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

Innovation (Approved)

Overview summary:
The Solihull Approach, an NHS based team of health professionals, have developed an exciting online course for parents, carers and professionals. ‘Understanding Your Child’ includes 12 modules (20 minutes each) and follows 5 other families. The focus of the course is  how our emotions affect our relationships and behaviour. It looks at brain development, play, styles of parenting, sleep, temper tantrums, communication and more and is based on the nationally and internationally acclaimed face to face course.
Challenge identified and actions taken :
Unlike antenatal support, there is a stigma around accessing parenting support.
We know a great deal about preventing mental health problems in future generations. We know that the brain develops in response to its environment and is especially sensitive to the quality of relationships with caregivers, particularly in the first three years of life.
There is “floor to ceiling” evidence that intervening early and preventatively pays both economically, emotionally, and cognitively and achieves life long impact.
A trial of universal parenting support was undertaken by the coalition government (CanParent trial 2012-15). The Solihull Approach was a provider in the trial. The range of courses on offer were very popular with those who took them but the trial reached only a fraction of the intended audience, less than 3000 out of an intended 20,000. A CanParent survey revealed that most 98% of parents would be interested in a course, but the difficulty is accessing one.
The Solihull Approach developed the online coures in response to this finding.
The Solihull Approach face to face course and online course were  the first in the country to be awarded the DfE’s Quality Mark.
The Solihull Approach is offering multi-user licences to corporates, schools, NHS trusts, local authorities, public health, and prisons.
 
Impacts / outcomes: 
Data analysed so far: 121 parents highly significant reductions in conflict and increases in closeness in the relationships between the parents and their children on the two subscales and overall score on the Child Parent Relationship Scale (Pianta, 1992).
Published research demonstrating effectiveness of face to face course:
 
  • Johnson, R., Wilson, H. (2012) Parents’ evaluation of Understanding Your Child’s Behaviour, a parenting group based on the Solihull Approach. Community Practitioner, 85: 5, 29-33.
  • Vella, L., Butterworth, R.,  Johnson, R.  and Urquhart Law, G. (2015) Parents' experiences of being in the Solihull Approach parenting group, ‘Understanding Your Child's Behaviour’: an interpretative phenomenological analysis. Child: Care, Health and Development 41:6, 882–894.
  • Baladi, R., Johnson, R., and Urquhart Law, G. (in progress) A pre, post and follow-up evaluation of Understanding Your Child’s Behaviour (UYCB): A parenting group intervention based on the Solihull Approach. Child: Care, Health and Development.
Which local or national clinical or policy priorities does this innovation address:
National Institute for Clinical Excellence (NICE) Guidelines for conduct disorder: ‘Antisocial behaviour and conduct disorders in children and young people: recognition and management’ NICE guidelines [CG158] Published date: March 2013 http://www.nice.org.uk/usingguidance/sharedlearningimplementingniceguida...
Supporting quote for the innovation from key stakeholders:
“The most amazing and immediately life changing course I have ever been on! And that’s after 5 years in childcare!” (Parent)
“Really enjoyed doing it and found it useful. Yes it made a difference. Was going to make a referral to the MAT team. Children's behaviour problematic at home, being managed at school, but a problem. Saw an improvement after the parent took the course. We could see a difference in school. Children much, much better. The mum was being more positive, a bit more confident, she seemed able to see things from their point of view, and had  changed the way she spoke to the children.” (Pastoral Lead at a Primary School)
 
Plans for the future:
To engage with corporate partners, health, education and social care. Develop implementation kits  to assist organisations to launch the course to employees and customers. Reach the whole population thereby elevating the emotional wellbeing of future generations.  
 
Tips for adoption:
Multi-user licences are available. Implementation kits are in development.
 
Read more
Hide details
Rebecca Johnson 11/01/2016 - 16:43 Approved
Overview summary:
By negotiating a new business model with our laundry service provider, we were able to introduce a more dignified patient robe, as well as make a cost saving on laundry. This new arrangement could now be exploited by other organisations wishing to improve on patient dignity.
 
