality, managing enquires, facilitating audits and more.
     
  • Moreover, we would like to explore other options to enhance and evaluate cost-effectiveness, patient benefit (as measured by changes in anxiety levels).
Tips for adoption:
System is web-based making it very easy for other centres to adopt the system. This has already been demonstrated through University Hospital of South Manchester, who operate on a different base IT system to UHNM, and have successfully adopted and utilised the eAIMS system.
Contact for further information:
For more information contact: Simon.Lea@uhnm.nhs.uk
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Dr Simon Lea 08/03/2018 - 12:37 Approved
Overview summary:
Stephen Lake, a consultant at Worcestershire Acute Hospitals NHS Trust, had the idea to create an eConsent software application. There are many factors that could cause problems when clinicians are writing up risk factors for patients, for example paper-based consent forms are open to increasing errors - handwriting may be unreadable, doctors could miss out crucial parts of patient data and patients may not understand abbreviations.
This led to the creation of the eConsent form, which MidTECH supported with its development and commercialisation.
 
Challenge identified and actions taken :
A consent form fully-informs patients and their agreement to proceed with a surgical intervention. The problem was that these paper-based forms had become complex and open to errors.

Stephen’s vision was of a structured digital version, supporting communication with individual patients. His initial approach was through his Trust’s IT project team, with whom he built a database in Microsoft Access. He and his colleagues used this to select and enter all the necessary fields clearly. The final form was printed out and signed by the patient.

After successful use within the Trust, the idea was ready for further development and commercialisation. This was a challenge that Stephen faced, he was having difficulty finding the right partner.

Action:
MidTECH was approached:
  • Their experienced consultants were able to call on their contacts in order to understand which firms had the expertise, experience and interest in a product like eConsent that would be able to take it to the next stage.
     
  • They also advised both parties on right agreements, from confidentiality agreements through to licence negotiations and contract drafting- striking the best shape for partnership.
     
  • Their wide network of clinical and commercial contacts meant that the project was uniquely placed to find the right collaborator, eHealth Innovation.
Impacts / outcomes: 
One of the outcomes was that with several years of success within the Trust behind the project (which became a Health Service Journal Award finalist in 2008); it was clear that the idea was ripe for further development and commercialisation.

In less than a year, the contracts were signed. Matthew Smith, Business Strategy Manager for Wellbeing Software Group, believed this process was crucial to successfully taking eConsent to market.

eHealth Innovations had the know-how to take a Microsoft Access database and turn it into something slicker and more intuitive to use. The package now runs off a hospital server and displays in an attractive user interface optimised for mobile devices, such as tablets. The process is fully digital too – the paper form is being finally consigned to history.

MidTECH are continuing to consult with e-Health Innovations and the Worcestershire team, supporting eConsent in its broader adoption. Via its links with the West Midlands Academic Health Science Network, MidTECH has encouraged regional adoption through workshops and launch events.

eConsent is a software application that originated within Worcestershire Acute Hospitals NHS Trust, resulting in a licensed commercial product which is now available on the market.

Such has been the success of the partnership that was facilitated by MidTECH that the adoption of eConsent doesn't stop there. "Only months after the official launch, we were invited to tender for introduction in thirty-eight hospitals in the USA," says Chris. "As of now, we've made it through to the shortlist”.

“We wouldn't have even heard about eConsent without MidTECH – and now we're working to market it the world over. Their networks have helped to make this happen."

Therefore, MidTECH has helped this project take international adoption.
 
Which local or national clinical or policy priorities does this innovation address:
Issues around the proper consenting of patients.
Supporting quote for the innovation from key stakeholders:
“I didn’t know then that this idea might be considered worthy of a prize, but it did seem an extremely useful time-saving, and quality–improving, concept.”
 
"What emerged from the MidTECH introduction was a really productive partnership. Both Stephen and the Trust were really keen to get the product out there – and so were we.”

