The ideas and innovations taking health services by storm
The Liberating Ideas Award was established to encourage the spread of service improvements. Alison Moore catches up with the 2011 winners to find out how they have fared.
Six months ago three NHS organisations presented their experience of improving services to a high-powered panel of judges.
Each organisation was already a category winner in the Capgemini/HSJ Liberating Ideas Award – designed to highlight great ideas generated in one part of the NHS and help disseminate them more widely.
The day’s overall winner was Colchester Hospital University Foundation Trust, where physiotherapists and nurses are working with trauma and orthopaedic patients to ensure they are mobilised as soon as possible after surgery to reduce their length of stay in hospital and that they are as mobile as possible when discharged.
Close behind were Derbyshire Community Health Services Trust, which is working proactively with care homes to reduce unnecessary admissions, especially from falls, and maximise independence; and Derby Hospitals Foundation Trust, where staff were working with others across the health system to offer pre-conception advice to diabetic women.
But in the six months since they were announced, how have the three category winners fared?
A key question is whether they have been able to spread their ideas within their organisation and more widely within the health service.
Colchester: spreading fast
The aim of the award was to promote the quick spread of good ideas – and to save other departments and other organisations from having to reinvent the wheel.
Colchester Hospital University Foundation Trust is certainly doing that. The principles of its scheme – which aims to get people mobile again after both elective and emergency orthopaedic treatment – have spread to other parts of the trust.
Senior physiotherapist Lyndsey Bingham says a medical respiratory ward and care of the elderly ward have adapted the approach for its own patients, and the scheme is in the early stages of being adopted across medical wards.
The approach is being embedded with training days and with increased support from consultants, including changing how they work so rehabilitation can start earlier.
The team is also working with patients in pre-admission clinics, assessing their suitability for enhanced recovery and explaining to them they could be up within four hours of surgery. They are now working extended hours on elective wards to ensure that patients operated on later in the day have the chance to be mobilised that day rather than wait overnight.
“People are coming up to us from different teams asking how they can do something similar,” she says.
The support of nurses on the wards, who play a full part in the programme, has enabled physiotherapists to concentrate on the more complex patients who have longer stays.
Data collection remains important as the trust is determined to show how effective the approach is in reducing length of stay. The team is now able to identify how particular subgroups of patients have been affected.
And the project has been beneficial for staff morale. The team can see patients being discharged earlier – but is also aware of the support it is getting from senior management and the way the award has changed its profile within the trust.
Financially, the project can show it can reduce length of stay for patients – thereby saving the trust money. This has led to investments in new posts to increase rehabilitation teams.
The hospital League of Friends has donated £7,000 to buy additional tables and chairs to enable more patients to sit down at a table to have their meals and drinks rather than being served in bed. This simple approach not only helps patients to socialise but contributes to their mobility.
The team has also had visits from two other trusts interested in taking up the scheme, has had a number of enquiries from other hospitals and is putting together an information pack to send out to trusts. At Burton Foundation Trust the scheme went live in April with a carefully selected group of patients – but there is already enthusiasm for extending it. And Buckinghamshire Healthcare Trust has set up a project team to move towards implementation.
Derbyshire: the big sell
The team from Derbyshire Community Health Services Trust has continued work to reduce falls among patients in care homes in the Amber Valley.
And the feedback at the Liberating Ideas event has enabled it to pull together a business case and to think about how to “sell” the idea more effectively.
This is beginning to pay off: the trust is now included in its five year plan provision of a service across the whole of the county.
Sam Pessoll, who leads the team, says the feedback from Capgemini helped the team present more effectively to commissioners – especially GPs, who quickly grasp the benefits.
“One of the things that was highlighted was that we had an awful lot of stakeholders, a lot of people who could put finance into the service,” she says. She has also been contacted by a number of other trusts that want to develop a version of the service in their locality – and Colchester, which sees the scheme as being complementary to its own work, has visited for the day.
Derby: massive opportunities
At Derby Hospitals, consultant Paru King praises the Capgemini team for the input they gave before the final judging at the end of last year. Since then, the scheme – which encourages women with diabetes to come forward for pre-conception care and monitoring during pregnancy – has gone from strength to strength with interest from NHS Diabetes, the Health Foundation and Diabetes UK. Eleven other centres have said they want to implement the PROCEED model.
“It’s been phenomenally successful. The opportunities that it has given us are massive; there are a lot of other organisations that want to take this on. I have organised a national event to look at this and 250 people attended.”
By adopting a model which uses nurses as the first point of delivery, PROCEED has managed to reach more women while also reducing waiting times. Compared with 12 months ago it is seeing twice as many women but with waiting times cut from 13 weeks to five.
It has also been able to produce proof that the model works. It has saved £61,000 (on a conservative estimate) in its first year and women who have been through it have experienced better outcomes. The stillbirth rate has reduced to zero.
Now the focus has shifted to making the model sustainable. It has been commissioned by InterCare Health, an integrated diabetes organisation, to provide care through 29 practices across Derby and southern Derbyshire. Dr King has also worked to position it for the shift to clinical commissioning groups.
She sees a key part of the process as general awareness-raising, especially as there is no national forum for people working with diabetic women who want to become pregnant. “The project’s success is based on strong links across boundaries. It would be good to support people with other chronic diseases,” she says.
“I’m using my experience with PROCEED to try to improve the general integration of diabetes care. But I’m also interested in long term conditions other than diabetes. Our integrated model would help with that.”
Martin Chambers, vice president for health at Capgemini, believes clinician engagement is crucial in rolling these schemes out further – one of the teams which visited Colchester was formed of clinicians who were enthused by what they saw and ensured it was adopted very quickly.
“That’s the real essence of what the awards are trying to do. It’s how do you foster innovation and copying of good ideas across the NHS. It’s those who can see the benefits and act on it quickly because it makes their lives easier and benefits patients,” he says.
Being able to crystallise the value of a project is essential to “selling” it both internally and more wisely, he says. Value is in the eye of the receiver, rather than the presenter, he points out, so identifying who is paying and what they get out of it can be key.
And he raises the question of whether it is the copying of good ideas which is actually the true innovation. The NHS has loads of great ideas but very few of them get taken up widely.
“We spend a lot of time flying people backwards and forwards across the Atlantic and not visiting the hospital next door. It’s getting people to look beyond the boundaries of their own organisation,” he says.
“We tend to have visits of managers and directors rather than those who can actually do the changes or can get enthused by change.
“You have got to adopt it as your own and generate your own meaning from it. You have to take the ideas and then localise them.”