SPACE e-magazine (#2508)

Idea Description
Overview of Innovation:
We are pleased to launch the first edition of our SPACE e-magazine. Click here to view the magazine featuring the latest news from the SPACE programme including:
  • Care home managers participating in Appreciative Inquiry training
  • Two housekeeping staff who 'braved the shave' for MacMillan Cancer Support
  • A new project launched in Walsall to improve wellbeing of residents, staff and visitors
  • Interview with a new apprentice who has joined the Walsall SPACE project.
Hope you enjoy the e-magazine and if you have any questions about the programme, please feel free to get in touch.
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Innovation 'Elevator Pitch':
A modular university accredited programme which builds the skills, understanding, tools and confidence of NHS junior and middle managers to implement innovations leading to greater efficiency and rapid improvement in services for patients
Overview of Innovation:
The gap between research evidence and practice is significant for healthcare organisations.  Healthcare interventions which we know to be effective can take a long time to enter common practice, whilst others which we know to be ineffective can take a long time to be discarded. The implementation rates of quality improvement (QI) initiatives, for example, are believed to be lower than 50%. Implementing innovations is demanding of employees and organizations--cognitively, emotionally, and physically.. When attempting to implement innovations, organizations face challenges such as misaligned incentives, professional barriers, competing priorities, and inertia.
Studies of innovation implementation in health care settings have shown that middle managers can play an important role in enabling innovation, and supporting healthcare innovation implementation as information brokers - communicating, diffusing and mediating information flow between senior leaders and frontline staff. Middle managers with the capability and confidence to innovate and to lead service improvements are therefore essential if the NHS is to deliver radical and transformational change across whole healthcare systems. But evidence suggests that middle managers are often slow to adopt innovations, whether through generating ideas for improvement or creating opportunities for spread of good practice across departments and organisations.The enablers for junior and middle managers to become improvement leaders have been identified as:
  • proficiency with management skills and tools, (including financial, HR and workforce, programme, operational and strategic management),
  • skilled use of improvement science and quality methods,
improved personal impact on the wider system, through understanding how to influence, motivate and engage effectively with other practitioners at all levels. 

This new programme seeks to bridge the research/practice gap through combining academic theory and conceptual frameworks with practical skills-based learning and behavioural development approaches to support junior and middle managers to become confident improvement practitioners. The programme combines classroom-based learning with application to identified improvement projects, ensuring that academically-rigorous teaching is linked to work-based practice and is grounded in the needs of managers, their organisations and the people who depend on health services. 
Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Advanced diagnostics, genomics and precision medicine / Wellness and prevention of illness / Education, training and future workforce / Wealth creation / Clinical trials and evidence / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Every £1 spent on management development in the NHS needs to  be  justified.  Research   suggests   that   the   financial   benefits of   effective  programmes  are  potentially  hugely  significant:  equivalent  to  up  to  £15,000 per programme participant due to staff retention, innovations and  improvements  which  lead  to  cost-benefits  and  better  patient outcomes.   This   is   set   against   an   average   programme cost per participant of <£5500.
The development of junior and middle managers with the confidence and capability to lead and support innovation and improvement will have multiple benefits for the NHS. For instance, the swifter adoption of improvements in process efficiencies will generate cost benefits; innovations in support to patients will lead to improvements in patient experience; adoption of new technologies will lead to innovative ways of working across multi-professional teams; the spread of good practice will be enabled.
The programme will be relevant to acute, community and mental health organisations across the West Midlands.Relevance to primary care and general practice will also be key, and longer term to social care providers potentially.  It should also be noted that these organisations are small and medium enterprises and by coming together on this programme may generate opportunities for collaborative improvement efforts.
Through the development of a cadre of peer-evaluators the programme will also support the building of a critical mass of junior and middle managers in the West Midlands health system, aiding succession planning and ensuring that the business of innovation and improvement is not confined to senior leaders or to specialist practitioners.
Online Discussion Rating
5.00 (1 ratings)
Initial Review Rating
3.80 (1 ratings)
Benefit to WM population:
Managers will come to the programme with ideas for a change they want to implement, or recognition of a problem to resolve. These could include a focus on the adoption of new technologies, introducing new skill-mix to service delivery teams, developing fast-track surgical pathways, developing whole system approaches to improving long-term conditions pathways of careasset-based approaches to person-centred care, improvement in the management of mental health problems in A&E, home-based exercise for older people to prevent falls, opportunities for cost-saving through better sharing of data. Since most, if not all, of these issues will call for multi-professional involvement, we will encourage participants to come on to the programme in pairs, trios and small teams. This will aid the rapid spread of ideas for improvement, and have immediate impact on services.
The programme will also enable junior and middle managers to swiftly assess and select between competing opportunities for improvement, develop workable project plans and compelling business cases, secure engagement of key supporters and manage resistance, and develop appropriate metrics to measure progress towards anticipated benefits.
The programme will be constructed as a proving ground: a space in which participants can test their ideas for improvement, learn from experience of application and develop the learning, skills and competencies they need to be influential managers. As such the participants will develop their skills as innovators and entrepreneurs.