“We wouldn't have even heard about eConsent without MidTECH – and now we're working to market it the world over. Their networks have helped to make this happen."
Plans for the future:
Chris Burdett is the Product Manager at e-Health Innovations and responsible for eConsent: "We're developing new functionality for eConsent all the time. Stephen's original idea has been totally reworked using our expertise into eConsent 2.0. The product emails a link of the form to a patient, so they can review it at their leisure – and they simply sign on the device the next time they're in the hospital. It's a huge move forward for the patient experience."
Tips for adoption:
If this is a system you would like to adopt in your organisation then please contact e-Health Innovations - http://e-healthinnovations.com/ 
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MidTECH Innovations 21/02/2018 - 14:44 Approved
Overview summary:
The West Midlands GMC (WMGMC) is the largest GMC, working with all 18 acute trusts in the region to underpin the delivery of the project. The WMGMC Education Team has developed a suite of educational programmes to ensure the region’s current and future workforce is equipped to understand how genomics medicine might impact on their role.
Challenge identified and actions taken :
The WMGMC Education Team has developed a suite of educational programmes to ensure the region’s current and future workforce is equipped to understand how genomics medicine might impact on their role. 
  • Developing and delivering consent training for healthcare staff across the region
  • The development of National Consent and Recruitment ‘Train the Trainer’ days for staff from all GMCs, using a blended learning approach Partnership working with the University of Birmingham, which offers an MSc in Genomic Medicine and associated Continuing Professional Development (CPD) modules
  • Delivering a Genomics Access Course to provide intermediate genomics training and support applications to the MSc in Genomic Medicine
  • Providing work experience opportunities in genetic counselling and genomics for GCSE and A-level students, in partnership with HealthTec
  • Contributing to the development of Advanced Clinical Practitioner roles in genomics
  • Working closely with the Genomics Ambassadors to promote education and training across the 18 trusts
  • Engaging with primary care.
  • Developing a system-wide training needs analysis in line with national requirements
Impacts / outcomes: 
The immediate training priority for the West Midlands was to train sufficient numbers of health care professionals, with some existing genetics knowledge, to recruit and consent patients across a number of local delivery partners (LDPs) in line with the phased roll out of the 100,000 Genomes project. A further learning need was identified whilst working with the University of Birmingham (UoB), the local provider of the MSc in Genomic Medicine;  non-medical health care professionals were dissuaded from applying for both CPD modules and the MSc due to insufficient knowledge in basic genetics science. 
 
The West Midlands working with UoB developed an Access Course designed to educate non –medical healthcare professionals who had little knowledge of genetics or genomics and to support them in successfully meeting the entry requirements for the MSc in Genomics. Other courses provided by the WMGMC included an interactive one-day recruitment and consent programme as well as a blended E-Learning Consent course which built on work from Health Education England (HEE).
A national consent training day was also organised to allow for additional training alongside the blended learning package.
 
The Recruitment and Consent course delivered both centrally and through blended learning has been hugely effective. Locally it enabled individual clinics across 18 LDPs to meet recruitment targets across cancer and rare diseases. Furthermore, these genomics training events are thought to have contributed to interest in and attendance on CPD modules as well as the full MSc in Genomic Medicine at the UoB.
 
The phased roll out of the 100,000 Genomes Project has also been assisted by the three Genomic Ambassadors. As part of a focus on precision medicine the AHSN sought to fund these 3 innovative posts known as Genomic Ambassadors. In the early days the role largely comprised of engagement of various healthcare professionals, coordinating teams ahead of going live to recruitment as well as training staff to consent patients. The genomics ambassadors regularly take part in regional and national events to raise awareness for not only the 100,000 Genomes Project but also personalised medicine, an important aspect which has also developed their ability to educate groups of people including nurses, scientists and students.
 
As well as events focussed on workforce training the Education Team have helped with activities to ensure the future workforce is aware of genomics. This includes enabling work experience opportunities for  school, college and university students ensuring the next generation of scientists, nurses and doctors receive vital experience within the genomics and genetics field.
 
The WMGMC has also worked closely with the national Genomics Education Programme team to ensure national requests are fulfilled. This has included producing a training needs analysis questionnaire to highlight the needs of different staff groups. Each GMC was asked to produce a questionnaire suited to their workforce with the focus of the WMGMC being Healthcare scientists. From this a national report is to be produced which will hopefully influence training and education opportunities in genomics that will be available in the future.
Which local or national clinical or policy priorities does this innovation address:
The 100,000 Genomes Project is a national initiative. To help deliver this project Genomics England was established. Two of the four main aims of Genomics England are to bring benefit to patients and set up a genomic medicine service for the NHS and kick start the development of a UK genomics industry. These points in particular highlight the importance of the Genomics Education Programme and the need for the workforce to receive the relevant training and education.
Supporting quote for the innovation from key stakeholders:
“I don’t want it to end, I don’t want to stop learning” ~ Genomics Access Course Participant
 
‘We certainly enjoying running the course and were excited to be able to share our insights into Genomics and the impact of the 100,000 Genomes project to healthcare both now and in the future.  We were pleased meet so many of our colleagues working in and around genomics in the West Midlands and be able to inspire and enthuse them to put their new found knowledge into practice.’

