Courage & Creativity Developing a culture of innovation ... · Benefits of EDs working together...

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Mid Essex Hospital Services NHS Trust

Southend University Hospital NHS Foundation Trust

Basildon & Thurrock University Hospitals NHS Foundation Trust

Courage & Creativity

Developing a culture of innovation through local hospital collaboration

6 September 2018

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The Mid & South Essex system - key facts

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Group (current) form: contractual joint venture

3

Trust Boards

Joint Working Board

Joint Executive Group

Site Leadership Teams

Remain as is, delegating maximum authority to a new

sub-committee as agreed through a CJV agreement

which meets in common as the joint working board.

Formed of the three board sub-committees meeting in

common, membership of joint executive group, chairs and

2 further non-executives from each board.

New single executive team which is common to each of

the three boards, responsible for driving strategic cross

organisational change.

Responsible for day to day delivery, led by a Managing

Director with each site director having accountability to

both the Managing Director, and a relevant JEG member.

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Group model helps sustain local services & support integrated care

Sustainability

❖ Benefits of EDs working together across our three local trusts: vacancy factor for consultants

more than halved since 2016.

❖ Seen improved recruitment where teams work together e.g. Radiology

❖ Movement of patients and expanded choice between Trust sites to facilitate better use of

equipment (e.g. robotics) and improved waiting times.

Local care

❖ Benefits of local sites working in system with local authorities, commissioners and GPs

❖ Integrated medical centres on the high street; joint projects e.g. schools, housing

❖ Improved discharge, STP “winter room”; new model of hospital at home

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Creating fertile ground for innovation

5

All 3 trusts are committed to embedding new ways of working that encourage

innovation in order to improve outcomes for patients – laid out in strategic

objectives of our partnership

The increasing structural integration within the sites gives us a chance to

develop a shared approach to innovation across the group that:

▪ Helps find and encourage new ideas

▪ Creates consistency in supporting these

▪ Aids adoption, adaption and helps spread of the best ideas across the group.

▪ Helps manage any risks involved by creating clear and transparent processes

at every stage

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delivering change : institute.

5

It is our ambition to equip our people with the

skills they need to be able to make changes to

improve their services and the clinical skills they

need so that they are ready for new service

models.

We will lead the development of a new

approach to workforce supply, including the

support required to strengthen leadership and

create the leaders of tomorrow.

Future ready and

change positive people

Our people to make changes

and giving them the skills to

improve their job, team and

service.

Equipping

01 Systematic and systemic

approaches to improvement,

delivering better outcomes.

Enabling

02 Our people through change,

developing and sharing best

practice and innovation.

Supporting

03

We will develop and implement a systematic

and systemic approach to improvement and

project delivery which can be tailored to support

the development of new pathways of care at

both local and regional level.

Creating 21st century

services

Our change managers will support individuals

and teams through change and help secure the

benefits of this change for patients and the

communities we serve.

We will work across the health system and with

academic and industry partners gather to

develop and share best practice and act as an

incubator for innovation in service delivery and

new ways of working.

Supporting innovation,

driving best practice

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msb Innovation Fellowship 2018/9

7

Fellowship aims to advance improvements in care for our patients, communities, and

staff. It provides the opportunity to adopt new ideas, approaches and tools in local

services, with comprehensive support and structure to mitigate risks.

msb Innovation Fellows will be supported to test their innovations in relevant and

appropriate services across the msb group, and the wider Mid & South Essex

Sustainability and Transformation Partnership (STP).

Through introductions, networking, mentoring, and challenge sessions we will

develop their knowledge and experience of innovation development, adoption and

scaling and help to reduce barriers and improve the quality of care.

