Author: Vanesther Hamer

Shomais Amedick, Project Support Officer, shares her observations on our Maternal and Neonatal Heath Safety Collaborative learning sessions.

I love that the UK has a National Health Service for its citizens and values the dignity of human life. This strength shines through the Maternal and Neonatal Health Safety Collaborative (MNHSC) by improving the healthcare experience for all women, babies, and families across England. You can find out about the background to the collaborative here.

I joined the MNHSC in April 2019 at the start of Wave 3. I think that it is great that trusts are offering their improvement leads time to attend the nine learning sessions during the wave. I have seen this benefiting the trusts, by strengthening their quality improvement capabilities, and in our site visits can see the teams maturing in ‘living’ and ‘leading’ their quality improvement projects and making great progress at a regional and national level.

The National Learning Days offer a great networking opportunity with multidisciplinary teams all across England. This is where teams working on the same driver have time to learn from each other and overcome ‘barriers’ in their improvement.

Teams are also learning about Patient Safety Culture and this is strengthening trust and psychological safety within their teams and their trusts.

We work in healthcare because we care about people and are passionate about offering a great healthcare service. It is fantastic to see this passion at all the learning sessions. These learning days offer the space and time for creative thinking and reflections about why we do things and evaluate the value in the processes we perform; if we continue doing them or how we can refine or get rid of unnecessary processes to make patient care more effective, efficient and better – leading to improvement. Getting rid of unnecessary processes is important as this creates more capacity in busy teams to do improvement.

Find out more about the Maternal and Neonatal Health Safety Collaborative in the West of England.

Register for the West of England AHSN Maternal and Neonatal Health Safety Collaborative Local Learning System 5 if you would like to get involved in your local team.

Andrea Byles, Mental Health Collaborative Programme Lead, introduces the work of the collaborative.

I first became involved with the South of England Mental Health Collaborative (MHC) in 2014 as the Programme Manager for Sussex Partnership NHS Foundation Trust. After attending my first Learning Session I quickly became passionate about all things MHC. I couldn’t believe that we could ‘shamelessly steal’ other Trusts ideas and did not have to reinvent the wheel! I was also impressed by the culture and openness of the session. Now five years later I feel very lucky and proud to be the Programme Lead.

Our aim is to make care safer by improving quality in mental healthcare. The MHC empowers people with lived experience and healthcare staff to work together to identify and develop solutions to local problems. These are then implemented and tested within their local areas before being shared at the learning sessions with others.

We have a membership of 11 mental health trusts across the South of England and are sponsored by the West of England and South West of England AHSNs. A multi-disciplinary faculty of experts from across the area provide leadership and each trust has a dedicated Programme Manager as our link to the trusts in the programme. It is the longest running Mental Health Collaborative in the country, starting off in 2009 as the South West Quality & Patient Safety Improvement Programme.

We facilitate three learning events a year and use the 3Ls (Learn, Live, Lead) framework to enable delegates to assess their knowledge of Quality Improvement (QI) and attend the right learning workshop for them to develop their QI skills. So whether you’re a learner and have very little knowledge of QI or the Model for Improvement, or have some knowledge and practice of QI within your local area or team (living), or are leading QI work within your trust we have a workshop to further your QI development.

Our events create a safe space and time to work on patient safety issues and provide opportunities to continually learn from each other. We have national presenters at each event to enable delegates to hear about national workstreams and how this will fit with their local work.

Trusts also present improvement work that is happening within their trusts in order that others might ‘shamelessly steal’ their ideas and innovations to spread within their own areas.

For 2018/19 our focus has been on ‘learning from deaths in mental health’. At the March 2019 learning session 100% of member trusts presented their local improvements on learning from deaths in mental health.

You can find out what it’s like to attend a learning session on our Youtube channel: Mental Health Collaborative

For further information on the MHC visit the website or follow us on Twitter @IQMentalHealth

Hannah Little, Patient Safety Improvement Lead and Senior Project Manager, reflects on the spread of NEWS across the country, and beyond.

The National Early Warning Score (now NEWS2) saves lives. It provides a simple, objective overview of a person’s physiological condition by turning vital markers of deranged physiology into a score. The higher the score, the more likely it is that the person needs an urgent clinical review.

NEWS2 helps identify time-critical conditions, such as sepsis, early. It is a simple concept, initially developed to provide a common language of deterioration across acute settings. It is unsurprising that other areas of the health system have been keen to adopt this lifesaving tool, in order to provide clinicians working across an often discombobulated health system with a quick objective indicator of deterioration. NEWS2 can enable the easy track-and-trigger of deterioration and recovery across pathways, from the moment a person first presents as unwell to the moment they are discharged.

