courage & creativity developing a culture of innovation ... · benefits of eds working together...
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@acadiant
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
The Mid & South Essex system - key facts
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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.
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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.
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
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BTUH HSMR - Rolling 12 MonthsData source: HED
Overall HSMR Target Line 100
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
105.93
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Overall SHMIData source: HED
Overall SHMI
Target
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
• 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.
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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.
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Fracture NOF 50% reduction in mortality
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
First we turned the Structured Judgement Review from paper into a secure, auditable platform
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Then we made it more relevant and highlighted key learnings
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Used interoperability to minimize the cognitive burden on consultants
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Created on-demand status boards for new facilitators to track workflows
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Expanded to incorporate the new Medical Examiner role & process
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Built dashboards to track the Medical Examiners’ activity and outcomes
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Linked the Medical Examiner and Structured Judgment Review processes
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Distilled meaningful data & trends from EPR to view deaths in context
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Provided data to compare deaths to the broader Trust trends
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
• 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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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.
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Thank you!
Jackie Kestenbaum, PhD
Director, Acadiant Limited
@acadiant
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Rheumatoid Arthritis – optimizing patient care
Target
DA
S28
sco
re
2.6
7.0
Time - years
OPD Episodes
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Current model of data sharing
Patient
GP
Hospital
Diagnostic services
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Cloud
Patient
GP
Hospital
Diagnostic services
AI
Future model of data sharing
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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
@acadiant
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
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