Laura Boyes, Lead Consultant Genetic Counsellor
Plans for the future:
Education in the West Midlands Genomic Medicine Centre continues to be vital. With the return of results from the 100,000 Genomes Project staff will need to be trained to effectively inform patients about the outcome of their genetic testing. Currently the hope is for members of Multi-Disciplinary Teams and leads of the soon to be established Tumour Boards to receive two days of training with the opportunity for further half days of training which will delve into more advanced content.
 
As well as this the Education Team have recently been successful with a bid to HEE for the development of an interactive education and training tool around Genomics aimed at supporting higher education institutes to deliver high quality education to their undergraduates. This will start initially with undergraduate nurses and medical students but will be expanded to support other programmes. The programme will be `train the trainer` style to expand the knowledge base of genomics across undergraduate teachers.
Tips for adoption:
Identify and plan for both immediate and longer term needs with the right stakeholders to ensure that the training offered is delivered at the relevant time and has the right buy in. 
 
Classroom based training in this instance has needed to be followed up to ensure course participants have the confidence to practice. Having on the ground ‘ambassador roles’ has enabled the right level of support to be given locally following formal training and which has been essential.
 
Good Planning!
Contact for further information:
Kirsten Chalk
Education and Engagement Project Officer
2nd Floor Open Plan Office
Institute of Translational Medicine
Heritage Building, QEHB
Mindelsohn Way
B15  2TH
 
0121 371 8161
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West Midlands Academic Health Scien... 21/02/2018 - 10:53 Approved
Overview summary:
Nationally there is a decline in prevalent ladies attending for Breast screening and engaging with services. We created a Facebook page as an alternative innovative method of engaging with local communities, with the aim of targeting prevalent ladies. This is delivered as a practitioner-patient communication platform that informs, influences, and motivates cohorts to make better health decisions to improve cancer outcomes.  Positive peer to peer encouragement has resulted in hard to reach ladies engaging with services.
Challenge identified and actions taken :
Through the use of Facebook and publishing community posts to the wider community networks, we are highlighting and promoting the breast awareness message and the importance of early detection through screening, thus improving cancer outcomes. We have established a positive conversation with targeted community cohorts, therefore enabling and empowering women to make informed choices. These posts are breaking down a number of barriers, including organisational and misrepresentation barriers and are resulting in behavioural changes towards Breast screening. On updating specific screening information, we are able to encourage engagement and advice on correct pathways to the service.

In targeted areas, engagement posts are published at regular intervals, to prompt ladies of their appointments.

We have identified that there is a misconception in the over 70’s being entitled for Breast screening. This is highlighted in each engagement post.

During the creation process, I encountered a number of organisational barriers and concerns. The implementation of the digital strategy had to adhere to all trust policies.
Impacts / outcomes: 
These initiatives have resulted in two large village practices having an increase in the overall uptake rate in 2017, compared to 2014. With a large increase in prevalent ladies attending from both practices. It was also noted that the number of ‘A’ symptomatic cancers diagnosed with the screening service in 2017 was double compared to 2014. The Facebook engagement initiatives have resulted in uptake amongst the prevalent and incident cohorts and therefore improved cancer outcomes.
 
Nationally we have the largest number of followers out of all the Breast Screening services, this currently stands at 1,172. On average, the monthly reach of published post is 37,464, with a high proportion of this being organic.
 
The animation of the breast screening pathway, which is understandable to all health literacy levels and is also culturally sensitive has been viewed over 26k times.
Improved digital communication and engagement methods have resulted in a number of perpetual non-attender ladies making direct contact over the page. With the practitioner-patient conversation, individuals then felt empowered to make a positive behavioural change and attend for their screening invitations. 
Which local or national clinical or policy priorities does this innovation address:
To enhance national cancer screening uptake and to reduce mortality rates. • To optimise the likelihood of effectiveness of cancer treatment from early identification • Enhancing digital health literacy • To promote health behavioural changes • To endorse the breast awareness message • To minimise cost of cancer treatment for the NHS
Supporting quote for the innovation from key stakeholders:
From patients

“If I had not seen the post on Facebook, I would not of asked or checked myself because where else can we women go. You only go to the doctors if you’re ill and even then you are in two minds.”

“I saw the post and knew that mum was due screening but hadn’t heard anything from the doctors so we got in touch, which was very easy. We’ve both discussed that neither of us were particularly aware and rarely or never checked ourselves so we’ve definitely become more aware now.”

“It made me chase up a missed appointment.”

“It certainly got myself, family and friends chatting about screening and checking. I think personally ladies are more likely to check themselves after seeing social media or TV ad’s nowadays.”