The programme will use peer-evaluation of progress as an element in the assessment of the Certificate, recognising that one test of managerial skill is the impact on others. In this way participants will become skilled evaluators and assessors of innovation, developing skills which are immediately transferable to the workplace. Finally the design of the programme will enable participants to build relationships across professional and organisational boundaries, one of the key enablers for more effective and productive system-level  innovation
Current and planned activity: 
In 2017 the HSMC undertook research work on behalf of the University of Birmingham Health Leadership Group. This involved meetings and interviews with the most senior leaders in health and social care across the West Midlands to ascertain the learning and development gaps in their workforce. A key theme emerging from this research work was the need in the NHS for further development of the practical skills needed by junior and middle management in order to properly and effectively improve services; implement innovative practices; lead people; manage resources; and enable change. Aligned to this feedback was a request to support team development and multi-professional education and training. We have continued to work with NHS organisations and leaders to develop the ideas which underpin this programme proposal, which now includes opportunities for peer challenge and support, shadowing and developing system sightedness amongst junior to middle managers.
What is the intellectual property status of your innovation?:
The IP resides with HSMC at the University of Birmingham.
Return on Investment (£ Value): 
Return on Investment (Timescale): 
3 years +
Ease of scalability: 
Regional Scalability:
Please describe how the innovation could be scaled across the WM region. Have you implemented at scale in any other regions?
What outcomes are you hoping to achieve and what are the measures that you will use to gauge the success of the innovation and how will these assessments be made? Please ensure that you have quality, safety, cost and people measures.
Adoption target:
What are the targets for adoption across the WM and what are the minimum viability levels?
Rejection Reason:
Board decided not to support - feedback provided and innovator decided not to pursue
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Innovation 'Elevator Pitch':
Meeting Centres are a local community driven, evidence based resource for people with dementia and family carers. enabling people and families affected by dementia to build resilience for the longer-term.
Overview of Innovation:
Meeting Centres were first developed in the Netherlands 25 years ago. Currently, there are 150 Dutch centres with a national network that local groups can utilise. There is good evidence both from Dutch research and recent UK research ( that people attending Meeting Centres experience better self-esteem, greater feelings of happiness and sense of belonging than those who don’t attend.  Recently completed translational research to implement Meeting Centres in the UK, Italy and Poland led to two successful Meeting Centre demonstrator sites being set up in the West Midlands: Leominster in Herefordshire and Droitwich Spa in Worcestershire. A new grant from National Lottery provides the opportunity to support new Meeting Centres and we are looking for people to set up new Meeting Centres.
The Dutch have a well-developed community process for developing new Meeting Centres that engages all local stakeholders in both the local development and longer-term implementation thus promoting local community engagement across health, social care and community groups.
At the heart of each Meeting Centre is a social club where people meet to have fun, talk to others and get help that focusses on what they need. A team of staff and volunteers trained in the Meeting Centre ethos provide an enjoyable and flexible programme for both the person with dementia and their family carers. The social clubs meet 3 days per week for 15 to 20 members per day.  Family carers get assistance with practical and emotional issues, as well as being able to contribute to social club activities. This can all help reduce social isolation and build resilience.

All activities are designed to help people adapt to the challenges that living with dementia can bring. This involves a chance to get together socially, to be creative, to get active and to share lunch. Everyone brings their skills and talents to the Meeting Centre and the programme is driven by what people want to do. People attend as little or as often as they need.

A diagnosis of dementia is a huge challenge to come to terms with. If people make good emotional, social and practical adjustment to dementia following diagnosis, then it is likely that they will experience fewer distressing symptoms later and will be able to live at home for longer with a better quality of life for them and their families.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Innovation and adoption / Person centred care
Benefit to NHS:
Dementia is a key priority for both NHS England and the Government. In February 2015 the Prime Minister launched his Challenge on Dementia 2020, which set out to build on the achievements of the Prime Minister’s Challenge on Dementia 2012-2015. There are four key aspiration and this is the where Meeting Centres fill the gap ‘Every person diagnosed with dementia having meaningful care following their diagnosis.’ In terms of the West Midlands
In the Dutch studies and the MeetingDem project ( it was found that those who attended most regularly showed fewer of the more distressing symptoms of dementia and a greater feeling of support. Family carers also experience less burden and feel better able to cope. People with dementia and carers report high levels of satisfaction with the programme, seeing it as an important way of keeping active and feeling supported. In the Dutch studies it was found that attending Meeting Centres can extend the length of time before admission to care homes.
Initial Review Rating
4.20 (2 ratings)
Benefit to WM population:
There are over 73,000 people living with dementia in the West Midlands ( ).  Dementia is a priority under a number of the West Midlands STP areas including Herefordshire and Worcestershire  which states that, ‘Our strategy focuses on people and patients so that every person with dementia, their carers and families have access to and receive compassionate care and support not only before diagnosis but after diagnosis and through to end of life.’  So far over 250 people affected by dementia have benefitted from attending Droitwich Spa and Leominster Meeting Centres. The cross-community information meetings, initiative and advisory groups as well as linkage with dementia friendly communities has raised the profile the profile of dementia in the communities and as a result reduced stigma. Aside from Droitwich Spa and Leominster there is a Meeting Centre in Ross on Wye (Herefordshire) and a great deal of interest from across the West Midlands, including Birmingham, Redditch, Worcester and Hereford. This will mean that the benefit to the WM population will increase in the future – see below.
Current and planned activity: 
The Association for Dementia Studies (ADS) at the University of Worcester has been awarded a National Lottery grant from the Big Lottery Fund - The UK Meeting Centre Support Programme. The project will run from 1st Sept 2018 to 31st August 2021. The aim is to help establish new Meeting Centres in different parts of the UK to work with their communities to support people and families directly affected by dementia.  In addition there will be further evaluation of the Droitwich Spa and Leominster demonstrator sites and the development of a toolkit for other Meeting Centres to self-evaluate in terms of benefits and cost-effectiveness. 
If you would like to set up a Meeting Centre we can support you with  this.
You can find out more by visiting  and  or emailing  or reading the flyers attached below.
What is the intellectual property status of your innovation?:
The Meeting Centre concept has been develope by Professor Rose-Marie Droes at the  VUmc, Amsterdam see 
Return on Investment (£ Value): 
Return on Investment (Timescale): 
Ease of scalability: 
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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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