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msb Innovation Fellowship

8

For the first cohort of this new 12-month Fellowship, we looked for innovations and novel ideas

in the two themes:

▪ Improving patient safety

▪ Supporting and better connecting our workforce

8 February 2018 opened applications to internal staff across the msb group and anyone who is

currently participating in the NHS Clinical Entrepreneur Programme

28 February 2018 32 applications received

March/April 2018 – selection and interviews

May 2018 – 16 fellows selected

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SMART – Learning from Deaths Structured Mortality Analysis & Review Tool

“Creativity & Innovation Collaborating with msb group”

Dr Godwin SimonLead for Mortality Review

Jackie Kestenbaum, PhDDirector, Acadiant Limited

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91.8689.9688.9

87.4587.0384.9883.91

85.3885.3084.4583.05

84.6084.4885.8486.7486.69

88.0890.3590.9190.7690.4591.48

93.4496.3195.7496.6296.24

97.7298.8198.2196.5996.59

99.2196.92

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BTUH HSMR - Rolling 12 MonthsData source: HED

Overall HSMR Target Line 100

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112.55 112.13110.70

109.42107.34

104.16 103.13

98.49

93.06 93.9592.23

93.58

98.28 98.13

101.14103.74

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Overall SHMIData source: HED

Overall SHMI

Target

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• The National Mortality Case Record Review (NMCRR) Programme by the RCP, in pilot phase. Yorkshire and Humber Academic Health Science Network’s, Health Quality Improvement Partnership (HQIP).

• around 3–5% of acute hospital deaths are thought to be potentially preventable,PRISM2 study

• The structured judgement review (SJR) review methodology has been validated and used in practice

Hutchinson A, Coster JE, Cooper KL, Pearson M, McIntosh A, Bath PA. A structured judgement method to enhance mortality case note review: development and evaluation. BMJ Quality and Safety 2013 doi:10.1136/bmjqs-2013-001839.

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RCP Structured Judgement review

The standardised approach referred to as a Structured Judgement Review assesses separate phases of care including:

• admission and initial care – first 24 hours

• ongoing care

• care during a procedure

• perioperative/procedure care

• end of life care or discharge care

• assessment of care overall.

Vulnerable adults/All deaths in patient with Learning Disability needs review

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BTUH Mortality Review- Medical Examiners

In Hospital death

ME visits bereavement office within 24 hours to review

death

Junior doctor completes death certificate with support

from ME

Case note reviewer assigned on Acadiant (if identified as a

case for further review)

ME scrutiny is completed (when introduced, recorded

using the electronic Acadiant system)

First Structured Judgement review completed

If sub-optimal care identified, case is referred for a second

tier review

ME completes part 2 of cremation form

Learning/themes/changes in practice from mortality

reviews are fed into Trust’s mortality governance

structure

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Fractured Neck of Femur

• The Royal College of Physicians and the National Hip Fracture Database (NHFD) report in 2017 - the mean 30 day mortality in 2016 was 6.7% nationally and 10.67% for Basildon & Thurrock University Hospital in that same year.

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Fracture NOF 50% reduction in mortality

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How we partner with Mid-Essex, Southend, and Basildon and Thurrock Hospitals:

• Listen to discover the real “ask” beneath the request:• Is it to build Structured Judgment Review in software?

or something bigger:• To help the Trusts in Learning from Deaths –

especially from avoidable mortality?• For Acadiant, this was the opportunity to be creative

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First we turned the Structured Judgement Review from paper into a secure, auditable platform

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Then we made it more relevant and highlighted key learnings

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Used interoperability to minimize the cognitive burden on consultants

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Created on-demand status boards for new facilitators to track workflows

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Expanded to incorporate the new Medical Examiner role & process

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Built dashboards to track the Medical Examiners’ activity and outcomes

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Linked the Medical Examiner and Structured Judgment Review processes

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Distilled meaningful data & trends from EPR to view deaths in context

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Provided data to compare deaths to the broader Trust trends

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• SMART supports clinical governance processes e.g. allows linking of incidents and deaths

• Valuable tool for targeting and measuring further quality improvement

• Supporting clinical appraisal and revalidation

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Next steps for SMART?

To support you in managing your Structured Judgement Review and Medical Examiner processes with our software-enabled solutions, as the new Medical Examiner role is introduced from April 2019.

We invite you to join us.

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Thank you!