“Really pleased to find a contact for queries regarding breast screening. I have had great difficulties in the past accessing breast screening due to BRAC+ status and having ovarian cancer. I am more than pleased that I can say I can message someone and not have to go through switchboard trying to find a department who may be able to answer queries and offer support/advice. Thank you.”
Plans for the future:
To explore further avenues in engagement and awareness, with a particular focus on hard to reach groups.
 
A video of the patient pathway is currently in production, this will feature local ladies who were diagnosed through our screening service. This video will deliver a powerful message within the local community in that through early diagnosis with the Breast screening service, mortality rates from Breast cancer are greatly reduced and quality of life is increased.
Tips for adoption:
Perform mapping exercises and identify relevant community pages and closed groups, they normally have a large following with regular engagement and interaction within the group. Write an editorial article and get this published on the main news feed, informing and encouraging ladies to make contact with any queries or concerns.
Contact for further information:
Gina Newman
Health Improvement Practitioner
Breast Care / Breast Screening
County Hospital
Weston Road
Stafford
Staffordshire
ST16 3SA
 
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Gina Newman 20/02/2018 - 13:06 Approved
Overview summary:
The Solihull Approach is a training method for practitioners working with families, children and young people, developed from within the Heart of England NHS Foundation Trust. Hazel Douglas, a clinical psychologist is the Director of the approach.

The approach began in 1996 as a new method of training health visitors supporting parents of children experiencing sleep, feeding, and toileting or behaviour difficulties. As the approach became popular it now needed trademarks, intellectual property agreements etc. This is when MidTECH was contacted.
Challenge identified and actions taken :
The approach was successful with health visitors who first utilised it, that it quickly began to be applied more broadly, becoming an integrated model for many practitioners. Hazel and the team wrote and produced their own course packs. These ever since have been used to think about the behaviour of children in a holistic, relationship-based way.
Trademarking:
 This success posed challenges, however: as the approach grew and began to be disseminated widely, questions of ownership arose. For Hazel, who had devised the method the question of rights to the ideas behind it became critical.
Franchising the Model:
In addition franchising the model also had its difficulties. MidTECH thus helped to protect Hazel and her team from copy-cats looking to steal their work. MidTECH enabled them to establish a framework for establishing franchises.
Action:
Trademarking:

MidTECH became Solihull Approach's in-house IP specialists. They explained the process of registering a trademark so clearly and MidTECH worked with lawyers who inevitably became involved.
Franchising the Model
MidTECH enabled a framework for establishing franchises. Via an intensively consultative process, MidTECH worked extensively with lawyers on Solihull Approach's behalf to devise a set of proper legal agreements which could govern these sorts of arrangements.
Impacts / outcomes: 
The security MidTECH provided to the Solihull Approach and their efforts to spread their successful model ever further can't be underestimated: on the day we touched base with Hazel to write this article, the Trademark Office had called her to highlight a new trademark which had the potential to infringe upon Solihull Approach's.  Needless to say, she turned immediately to MidTECH for advice on liaising with her lawyers, the Trademark Office – and assessing the potential clash.
MidTECH have helped to create a strong theoretical model which now educates people in how to understand their relationships and in a way that increases the wellbeing of individuals with of training health visitors supporting parents of children experiencing sleep, feeding, and toileting or behaviour difficulties.
Which local or national clinical or policy priorities does this innovation address:
The Solihull approach was developed from within the Heart of England NHS Foundation Trust but now the model is used Nationwide.
Supporting quote for the innovation from key stakeholders:
"They explained the process of registering a trademark so clearly that we could do it ourselves. That advice was absolutely crucial, and MidTECH was able to work with the lawyers who inevitably became involved”. 

“People in professions are trained to give advice – but it’s often difficult to make it heard. We now have in place a strong theoretical model which educates people in how to understand their relationships and in that way increase their well-being.”
“We got in touch with MidTECH through our Trust, the Heart of England NHS Foundation Trust," recalls Hazel. "They very quickly got to work."
"Not only that, but we recently needed our trademark to be appropriate to new activity in China: without MidTECH, we wouldn't have known whether or how to extend ours to cover a range of much less obvious classes in order to protect us in challenging international markets. There's no way we could have done that ourselves.”
“That's why it's so helpful to be able to access people who do know this world, who are experts. It gives you the confidence you need to innovate and expand."
Plans for the future:
Talks currently underway with China and adoption in Australia is underway.
Tips for adoption:
If you are interested in using Solihull Approach in your organisation please contact the team at - https://solihullapproachparenting.com/contact-us/
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MidTECH Innovations 15/02/2018 - 17:46 Approved
Overview summary:
Trajan has been working closely with New Cross Hospital’s pathology department to improve performance of bone marrow trephine (BMT) biopsy testing. Bone marrow diagnostic tests are usually undertaken for cancers that are most likely to affect bone marrow such as lymphoma & leukemia.
 