Challenge identified and actions taken :
Patients undergoing imaging are asked to undress and wear a traditional hospital robe. This ensures no metal is present in the MRI scanner, and that quality images can be achieved without any artefacts.
The robe ties around the patient, but does not completely cover the naked skin. Patients have complained about their loss of dignity. To address this, patients are offered two robes; one to tie around the front, the other round the back. However, this creates two new issues. Firstly, patients with restricted mobility find it difficult to tie fastenings around their back. Secondly, use of two robes per patient doubles our laundry costs.
As per our innovation development process, we searched the market to see what solutions may already exist. The 3-armed robe was identified as the best choice. This design ensures patients are completely covered. There are no fastenings; closure is provided by the garment having three arms (see attachements). Walsall Healthcare NHS trust had already introduced these robes and reported good patient feedback, so we decided to adopt the same. It was not viable for us to purchase the robes outright and then pay out again for the special return-to-sender laundry service.  Instead, we needed to negotiate a new business model with our laundry service provider. 
Impacts / outcomes: 
Since HEFT is a large trust, the large volumes required for the imaging services meant that it made good business sense for the laundry service provider to have the robes manufactured, and then provide them to us on the usual rental basis. The improved design enables us to provide each patient with one robe rather than two, and so as well as improving the dignity of our patients, we have also achieved a cost saving on laundry. We are waiting for delivery of the new robes and anticipate the same positive feedback experienced by our neighbour.
Which local or national clinical or policy priorities does this innovation address:
Adoption of innovation
Supporting quote for the innovation from key stakeholders:
Patients attending Walsall Healthcare NHS Trust have said they much prefer the three-armed gown because it allows their dignity to be preserved.
 
Plans for the future:
Our large volume requirement (purchasing power) has enabled the laundry service provider to source a manufacturer and provide the robes to us on a rental basis. Other trusts wishing to improve patient dignity can now benefit from this arrangement.
Tips for adoption:
Whilst the majority of patients put the robes on correctly, it may be useful to provide patients with photographic instructions. 
Read more
Hide details
Vicki Ensor 08/01/2016 - 13:26 Approved
Overview summary:
Technology Enabled Care Services (TECS) can transform the way people engage in and control their own healthcare. One method is Florence Simple Telehealth (Flo), a mobile phone text service. WMAHSN has supported Flo as an exemplar of technology in healthcare, providing resources and training for participating organisations.
Challenge identified and actions taken :
The UK’s diversity means that traditional methods of communication between clinician and patient are changing. Technology Enabled Care Services (TECS), such as telehealth and self-care apps, have the potential to transform the way people engage in and control their own healthcare, allowing citizens to monitor their health and activity levels by themselves, so the need to take up valuable clinician time is no longer necessary. One TECS method is Florence Simple Telehealth (Flo), a mobile text service to communicate with patients. A free mobile texting service, it is easy to use and was designed by NHS professionals to provide support and advice for patients to manage their own health conditions. Flo give prompts and advice and helps to monitor vital signs. Flo is being promoted to the whole population of West Midlands via all 22 CCGs and some acute and community trusts, alongside other forms of TECS:
  • CCG intelligence packs
  • Staying Independent online checklist
  • apps (COPD, asthma and diabetes type 2)
  • Skype and social media online toolkits (with some direct expert support)
  • general awareness of Flo with some support and resources for COPD and asthma.
Impacts / outcomes: 
  • Integrated care development continues across participating organisations and now with other interested organisations e.g. interest from community pharmacies in Flo protocols to support the delivery of their New Medicines Service and Medication Use Reviews to support patients, better medicines optimisation and improved patient experience, and avoided healthcare usage
  • A vision of how TECS underpins integrated care has been published (Tackling Telehealth 2) which describes different definitions of integrated care and how Flo and other TECS fit in. The draft paper received broad acknowledgment from clinicians around the country and key TECS leads at NHS England. This paper covers the transformative role that TECS can play in creating integrated health and social care systems based around the patient