Jackie Kestenbaum, PhD

Director, Acadiant Limited

[email protected]

[email protected]

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mailto:[email protected]

mailto:[email protected]

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Dr Mark Lazarus –MSB Innovation Fellow

• Consultant Rheumatologist at Southend University Hospital since 2016

• Special interest in lupus, rheumatoid arthritis and disease modelling (using biomarkers to predict disease flares)

• MSB Innovation Fellow in 2018 – aim of developing remote monitoring and artificial intelligence for our patients with inflammatory disease

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Aims

• Use digital technology and AI to improve the care of patients with rheumatic disease

• Improve access and communication between clinical staff and patients

• Improve and increase the frequency of clinical assessments

• Improve monitoring of disease and drug side effects – predict flares and complications earlier

• Enable self-management

• Reduce costs

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Rheumatoid Arthritis – optimizing patient care

Target

DA

S28

sco

re

2.6

7.0

Time - years

OPD Episodes

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Challenges

• How can we get our Rheumatology department ready for the benefits of artificial intelligence?

• Specific challenges in Rheumatology• Heterogeneous diseases – large amount of variation

• Data needs to be obtained from multiple sources (patients, pathology, radiology) to establish a diagnosis and monitor effectively

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Benefit Explained • Patients suffering from a chronic conditions such as Rheumatoid Arthritis typically require 3 to 6 OPD visits per year with unpredictable increase in attendance following a flare-up. Some of these face to face visits can be avoided and can be carried out through video conferencing, conducting a virtual consultation for routine checkups. Further benefits will accrue as we move to self-care models (level 3 and 4)

• According to sources more than 50% of the face to face consultations can be avoided through a combination of optional skype-based consultations as well as in-home monitoring based on patient-enablement tools.

Benefits Realization Benefits are expected to grow steadily with steady adoption of virtual consultation to reach optimized levels. (35% in year 1, 70% in year 2 and 100% in year 3)

Reduced Cost of Healthcare for chronic conditions due to

Virtual Health (Level 1)

Year 1 Year 2 Year 3 Average

£ 1,234,420 £ 2,468,841 £ 3,526,915 £ 2,410,059

3-Year Simulated BenefitsDescription User Inputs

Number of people suffering with chronic conditions and visit

doctors for checkups 12,000

% of people who's care is managed 100%

Average number of consultation for care management per

year 6

Average charge for face to face consultation £ 160.00

% of face to face consultations that can be avoided 50%

B e n e f i t s R e a l i z a t i o n Q u a n t i t a t i v e A n a l y s i s – H e a l t h c a re

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4 Steps to self-care Data Analysis and Management

Step 1Physician-led care

Interviewing• Physical and time constrained• Analogue

Physician-led• Managed care• Paternalistic

Step 2Physician-supported self-care

Cyber clinics• Conscious inputting• Chatbots

Informed management• Co-management• Virtual MDTs

Step 3Self-care with coaching and guidance

Wearable devices• Unconscious inputting

Self-management• Medical guidance• Coaching

Step 4AI Supported self-care

Cloud data• Extrinsic factors – eg

environment• Comparative data• Population data

Predictive analytics• AI/Augmented intelligence• Predictive/Personalised

management

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Current model of data sharing

Patient

GP

Hospital

Diagnostic services

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Cloud

Patient

GP

Hospital

Diagnostic services

AI

Future model of data sharing

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Biomarkers• Haematology

• Biochemistry

• Genetics

Subjective • PROMs

Objective• Physician assessment

• Radiology imaging

• Digital sensory devices

(e.g. wearables)

Electronic

Patient Record

Analytics• Machine Learning

• Predictive

analytics

• Artificial

Intelligence

Action• Medication

• Surgery

• Exercise/Diet

Outcome• Research/ Audit

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Further benefits

• Collaboration and culture of innovation has enabled better purchasing power and transfer of skills

• Shared ownership of data will: • empower patients

• improve relationships with GPs and community healthcare providers

• Reduce admin and duplication of work

• Connecting the 3 hospitals (MSB) means that we will triple the size of our data cloud, which will enable the development of AI algorithms for rare diseases

Courage & Creativity Developing a culture of innovation ... · Benefits of EDs working together...

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