How we work

We have drawn upon the best existing evidence on how to achieve change and service improvement at scale, this learning underpins our work and the approach that we have taken. We think that equipping individuals and teams to make changes in their own environment, and supporting them to do so is the best way to achieve sustainable change at pace and scale across the NHS. We work with multi-disciplinary teams and across different sectors and tailor our resources and support for specific settings. We engage staff and service users throughout our work.

We work across three key themes which means we are delivering outcomes and having impact on services directly at same time as acquiring and sharing key learning about the adoption and spread of innovation more generally.

What is unique about our approach is that we work collaboratively across sectors and disciplines and use education resources to create real and sustainable change that makes a different to the quality and outcomes of services for patients. We are not creating new innovations as such; we have created new ways of ensuring that the innovation is used in practice across the region. The diagram below pulls together the different elements of our model of working. The content of this page is available as a comprehensive briefing The Yorkshire and HumberHealth Innovation and Education Cluster: A Collaborative Approach.

 

Core aspects of the model are:

 An enabling approach

• We drive the adoption and spread of innovation from start to finish. Our themes are not one-off initiatives they are systematic programmes delivering sustainable improvements in a managed way.
• In order to drive adoption and spread of innovation our approach is both systematic and synchronised:

• Individuals, teams and organisations are at different stages of implementing innovations.  In order to be successful initiatives and resources need to be designed and delivered in a way that recognises and responds to this.
• In order to increase adoption and spread a combination of influencing, support and resources need to be delivered at the same time within all aspects of the related system, including recognition of the problem, evidence to inform interventions, engagement of leaders, staff and service users, education to sustain change, and on-going support for change.

• We have an inclusive approach to our board and our membership which strengthens our governance, but also means we have sign up from senior leaders in health and education across the region. Working in partnership helps to smooth the road for implementing our programmes and continues to be a good opportunity to learn from other sectors and organisations.
• We support and manage the planning, design and delivery of our programmes. We monitor progress and adapt our work streams as we go along to overcome barriers.
• We have launched innovative education resources to support the practical implementation of our programmes, we have done this to achieve real sustainable change to improve quality and/or increase productivity.

• When looking to increase spread and adoption at scale and pace across a region what is clear from our work is that individuals, teams and organisations have different challenges and expertise to address them. We have found that in order to be successful, our programmes and resources must be designed and delivered in a way that recognises  and responds to this and can be flexible to individual circumstances.
• Expertise in  advocacy is essential – nationally, regionally and locally and at all levels of the service from commissioners and leaders of provider organisations through to the practitioners making the changes
• In order to facilitate adoption and spread a combination of effective leadership so that teams are working towards a new vision, along with appropriate support and resources are key. This includes effective engagement with staff so that they recognise and agree what the challenge is, they understand the evidence to inform the solution andboth staff and service users understand the programme which is underpinned with education resources to support the change.

• We are seeking to implement innovation that supports sustainable improvements in the quality of services patients receive.
• We are not looking to deliver one off interventions that impact for a short time and then end.  Our approach is about being adaptable to suit the situation/organisation. We are also supporting staff to develop skills which can be used in other situations. Staff are learning:

• How to identify problems and work to find solutions – as a way of working
• How to use tools with their own experiences – Our work in Patient Safety through TAPS and using Behaviour Change to improve NPSA alerts along with that of the Maternal and Infant Health and Care “Getting It Right From The Start” project all develop understanding of innovation science that can then be transferred to other issues.
• How to own both the problem and the solution and to understand how to overcome barriers to change

• In order to sustain the adoption and spread of existing work and encourage shared learning and transferability, we are working across organisations to create communities of practice which will remain when YHHIEC programmes and specific interventions end.
• Working across the health economy  – we work across sectors, disciplines, settings engaging commissioners and staff at all levels.   We are focussing on the issue not the discipline so that the innovative approaches and ways of working can be transferred to different issues and embedded as common practice.

