Vincent Baxter (improvement manager) with the emergency care improvement support team (ECIST) describes how collaborative learning is being used to make ‘breakthrough’ improvements in quality. Midlands frailty focus is a collaborative led by the Midlands Region NHS England and Improvement team, supported by ECIST, that aims to improve the quality of care for individuals with frailty.
The NHS Long Term Plan sets out an ambition of “Supporting people to age well”. This includes improving people’s health in later life by slowing the development of frailty through earlier identification and preventative measures. As the population ages, frailty is becoming a more prevalent condition presenting local health systems with several key challenges. For example:
- More people living with mild, moderate or severe frailty are attending emergency departments, with over 4000 admissions daily for people living with frailty.
- Older people living with mild, moderate or severe frailty are more likely to have delayed transfers of care.
- Severe frailty often brings over four times the costs of non-frailty when the care needs of those experiencing it are met outside of the acute hospital environment.
In addressing and sharing best practice and approaches to identify and slow the development of frailty, the amount of time older people spend in hospital and urgent and emergency care will reduce. According to Professor Martin Vernon (National Clinical Director for Older People) “using the right data intelligence we can go much further, much quicker if we help local commissioners make the right decisions and plans which meet the needs of their local populations”. The recently published NHS RightCare Frailty Toolkit will support the achievement of this ambition. It provides a national case for change and expert practical advice and guidance on how to commission and provide the best care for people living with frailty.
The Frailty Toolkit provides an opportunity to apply sound science to improve the outcomes of current healthcare practice in relation to frailty. However, how can this science be implemented into daily work? This is a challenge, because all to often what we know doesn’t always translate into what we do; there is a gap. So how do we bridge this gap?
One approach to bridging this gap is to use collaborative learning, using a model such as the Institute for Healthcare Improvement (IHI) ‘Breakthrough Series’. The Breakthrough Series creates a structure in which interested organisations can easily learn from each other and from recognised experts in topic areas where they want to make improvements (in this case frailty). A Breakthrough Series Collaborative is a short-term (6 to 18 months) learning system that brings together a large number of teams to seek improvement in a focused topic area.
On July 31st 2019, in Birmingham, nine sustainability and transformation partnerships (STPs) from across the midlands NHS England and Improvement region began their Breakthrough Series journey at the first of three collaborative learning sessions. Midlands Focus on Frailty, has the collaborative as become known, was launched at a conference the day before attended by 200 delegates. Speakers at the conference included: Professor Martin Vernon (National Clinical Director for Older People at NHS England and Improvement) and Dr Adrian Hopper (Consultant Physician & Getting It Right First Time clinical lead for geriatric medicine).
The first learning session of the collaborative was introduced by Dr Ian Sturgess (Midlands NHS England and Improvement Regional Clinical Lead for Frailty). Collaborative participants heard keynote speaker Tommy Whitelaw (UK Project Lead and Health & Social Care Alliance Scotland Campaign Lead) talk about his emotional and amazing journey as a carer for his mother, and the concept of intelligent kindness. Some excellent examples of good practice were shared by teams from Derby and Salisbury, and participants also learnt about the model for improvement which they will use to test their change ideas. In addition, participants spent time developing their change ideas in preparation for testing them prior to the next learning session.
Following this first learning session participating teams move into the first of three action periods, where they will begin to test their change ideas using the plan, do, study, act (PDSA) process. During action periods participants will be supported using a range of resources, these include: using zoom conferencing to deliver teaching and question and answer sessions; access to an online workspace where they will find a variety of resources; and a generic email address for posting questions etc. In addition, participating systems have been ‘buddied up’ with one another, and an improvement manager from the emergency care improvement team (ECIST), to facilitate learning and obtain support.
As well as the learning sessions and action periods participating teams were expected to complete some pre-work prior to learning session one. This involved developing a storyboard that described their system, the team members and their roles, and information on the aim of their collaborative project, their change ideas and potential measures. They were supported to do this via two pre-learning session one teleconferences with some of the team running the collaborative. Prior to the second learning session participants have been asked to update their storyboards and share the results and learning from their first tests of change. This information is crucial to shaping the agendas of the second and third learning events, as these will involve more interaction among teams and between teams. This supports the principle ‘all teach all learn’ approach of the Breakthrough Series.
At the first learning session it was exciting to see participants come to the program with a commitment and passion to take on an important topic and leave with the skills and confidence to apply the collaborative method to solve their biggest challenges. It will be even more exciting, as the collaborative progresses, watching the impact participants will have on their organisations and systems as they apply the learning and experience acquired through the collaborative to implementing changes that will deliver improved outcomes for patients.
Emergency Care Improvement Support Team 