  • Since organisations (CCGs/trusts) took out WMAHSN-related project licences - between April 2014 and March 2015 - 2,489 patients had signed up to Flo, with some CCGs and trusts initially piloting Flo on Stoke-on-Trent CCG’s overall Flo licence prior to their own project licence being funded
  • The service hosted events across the West Midlands region - Stafford, West Bromwich, Coventry, Shrewsbury and Worcester - to raise awareness of the range of technology that can support common long term conditions, including COPD, asthma and diabetes, and redress adverse lifestyle habits, using social media, apps, Skype and telehealth. The events were aimed at general practice teams (practice managers, practice nurses and GPs), CCGs and acute and community trust staff. The events covered creating TECS in the NHS and digital delivery in workplace. The events were attended by more than 200 delegates from a wide range of health professionals, GPs, practice nurses, CCG managers and trust representatives. The project team was also pleased to have received the support from the Managing Director of the WMAHSN, who attended the Shrewsbury event
  • Heart failure (HF), diabetes and community pharmacy Flo protocols are ready for use. The HF protocols are related to an integrated care project between acute and primary care to upskill GPs in the titration of HF medication. Flo protocols have also been developed with a mental health trust and are now being deployed for pre-vascular dementia, mood management and depression. Pilot protocols being evolved or used are pre-bariatric surgery weight loss, multiple sclerosis, community and secondary care pharmacies– new medicine and medication review services, wound fluid discharge, enuresis and informal carers’ stress.
  • There is a wealth of additional interest and further innovations:
  • primary care interest in proactive/preventative monitoring of acute HF patients through monitoring of patient submitted data, blood pressure, weight etc.
  • wound fluid discharge monitoring in a community setting, alleviating time for clinician to attend patient home purely for this purpose
  • acute pharmacy interest in stratifying patients through A&E attendance due to medication issues and using Flo to support the patients with their medicines regime for a period of time post discharge
  • anxiety/stress management for carers to support their wellbeing, therefore reducing the chance of failure of care
  • Matched funds from Stoke-on-Trent CCG has supported the evolution of the TECS Staying Independent Checklist, a resource to allow health and social care and other professionals, during assessment of an individual’s support needs, identify what TECS are available and suitable for them
  • Organisations are keen to learn about broader work around TECS and the programme provides a good opportunity to share, promote and relate learning including Skype, child and adult asthma avatar apps, the TECS referral pathway and other WMAHSN projects including STarT Back, the Manage Your Health app and COPD primary care training, so the Flo programme has developed a wider TECS scope
  • The extensive networking undertaken created further interest, links and opportunities in the Flo exemplar project and related TECS
  • The capture of patient outcomes has been included in the evaluation with standard feedback captured at point of patient sign up to Flo and at termination and determined points in the Flo protocols.
  • The team is also working with each participating organisation to capture and evaluate their patient case studies to build a body of qualitative evidence to share and use to promote further the benefits of Flo
  • The Flo data will be used to review patient adherence to protocol/pathway and, dependent upon the LTC, determine any sustained patient outcomes e.g. blood pressure, improved inhaler use
  • There is a focused evaluation underway.
Which local or national clinical or policy priorities does this innovation address:
From the NHS Five Year Forward View: • Incentivising and supporting healthier behaviour • Targeted prevention • NHS support to help people get and stay in employment • Empowering patients • Out-of-hospital care needs to become a much larger part of what the NHS does • Services need to be integrated around the patient • We should learn much faster from the best examples, not just from within the UK but internationally • As we introduce them, we need to evaluate new care models to establish which produce the best experience for patients and the best value for money.
Supporting quote for the innovation from key stakeholders:
Jeff, Flo service user: “FLO resembles a friendly, good natured and trusted member of the family. I feel more able to cope and more confident about the future. Most importantly, it helps me cope with my situation.”
 
