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Report of the #ProjectA Accelerated Design Event about Falls, 28 January 2019


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Report of the #ProjectA event held on 28 January 2019 about improving the emergency response to people who experience falls.

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Report of the #ProjectA Accelerated Design Event about Falls, 28 January 2019

  1. 1. 28th January 2018 #ProjectA Report of the #ProjectA falls collaborative Accelerated Design Event Improving our response to people who fall
  2. 2. The purpose of this report What this report seeks to do: • Provide a record of the inputs and outputs from the day • Show what happened on the day and the energy in the room • Document the wealth of information and experience that the attendees brought to the day What this report does NOT seek to do: • Make verbatim notes • Analyse, synthesise or prioritise ideas • Develop a decision document or action plan Report compiled by Lynsey Oates and Leigh Kendall NHS Horizons
  3. 3. The activity: On your own, look through the magazines and find two pictures that symbolise for you: •How the midwifery profession is now (sometimes/always) •How things could be different in the future
  4. 4. Showcase table and wall area • We agreed that we would like to share and show materials from the falls initiatives around the country • Tables and wall areas were set aside for this • We encouraged delegates to make the connections – ask questions, be curious
  5. 5. Welcome Jason Killens Chief Executive Welsh Ambulance Service Why today is important………
  6. 6. Today is an opportunity to come together to develop work on our falls response. The priority is our patients and doing the best for them. It’s great to see representation from every single ambulance service. We want everyone to discuss a falls framework and how we can enhance it further with all the work and expertise in the room. There's lots of interest in improvement in the ambulance service at present. Let’s work together, collaborate and have a great day. People travelled to London from as far afield as Northern Ireland and Scotland to attend the event. Every ambulance service in the UK was represented Welcome by Jason Killens CEO of Welsh Ambulance Service
  7. 7. In the room are people who aren't ambulance staff - these are critical friends, and who are there to help you – embrace them! Helen Bevan Chief Transformation Officer NHS Horizons set the context for the day This is not your usual conference or workshop, it is a specially designed process which enables a depth and quality of output that would usually be unachievable in such a short timeframe...we’ll do three months’ worth of work today.
  8. 8. Helen Bevan reminded everyone of how the Falls Collaborative came to be and also that we are here for a very important reason; to design a response to people that fall. Helen encouraged everyone in the room to unleash their creative brilliance and their superpowers with the help of critical friends. • At a
  9. 9. What were the Aims for the day? What do we want to achieve? • Build connections and collaboration between people across the country who are passionate about improving the ambulance service response to people who fall • Share and build on existing frameworks and good practice • Co-create a framework that is relevant and useful to all • Build a commitment to turning the framework into practical action in local settings • Test out the ideas and identify our next steps #ProjectA
  10. 10. Everyone was granted four freedoms and two rules You have the freedom to: 1. talk about the way you see things, rather than how others want you to see them 2. ask about anything puzzling 3. talk about what is coming up for you, especially your own reactions 4. say you don’t feel you have had one of the above three freedoms Rules: 1. What we share here stays here 2. We start and finish all activities on time Source: #ProjectA
  11. 11. Connection and discussion? We asked three questions and asked people to move a corner of the room that reflected their answer. Once their everyone was able to have a discussion. The questions we asked were: • How long have you worked/been interested in falls? • Which type of organisation do you represent? • Where is your biggest interest in relation to falls? #ProjectA
  12. 12. How long have you worked in /been interested in the area of patients who fall? 38 Years ! 18 Months For as long as I have been a nurse for 41 Years
  13. 13. Which type of organisation or group do you represent? Telecare Patient Experience Berkshire Healthcare Emergency Care Intensive Support Team South West Ambulance Service
  14. 14. Where is your biggest interest ? Where is your biggest interest? Response to Falls Patient Pathways