An ongoing challenge for New Cross has been a higher than normal test repeat rate on BMT cases, due to tissue lifting off microscope slides during processing.
 
With minimal failure & repeat rates, using Trajan slides provides fast turnaround time for patient results.

Challenge identified and actions taken :
An ongoing challenge for New Cross Hospital has been a higher than normal test repeat rate on bone marrow trephine (BMT) biopsy sections due to tissue lifting off the surface of microscope slides during processing resulting in specimen loss.

BMT biopsy is carried out as part of assessment of various hematological conditions to evaluate marrow cellularity, cell distribution & morphology.

The bone marrow sample required is usually taken from the patient’s hip bone using a trephine needle.
 
Taking into account complexity of the trephine biopsy procedure & patient discomfort the small volume sample (~1.5-2 cm length) becomes highly valuable in supporting patient diagnosis.

Image below Sectioning ~1-2 µm thin bone marrow trephine specimens using microtome.


 
Trajan supplied specialised adhesive microscope slides for review in BMT cases by New Cross Hospital. The initial verification & validation exercise as part of the laboratory’s ISO15189 compliance showed Trajan Series 3 adhesive microscope slides dramatically increased the retention of BMT tissue sections on test slides.

With minimal failure & repeat rates, Trajan’s Series 3 adhesive microscope slides provide fast turnaround time for patients as results for H&E & other IHC stains are available within 48-72 hours of carrying out the biopsy depending on the applied protocol.
Impacts / outcomes: 
Trajan Series 3 adhesive microscope slides assist investigation of BMT biopsy samples with an aim to support diagnosis and management of hematological conditions. The slides provide excellent specimen adhesion and the mounted sections can be used for an array of routine and IHC stains.
 
Since the adoption of the Series 3 adhesive microscope slides, they have been used in more than 235 bone marrow trephine biopsy cases at New Cross Hospital and have demonstrated outstanding results with regards to stain quality as well as minimum repeat rates due to tissue loss.
 
Previously each repeat stain for a repeat test would take a day and a half to complete (cut and dry on overnight and stain the next day). With Trajan Series 3 Adhesive slides, due to their strong adhesion quality, no repeat tests are required.
 
Trajan Series 3 Adhesive slides are now used for ALL Bone Marrow Trephine biopsies at New Cross Hospital.

National Clinical / Policy Priorities:

NHS England’s 2016-17 Business Plan – https://www.england.nhs.uk/wp-content/uploads/2016/03/bus-plan-16.pdf
 
“Cancer is increasing – there will be 300,000 new diagnoses a year by 2020. Following publication of the Cancer Taskforce report in July 2015 we will drive down waiting times, increase diagnostic capacity and develop a modern national radiotherapy network.
 
Trajan Series 3 adhesive microscope slides assist investigation of BMT biopsy samples with an aim to support diagnosis and management of hematological conditions, helping to improve patient experience and outcomes.

Image below: Robust tissue adhesion with H&E stain of bone marrow trephine (BMT) biopsy section on Trajan Series 3 adhesive microscope slide.



Image below: Minimal background staining with the reticulin silver stain of bone marrow trephine (BMT) biopsy section on Trajan Series 3 adhesive microscope slide.


 
Which local or national clinical or policy priorities does this innovation address:
Supporting quote for the innovation from key stakeholders:
“Since the adoption of Series 3 adhesive microscope slides from Trajan Scientific and Medical, we have used them in more than 235 bone marrow trephine biopsy cases which demonstrated outstanding results with regards to stain quality, as well as minimum repeat rates due to tissue loss.”
Glyn Woodward, Quality Lead, New Cross Hospital.

“Trajan Series 3 adhesive microscope slides have worked well with these BMT biopsy specimens as they provide much improved tissue adhesion during staining. Their positively charged hydrophilic nature prevents any tissue loss in this particular specimen type.” “We do not have to worry about tissue lifting off the slide surface, which has helped us with our turnaround time too because we don’t have to repeat stains where specimens have fallen off.”
Pam Leach, Immunohistochemistry Lead, New Cross Hospital

To read the full Testimonial - click here.
Plans for the future:
N/A
Tips for adoption:
Finding time to complete the tests using Trajan Series 3 Adhesive slides was the only real challenge.
 