Education at the heart of what we do

• The value of the HIEC as a model is that it blends research evidence, innovation and education to deliver tangible improvements for patients.
• Driving innovation through education is important to achieve spread at pace and scale, it can bring about changes in behaviours and attitudes and mobilise individuals and teams to implement innovation in their practice.
• Using education as a tool to develop the workforce maximises the benefits from integrating evidence and research findings. With ~60% of the NHS budget used to fund workforce (NHS Choices, 2010), it is critical that the workforce is equipped and skilled to implement innovation to make improvements in their practice.
• Our education resources range from e-learning introduction packages to full on-line modules and toolkits, alongside tailored education and training programmes that run over a number of weeks/months.
• Our education work is grounded in educational theory to help to promote knowledge and understanding and to develop sustainable change

Collaboration, participation, networks and partnerships

• We collaborate with our members through every stage of the journey which delivers a number of benefits:

•  We have worked collaboratively across the region to identify the priorities the HIEC would address. It was important to gain support for our work from practitioners and senior managers, so that our work would add value in their organisations. For example, the Patient Safety Theme has developed an education tool for junior doctors called SAVI. SAVI is now being incorporated into the Junior Doctors Passport in Bradford, because we worked in partnership with the Universities’ and clinicians designing this resource.
• We are working in partnership with the commercial sector to develop education tools such as the Long Term Condition Theme’s introduction to Telehealth and Telecare e-learning resource. We developed in partnership with Virtual College, which enabled us to develop the resource quickly, without any upfront funding and the resource remains free to colleagues in Yorkshire and Humber.
• We have developed resources collaboratively with the people who will be using them. For example, both staff and patients led the design of SAVI resource; as a result we have a resource that is relevant and useful.  The Maternal and Infant Health and Care theme allowed staff and parents a voice in describing their engagement in the work and what their views shaped both the program of work and the priorities for implementation.
• When co-designing interventions to enable teams to identify their challenges, they are far more willing to engage with the work, we have found it is possible to move further faster when the teams were supported to develop their own solutions, drawing upon available evidence.  This creates a sense of ownership and unlocks far more willingness to implement the changes. Our Maternal and Infant Health and Care team conducted a region wide consultation with input from over 400 colleagues to inform the implementation of their work. Their priorities are to promote breastfeeding and attachment in neonatal units and to reduce caesarean section rates across the patch.  As a result of this engagement all 18 neonatal units and 24 Maternity units are now deeply engaged in the programme of change.
• We engage with service users throughout our work.  For example our Long Term Conditions team recently worked with the Yorkshire and Humber voluntary sector to bring together health staff, carers and service users with Telehealth providers. The aim was to raise awareness and find out how existing technologies could be adapted for patients with neurological conditions.  Another example is our  MIHC advisory Group which is co-chaired by a service user and a practitioner.

Evidence based innovations

 

• All our work draws upon an evidence base at every stage; we use evidence to help identify an area as a priority or a challenge, we use evidence to identify potential solutions and how we might best implement our work.  This evidence comes from a range of sources including good quality research, as well as input from government, individual organisations, charities etc. regionally, locally, nationally and in some cases internationally.
• We are gathering evidence regarding our impact and effectiveness as a core part of our work. We are gathering evidence to understand where we have been successful and to understand any challenges that we have had. We are seeking to create a continuous feedback loop in order to refine the practices and further build on existing evidence.  We have commissioned an independent evaluation of our work, which has helped us to understand how we can maximise the impact of our work over the coming year. More detailed work is on-going in each of the themes to examine processes and outcomes, and the views of staff and patients/parents.
• Part of the value of our work is that we relate the evidence base with the lived experience as we implement our work.  For example, the Patient safety theme are working to reduce the harm caused by misplaced nasogastric feeding tubes demonstrated this. The original problem was diagnosed as the misreading of x-rays when the actual issue, as identified when behavior change theory was applied within a multi-disciplinary team, was that the x-rays may not be necessary to begin with. This type of feedback learning means that we fully understand the situation that we are seeking to change and we understand the behaviours that we need to change. This is critical to achieve the outcomes you anticipate.
• Although a robust evidence base is important, we do take a pragmatic approach.  We do not always have all the evidence at all the stages from the very start. Part of the strength of the HIEC approach is sharing what actually works from existing evidence and refining/developing and evaluating this as part of the process.