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:
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 –
“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:
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
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Azeem Hanif 07/02/2018 - 16:03 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:
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Neomi 06/02/2018 - 12:13 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 – “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
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Simon Wright 18/01/2018 - 11:03 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 
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West Midlands Academic Health Scien... 18/01/2018 - 10:34 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 01782 734868
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Nicola Evans 17/01/2018 - 15:06 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 -
Marc Schmid -
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Paula Stather 10/01/2018 - 14:46 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:
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
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Ken Garner 08/01/2018 - 15:05 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.

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:
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 -
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Sam Bhatt 30/10/2017 - 12:42 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  
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Lucy Chatwin 29/09/2017 - 15:19 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:
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
07736 008380
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Sue Wood 01/09/2017 - 09:40 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:
The following articles have been published regarding social media:
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:    
Contact for further information:
Marc Schmid
Project Lead
07736 008380
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Sue Wood 01/09/2017 - 09:30 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.
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 
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Sue Wood 01/09/2017 - 09:21 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 - 14:13 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 - 10:41 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 [], 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: 
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Manish Patel 02/06/2017 - 10:22 Approved

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