NEWS2 is in use across the health system in the West of England, which now has the lowest mortality from Suspicion of Sepsis in England, according to recent data from the Patient Safety Measurement Unit. England’s 14 other Patient Safety Collaboratives are now all working hard to spread NEWS2 beyond acute settings. In true quality improvement style, all are taking a slightly different approach – with workstream leads meeting often to learn from each other.

The reach of NEWS2 continues to grow. We have had enquiries from professionals and organisations looking to learn from the success of NEWS2 in Ireland, Scotland, Sweden, Ghana and most recently, Canada. The Royal College of Physicians (RCP) have also had international enquiries; the benefits and opportunity for easily applying this lifesaving initiative in other health systems is clear. Who knows, one day we could have an International Early Warning Score.

Melody Moxham, Project Support Officer, reflects on the collaborative and supportive work of our Mortality Reviews Steering Group.

I’ve been supporting our Mortality Reviews Steering Group since summer 2018. I think it is a fantastic example of how collaborating across our region helps to improve patient safety.

Since 2017 all of the acute trusts in the West of England region have used a standardised process for their mortality reviews – Structured Judgement Reviews (SJRs). (You can read more about how we implemented this process in the Patient Safety Journal).

The SJRs take place in each trust and the accumulated data is brought to the steering group meetings. For example, one trust might share that they had 200 deaths during the last quarter and that 70% of these qualified for an SJR. Of those, one or two were judged as having had poor care and one as having had very poor care, and that case has been escalated as a Serious Incident. The vast majority of cases identify good or excellent care. Critically, trusts also talk about their learning from the SJRs, either positive feedback or areas to improve, and how this is shared. For example in their internal newsletters or magazines, through quality improvement projects, feedback to teams or individuals, and at Board level.

During my time supporting the group I’ve noticed how the monthly meetings provide a ‘safe space’ for colleagues from six trusts to access peer support regarding the results of their SJRs. By sharing their monthly and quarterly SJR data, and more in-depth information about specific (anonymised) reviews, common themes can be identified and solutions shared; all which help to improve patient safety. I’ve been impressed at how open the group discussions have been, which really nurtures collaboration across the region.

We followed the IHI (Institute for Healthcare Improvement) Breakthrough Collaborative Series model for this project, which enabled our trust representatives to learn from each other and improve together. The clinicians in the group have shared resources, such as Board Reports and recruitment documents for specific roles to further learn from each other and replicate effective systems. This has saved work being duplicated and allows others to adopt tested solutions more efficiently.

In my role at the AHSN, I’m a few steps removed from the front line delivery of patient care, so for me this has been a fascinating window into our colleagues’ world, working in acute services. The most immediate impact that I experience is not seeing how systems and care are improved from the SJR process, but the benefits that these meetings bring to the clinicians. The support that they provide each other is clearly so beneficial, and helps to create and sustain a culture of sharing learning within our region, for the ultimate benefit of improving our patients’ safety.

Greg Harris, Project Support Officer, reflects on the commitment of our Emergency Laparotomy Collaborative members, now recognised as a national improvement programme.

Half a year ago I became the Project Lead for the Emergency Laparotomy Collaborative (ELC). Conceived as a two-year quality improvement (QI) project between three Academic Health Science Networks (AHSNs); the West of England, Wessex, and Kent Surrey & Sussex, it delivered a care bundle across 28 hospitals that reduced the length of hospital stays by 1.3 days, and crude mortality rates by 11%.

The project ended in 2017 but what impresses me is that our Clinical Leads have continued to meet in the West of England! One of the greatest challenges to QI projects is sustainability – how do you ensure that all that great work doesn’t disappear after the official project end date?

Hopefully you considered sustainability right from the outset of your project but, beyond its life cycle, committed individuals are key to championing the work within their trusts; to keep on top of achieving until it’s not a stretch target anymore but the standard.

It also helps if the work becomes a national programme…

Earlier this year, NHS England + Improvement asked all trusts across England to roll out the ELC care bundle in their hospitals.  This wouldn’t have been possible without the strong evidence collected from the original ELC project showing the significant improvement achieved. The evidence wouldn’t have been there without committed individuals.

Our Clinical Leads now meet on a quarterly basis, rotating the meetings across their hospitals. They continue to maintain the high standard of delivering the ELC care bundle but they are now looking at adding to this with new QI work – the Best Practice Tariff, Surgical Site Infections, Enhanced Peri-Operative Care for High-risk patients (EPOCH), Enhanced Recovery, and FLuid Optimisation in Emergency LAparotomy trial (FLOELA).

Individuals such as our Clinical Leads have the ambition for continuous improvement – a taste for it, in fact! – and I’m sure this positively rubs off on the staff they encounter on a daily basis.

This is where the West of England AHSN comes in. We facilitate, support, and offer our QI skills to those individuals with the ideas, and help them deliver evidence-based work – from junior to senior staff, to those within and those outside the NHS.

We support commitment.