Sarah, Lead Nurse for respiratory medicine (general practice): “The app has excellent content, is quick to download and ensures patients have their asthma management plans with them all the time, rather than at the back of a drawer. Inhaler technique is key to managing asthma and the avatar demonstrates this perfectly. This app could help prevent hospital admissions and deaths.”
 
Dr Ruth Chambers OBE, GP principal, Stoke-on-Trent, Chair, Stoke-on-Trent Clinical Commissioning Group, Honorary Professor, Keele and Staffordshire Universities and Clinical Lead for Long Term Conditions, WMAHSN: “The importance of what we are trying to help teams deliver cannot be overstated. Demands on our services are continuing to increase. Utilising technology will not only enable us to shape services to suit the needs and preferences of individual patients; embracing it will also help us take on the challenges we face every day.”
Plans for the future:
  • To drive person-centred care through the use of TECs (with Flo as an exemplar) to span patient pathways across different healthcare settings with general practice teams and other providers prioritising applications that best meet the needs of their population, at specific points on those pathways
  • To drive regional spread/deployment of  Flo within organisations to disseminate the knowledge and learning achieved from previous deployment and successes to support the move towards a culture shift/perception of TECS for asthma, COPD, medication adherence and hypertension
  • Development of other Flo protocols ready for 2015/16 to support other LTCs beyond the project’s initial launch protocols.  
Tips for adoption:
To take TECS forward at pace we need to:
  • establish and support leaders and champions of TECS throughout the commissioning cycle to communicate the benefits and drive change
  • enable patient and public involvement and engagement
  • use digital modes of delivery such as Skype, telehealth, telecare, teleconsultations or telediagnostics to drive person-centred, integrated care rather than standalone solutions
  • focus digital delivery of care on areas in patient pathways where enhancing self-care has a substantial impact by improving patients’ clinical outcomes and/or reducing avoidable healthcare usage  
  • anticipate consequence costs such as increased frequency of clinician alerts
  • train health and social care professionals: enhance workforce competences and capabilities for the rollout of technology enabled care
  • match the mode of digital delivery of care to suit the patient population – selected mode or individualised for their needs and preferences
  • rigorously evaluate any implementation or trial of TECS and use this information to underpin any future business cases
  • utilise improvement tools to underpin commissioning and service improvement – leadership, transformational change and service redesign
work closely with all stakeholders to integrate technology in care to improve outcomes for all services; redress ongoing issues in constructive ways before progress with rollout is stalled.
Contact for further information:
Dr Ruth Chambers
ruth.chambers@stoke.nhs.uk
0121 371 8061
Read more
Hide details
Sarah Millard 07/01/2016 - 17:00 Approved
Overview summary:
Capitalising on a successful e-learning programme, we are developing SCRIPT for nurses. SCRIPT is a suite of 15 modules aimed at developing and maintaining professional knowledge and competence relating to medicines. The platform is generating a significant amount of interest and support.
Challenge identified and actions taken :
Medicines are the most common intervention in the NHS, but evidence suggests that the use of medicines in the NHS is often sub-optimal. Medication errors account for 10–20% of all adverse events in the NHS and preventable harm from medicines costs more than £750 million each year. Ten days after starting a new medicine, nearly a third of patients are non-adherent. To address the training needs relating to medicines management/optimisation, SCRIPT is an established suite of web-based e-learning 15 modules, aimed at developing and maintaining professional knowledge and competence relating to medicines. The modules, agreed as a result of feedback at WMAHSN events, have been authored by specialist physicians, nurses and pharmacists in the region and six modules are currently in final production ready for launch. Planned outcomes were a suite of modules to develop and maintain the professional knowledge and competence of qualified nursing staff relating to the safer use of medicines. This work builds on the established SCRIPT e-learning programme available for junior doctors (www.safeprescriber.org). The modules were scoped and developed as part of a collaboration between Coventry and Warwickshire NHS Partnership Trust, the University of Birmingham and OCB Media. 
Impacts / outcomes: 
  • The scale of delivery has already increased from the original proposal, from nine modules to 15 module categories finalised
  • Specialist physicians, nurses and pharmacists in the region have been involved in the authoring of modules
  • Six modules have been launched (UK Medicines Policy, Evidence-Based Practice, Introduction to Pain Management, Pharmacological Pain Management, and Adverse Drug Reactions, Anticoagulation Part 1)
  • Two modules are currently undergoing final edit (Anticoagulation Part 2 and Medicines Management in Care Homes)
  • One module with author for final review (Respiratory)
  • Two modules currently undergoing edit (Dosing and Calculation and Advanced Pain Management)
  • Nursing SCRIPT User Guide drafted
  • The e-learning platform is available online at www.saferuseofmedicines.org
  • As this e-learning will be available to all nurses across the healthcare sector, it is generating a significant amount of interest and support. In addition, interest is being received from academic institutions in the West Midlands that train nurses at undergraduate level as they are keen to ensure that nursing competencies with regards to medication administration are gained prior to entry in clinical practice
  • Working in collaboration with a number of authors from various backgrounds and trusts across the region, SCRIPT has not only built a network of clients but a wider regional interest in drug safety.
Which local or national clinical or policy priorities does this innovation address:
From the NHS Five Year Forward View: • As the ‘stock’ of population health risk gets worse, the ‘flow’ of costly NHS treatments increases as a consequence • Future models will expand the leadership of primary care to include nurses, therapists and other community based professionals. It could also offer some care in fundamentally different ways, making fuller use of digital technologies, new skills and roles, and offering greater convenience for patients • access to GPs or nurses working from community bases equipped to provide a much greater range of tests and treatments. In partnership with local authority social services departments, and using the opportunity created by the establishment of the Better Care Fund, we will work with the NHS locally and the care home sector to develop new shared models of in-reach support, including medical reviews, medication reviews and rehab services. NICE guidance on medicines management, adherence and optimisation.
Supporting quote for the innovation from key stakeholders:
Dr Jamie Coleman, Professor of Clinical Pharmacology and Medical Education, University of Birmingham: “The administration of medicines occurs in all areas of health and social care, many of which are given by nurses and professional carers. Errors that occur at the administration stage are often not intercepted by others, unless the patient notices an error, and therefore this is an important focus for education and training. The SCRIPT project team are excited to be working on new e-learning modules to provide for the Safer Use of Medicines for the region.” 
Plans for the future:
  • Completion of remaining modules
  • The e-learning platform will be promoted regionally in the first instance, with the ability to expand the scope nationally
  • The first six modules will be officially launched by March 2016.
Contact for further information:
Prof Jamie Coleman 
j.j.coleman@bham.ac.uk 
0121 414 3778
Read more
Hide details
Sarah Millard 07/01/2016 - 15:51 Approved
Overview summary:
A new and innovative telemed system was implemented in order to improve the quality of service offered to ENT patients, as well as to try and reduce unnecessary referrals. The key objectives were achieved. We now plan to initiate discussions with commissioners in order to assess the benefits of using this system in primary care.
 