New Cross Hospital completed 6-7 cases and witnessed vast improvements in results with regards to stain quality as well as minimal repeat rates due to tissue loss. As a result, a decision was taken based around the improved quality using Trajan Series 3 Adhesive slides.
Contact for further information:
Azeem Hanif, Commercial Projects Executive
Trajan Scientific and Medical
 
Direct: +44 (0) 1908 568 844
Mobile: +44 (0) 7534 140 969 

ahanif@trajanscimed.com
 
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Azeem Hanif 07/02/2018 - 17:03 Approved
Overview summary:
The Multi Award Winning Neo-slip® is a novel, innovative yet practical solution that aids application of TED (thromboembolism-deterrent) stockings in a ward environment or whilst the postoperative patient is recovering at home.
Challenge identified and actions taken :
After seeing both nurses and patients struggling to apply compression garments in my role as a registered nurse I experimented with different materials in the hope of creating a smoothing aid that reduced friction and helped in the application of tight compression.

The result? The Neo-Slip.

Neo-slip® is a new, innovative low friction pouch available in colour coded sizes and fits onto the limb before the tight fitting compression, this creates a lubricous/slippery effect which slides the stocking into place and makes putting on stockings as easy as applying socks.

Neo-slip® enables patients to live independently and improve their quality of life thus enabling staff to focus on other tasks. Patients in the community no longer have to rely on nurses or social workers coming into their homes to apply tight surgical stockings.

Impacts / outcomes: 
Neo-slip® delivers value for money by reducing the significant costs associated with DVT for the NHS, the economy and individual patients, which could also affect their family.
 
Health Select Committee estimated in 2005 that the total cost including the indirect cost to the UK for the management of DVT was approximately £640 million. In addition, the total annual costs of treating venous leg ulcers, a consequence of DVT, in the UK were in the region of £400 million.

Cost of treating complications is also very high; if you compare it to the cost of purchasing our product Neo-slip®, this will go on to encourage patients to wear their stockings that are vital in the battle against DVT.

Estimates show cost of treating a patient with DVT is £216 per day. With a typical stay in hospital of 5 days bringing total cost £1080 for just one occurrence of DVT.

Neo-slip® is sold to the NHS at £5.80 per unit and saves considerable time (and hence costs) of applying TED stockings, significantly reduces the cost of additional treatment and expensive stays in hospital (and thus increasing bed availability for serious illness) but most importantly helping nurses and patients, particularly when at home to apply their TED stockings correctly and easily.

Our strategy fits with current NHS strategy and objectives in driving efficiency and tackling waste, to make money invested in the NHS go further by delivering the services that patients want, including the latest technology.

Our innovation supports this by encouraging more efficient use of TED stockings. For example, a hospital purchased 27,779 pairs of anti embolism stockings at a cost of £68,158. However, Quinn et al (2015) surveyed 60 patients and found that over half found difficulty in the application of TED stockings, whilst physicians predicted that difficulty in the application was the main reason for non-adherence.

Anecdotal evidence suggests many patients do not adhere to the advice given in hospital to wear stockings for up to 6 weeks following discharge due to the difficult application.

Our innovation fits with current NHS strategy and objectives because the low unit cost pricing matrix of our innovation will support the NHS to take further action nationally to ensure that they can deliver more benefit for patients from every pound of its budget. As well as harnessing people power the NHS needs to leverage the potential of Innovation, which enables patients to take a more active role in their own health and care
 
Which local or national clinical or policy priorities does this innovation address:
Our strategy fits with current NHS strategy and objectives in driving efficiency and tackling waste, to make money invested in the NHS go further by delivering the services that patients want, including the latest technology.
Plans for the future:
We are expanding our range to include children size Neo-slip. This is a direct result of requests from nurses in the lymphedema clinics
Tips for adoption:
In the past two years, I have completed the design registration for Neo-slip®, trademark, patent pending, have obtained ISO9001 recognition, gained availability via NHS drug tariff (prescription) and, earlier this year, our nurse-led company achieved accreditation and listing on the NHS Supply Chain.

Listing on the NHS Supply Chain is vital for the future growth of the company, as this listing allows all NHS hospitals to order Neo-slip® without having to undertake their own due diligence on a product's efficacy and quality.

We currently supply  private hospitals across the UK and recently have signed an agreement with Boots chemist to fulfill our prescription orders for community patients.
Contact for further information:
www.neo-slip.co.uk
07961738165
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Neomi 06/02/2018 - 13:13 Approved
Overview summary:
Lantum is an intelligent clinical bank management platform using AI & machine learning to send the right shifts to the right people with minimal effort

Our Health Partnership (OHP) is a GP partnership in Birmingham/surrounding areas, consisting of 38 practices & nearly 240 GPs serving around 333,000 patients
 
Lantum set up a collaborative staffing bank for OHP in August 2016 with salaried “roving” GPs/local locums. Lantum’s approach of establishing a network of trusted, readily accessible online local doctors has led to impressive results for OHP
Challenge identified and actions taken :
As part of their aim to improve life for their members, Our Health Partnership (OHP) were looking to provide a way for all practices to share local GPs without paying high agency fees.
 
The challenge they faced, was how to achieve this without creating more time consuming, manual scheduling for the central admin team and local practices.
 
In June 2016, Lantum began working with OHP to set up a digital collaborative staff bank, with the goal of transforming the way member practices manage their locum requirement.
 
Lantum provided an end to end platform with tools for both GPs and OHP practices. For both admin staff and GPs everything is highly automated to save time and effort: timesheets, payroll, pension forms, optimising gap filling and even much of credentialing.
 
Lantum also helped OHP devise an implementation strategy including communications to both practices and GPs, a launch event, and support via a dedicated activation team.
 
The bank - comprised of local locum contacts & salaried ‘roving’ GPs to further reduce costs - went live on the 8th August, 2016.
Impacts / outcomes: 

Lantum’s technology now allows OHP practices find GPs in seconds.
 
When a job is posted on Lantum it triggers smart app, text message and email notifications to be sent to GPs who are available to work in the area. OHP Practices can also choose for any sessions not filled by staff from the collaborative bank to be made available for the wider community of local GPs on Lantum.
 
3 months after the launch, OHP practices filled 90% of all hours posted on Lantum. 46% of those hours were filled with an OHP bank GP, saving practices £2,653 in agency fees.
 
Cumulative savings 12 months after launch were in excess of £24k and there are now nearly 90 OHP bank GPs, working as many as 100 hours per month across member practices.
Which local or national clinical or policy priorities does this innovation address:
NHS England’s 2016-17 Business Plan – https://www.england.nhs.uk/wp-content/uploads/2016/03/bus-plan-16.pdf “Primary care is the bedrock of the NHS. We will support GPs, widen the workforce, harness digital technology and increase use of pharmacists. We will extend the range of services and improve access to them.” Lantum’s intelligent staff management platform uses digital technology to assist healthcare providers to improve the continuity of care they provide to their patients by enabling them to source high quality and cost-effective GP cover for their practices.
Supporting quote for the innovation from key stakeholders:
We were looking for an innovative way to meet the challenge of sourcing high quality and cost-effective GP cover in our practices. We wanted a reliable and effective solution and the Lantum approach, of establishing a network of trusted local doctors that are readily accessible online, was instantly appealing.
 
The platform is easy-to-use and the energetic activation teams who assisted with the set-up meant our practices were fully bought in from the word go. We have seen impressive results since its launch and are excited to see what it can deliver in the future.

 
Dr Mark Newbold, Managing Director, OHP

The beauty of the Lantum platform is how easy it is to use and the cost savings it offers to our member practices when they book a bank GP. Looking to the future, we are really excited to see how the idea can be applied to other grades of staff.”
 
Lesley Evans, Operations Director, OHP
Plans for the future:
OHP and Lantum are now working on applying the GP bank model to other grades of staff. By building a flexible staffing platform for forward thinking providers like OHP, Lantum aims to help maximise the potential of local workforces across the NHS, improving patient access and reducing temporary staffing costs.
Tips for adoption:
Engagement (of both practice staff and locum GPs) is key to the success of a collaborative staff bank. In practical terms, this means communicating the goals of the initiative early and often, whilst making sure everyone understands the benefits they can expect by participating.
 
I particularly liked the approach of OHP working in collaboration with Lantum to bring the concept to life. Their team provided ample support throughout the process with bi-weekly conference calls to discuss the progress of onboarding practices and GPs. We were able to quickly build a great working relationship and I believe this was key to the bank’s success.”
 