Challenge identified and actions taken :
Approximately 10% of patients referred to a hospital ENT consultant require surgery; 90% can be managed with medical therapy and/or reassurance and an explanation of their condition. HEFT receives approx. 90 referrals to its ENT service per month, and has a waiting time of 6 weeks, which is typical in England.
The ENT Directorate at HEFT wanted to:
  • reduce the number of unnecessary referrals, and thereby reduce waiting times to see more urgent cases
  • enhance efficiency in healthcare resources using telescopic referrals
  • improve the quality of care it provides to its patients
  • implement care pathways that promote patient-centred care
  • provide cost-effective and secure documentation of digital images
  • support more effective communication at multi-disciplinary team meetings by providing digital images of cases, and thereby reduce the need for patients to attend a specialist referral centre (University Hospital Birmingham)
  • improve medical teaching
The endoscope-i system (www.endoscope-i.com) was implemented for a trial period. This system utilises an iPhone, an endoscope, endoscope adapter and mobile app, and enables videos and images of the ear, nose and throat to be recorded in real-time. The images can then be transferred wirelessly and uploaded securely to the electronic patient record.
Impacts / outcomes: 
The pilot has enabled a number of intangible benefits for both patients and clinicians. Notably, the endoscope-i system enabled an improvement to the quality of the consultation and service provided, as well as enhancing patient safety. As patients are able to view high quality images and videos of their condition, the system has enabled/supported:
  • Reassurance for patients when nothing abnormal was found in their ear, nose or throat, reducing unnecessary repeat appointments
  • Obtaining informed consent for a procedure; patients were able to see the problem and better understand the need for surgery, empowering them to play an active role in the decision-making
  • Emphasis of advice following surgery, for example, the importance of rinsing the nasal cavity; the images demonstrated that this advice was not being followed
  • Capturing images over time has enabled (remote) monitoring and review of disease states, without the need for referral, thereby reducing the amount of referrals to the outpatient department, and saving the patient from the inconvenience and expense of travelling to the hospital (this needs to be quantified).
  • The ability to access stored images remotely, and via videoconferencing, has enabled a more productive multi-disciplinary team discussion of cases; clinicians can see first hand the issue without the need to bring in the patient to the discussion. The risk of misinterpreting sketches, or sketches missing out detail, is obviated.
  • Stored images of the throat of a patient with throat cancer have been used by an anaesthetist to assess suitability for intubation pre-surgery, rather than scoping and creating an airway emergency if the patient is not fit.
Which local or national clinical or policy priorities does this innovation address:
Reducing unnecessary outpatient visits, improving patient experience
Supporting quote for the innovation from key stakeholders:
A patient reported that for the first time in 15 years of attending ENT outpatient clinics, this was the first time he had actually seen a real image of his disease.

 
Plans for the future:
Whilst the system was implemented as a trial, it is now embedded, and there are plans to purchase extra kit so that all ENT doctors can use it. 

We intend to initiate conversations with commissioners in order to test how this system could reduce unnecessary referals to secondary care.
Tips for adoption:
Develop good relationships with all the key stakeholders.
Fully define the challenges experienced first, then consider if this is the right solution.
Ensure there is a clinical champion.
Ensure there is support within the organisation for Apple products.
Contact for further information:
Read more
Hide details
Vicki Ensor 07/01/2016 - 15:43 Approved

Active Campaigns