Lesley Evans, Operations Director, OHP
Contact for further information:
Simon Wright, Engagement Manager
07985 648 871
0203 793 4257
simon@lantum.com
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Simon Wright 18/01/2018 - 12:03 Approved
Overview summary:
The project used existing pharmacy interventions, New Medicine Service (NMS) and Medicines Use Reviews (MURs) to improve knowledge and confidence in using the correct injectable therapies for both community pharmacy and patients. Pharmacists attended 2 training events focused on improving knowledge and consultation skills with patients with diabetes who were using injectable therapies. Pharmacists were also introduced to a consultation framework, the Five Star Diabetes Consultation, which became the framework for future patient consultations.  
Challenge identified and actions taken :
It was intended that the project would:
  • Develop an education framework for a community pharmacy consultation on injectable therapies in diabetes  
  • Develop a community pharmacy consultation framework for injectable diabetes therapies
  • Enable community pharmacists in the pilot to deliver patient support for injectable therapies for diabetes via a consultation
  • Measure outcomes to show the value of interventions  
  • Increase confidence of pharmacists in conducting consultations and improve the competence of patients using injectable therapies
  • Foster closer relationships between community pharmacy and general practice
27 community pharmacies and eight general practice surgeries in the Coventry and Rugby CCG participated in the project around the following areas: 

Pharmacy education: An initial engagement meeting was held ito communicate the project. This also provided an insight into the training needs for community pharmacy. Two pharmacy training events were delivered. 

Framework for pharmacy consultation: The project team developed a pharmacy consultation framework, the Five Star Consultation, which provides a guide to pharmacy on how to deliver a patient consultation.

Development of an education framework: A declaration of competence was produced in order to provide a framework for pharmacists to develop and maintain skills.
Impacts / outcomes: 
Project outcomes include: 
  • A pharmacy consultation and education framework was written
  • Pharmacists who attended the training reported an increase in confidence pre- to post-training as a consequence of the training, with 77% likely to complete and NMS/MUR consultation as a result of the training.  
  • During May and June 2017, 50 consultations on injectable therapy were completed as a result of the training.
  • An improvement in pharmacists’ ability to deliver consultations for diabetes injectable medication.  
  • Pharmacist reported a significant increase in their confidence to deliver consultation for patients taking injectable diabetes therapies. Figure 1: illustrates the impact which the project has had on improving the ability of community pharmacy to deliver NMS/MUR.
  • Pharmacists felt the face to face training was excellent, ‘the best’ one the pharmacist had ever attended. 
Videos of the 2 start and 5 star consultation along with an engagement video are available upon request. 
Which local or national clinical or policy priorities does this innovation address:
Five Year Forward View and providing support to long term conditions
Supporting quote for the innovation from key stakeholders:
“As barriers are broken down across the NHS and boundaries become blurred, patient pathways for injecting become all the more important and this needs to begin with better support for Advanced people to manage their own health. 

“Much greater pharmacist support to people with long-term conditions should be the ultimate aim, but only as one element of a patient’s care and alongside measures to improve public health. It needs to be delivered in a way that is integrated both in terms of NHS and public health systems.”

Community Pharmacy Clinical Review The Kings Fund 

"Diabetes is a fast growing health threat facing our nation.  Over 3 million people are living with diabetes in England.  If their condition is managed they can live longer and fuller lives. The cost of diabetes to the NHS will continue to rise.  In order to ontrol these costs, the Department and the NHS must take significant action to improve prevention and treatment for diabetes in the next couple of years"

Diabetes United Kingdom - State of the Nation 2016
 
Plans for the future:
This programme highlighted the benefits of involving Community Pharmacists in supporting people with long term conditions and the future could involve a much wider cohort of conditions to support.  The Health Living Pharmacies start to underpin this approach and are evolving across the region at pace and scale. 
Tips for adoption:
Conclusions and lessons learned:
  • The project identified a lack of integration between general practice and community pharmacy, with little or no incentive to integrate community pharmacy into general practice. Figure 2 within the case study attached illustrates the current interface between general practice and community pharmacy and an envisioned process.
  • The project team had not anticipated the lack of awareness from primary care of pharmacy NMS and MUR
  • When engaging with general practice it is essential to secure a CCG sponsor who will facilitate engagement from general practice
  • Education and consultation frameworks were developed and can be used for future projects
  • Completing the data recording paperwork by pharmacists was a barrier to data collection owing to other data collection work happening at the same time. This resulted in a lower than expected data return. 
Contact for further information:
NHS England’s (NHSE) West Midlands Pharmacy Local Professional Network, the West Midlands Academic Health Science Network, Coventry and Rugby Clinical Commissioning Group (CCG) and Coventry Local Pharmaceutical Committee, Lilly UK and Novo Nordisk Limited completed a joint working project aimed at improving the outcomes of patients with diabetes who were taking injectable therapies. 

More information can be found in the attached document or by contacting: 

Lucy Chatwin 
lucy.chatwin@wmahsn.org 
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West Midlands Academic Health Scien... 18/01/2018 - 11:34 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 - 16:06 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 - 15:46 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 - 16:05 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 - 13:42 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 - 16:19 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 - 10:40 Approved

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