  15. 15. TRIZ How could we deliberately design the way that an ambulance service responds to people who fall so that it completely fails to meet the needs of patients and staff? TRIZ #ProjectA
  16. 16. Step 1 As a table group make a list of “to-dos” on the first paper sheet in answer to the question: How could we deliberately design the way that an ambulance service responds to people who fall so that it completely fails to meet the needs of patients and staff? • Include some creative answers TRIZ
  17. 17. Where is your biggest interest ?
  18. 18. Step 2 As a table group, go down your first list and ask: ‘Is there anything that we are currently doing that in any way, shape or form resembles any of the items on list one?’ • Mark the items from list one that apply • Be unforgiving about these items and talk about their impact TRIZ #ProjectA
  19. 19. Where is your biggest interest ?
  20. 20. Step 3 As a table group, go down your second list from step 2 and ask: “what are the first steps that will help us stop getting undesirable results?” • Make a list of actions on the other side of the sheet • Identify one big idea for action TRIZ #ProjectA
  21. 21. Where is your biggest interest ?
  22. 22. TRIZ : Our big Ideas Table no. 1 - A designated telephone number for falls that is nationally publicised 2 - A system to respond 24/7 to the help and needs of our customers consistently and selectively ensuring a full start to end service 3 - Make lifting equipment more accessible to community teams 4 - More education for clinicians to improve assessment 5 - Appropriate response training 6 - Electronic health care records that all staff can access 7 - Keep a realistic time line of events for realistic change to happen little and often 8 - Training to the wider community 9 - Greater use of technology 10 - Integrated health and social care 11 - Resilience in care home settings so they can pick up patients without defaulting to 999 12 - A centralised number for referrals
  23. 23. TRIZ - Feedback from the floor • What can we stop? If we want to do more of something new, what can we stop? Easy to add more tasks but need to take some away to do more. • Care home focus, number of falls calls coming from nursing and care homes. Want to reduce, needs education, governance and commissioning to ensure holding care homes to account and to ensure patients are safe. • Need to have one number that everyone knows for falls. How could we create one number? Calls to 111 or 999, each call handler to have access to the correct information. It shouldn’t matter to the caller where their call originates from but matters what response we give. • Each ambulance service covers urban and rural, CCG communications, Health Trust, Social Service complicated process and staffing issues. These are our issues to deal with, not the patients.
  24. 24. Learn and share • We paired teams from ambulance services to have discussions about their current approaches to patient falls: • What are our ambitions? • What do we do well? • What are our biggest challenges? • Our current improvement ideas/initiatives • What needs to happen? • We allocated critical friends to join the groups #ProjectA
  25. 25. Falls- Learn and Share activity Collaboration and shared learning in action
  26. 26. Falls- Learn and Share
  27. 27. Falls- Learn and Share
  28. 28. We want to emphasise that we are not experts The framework is a new framework, we are looking to evaluate what we are doing. It’s a work in progress. We are here to learn with you, we want to learn from what all of you are doing. Claire Roche WAST Assistant Director ,Quality, Governance and Assurance Welsh Ambulance Service presented the work undertaken in Wales WAST Story so far: • Began in Summer 2017, from a brief from Medical Director and Director of Quality and Nursing • Bring a “Focus on Falls” • Jointly led by Asst Dir Quality and Head of Clinical Operations • Falls groups established August 2017 • Falls Improvement Plan
  29. 29. • Falls is complex, lots of different opinions, felt like we couldn’t make sense of it at first. • Not one way of responding to those who fell, needed to respond on the level of need. • Different themes emerged, started to work out the parts of the service in practice. • Then needed to put ideas into action, how we would put the framework together. • July 2018 the framework was approved by Executive Management Team. • Framework composed of 5 themes. • Two dominant themes- assessment and response. Other three themes equally important to sign up and to be part of. Claire Roche introduces the WAST falls framework #ProjectA
  30. 30. #ProjectA • Approved by the Executive Management Team July 2018 • Subsequently endorsed by our Quality Committee and Trust Board • Enabling discussions with Health Board partners/ National Falls Taskforce • Supported funding from Commissioners to increase clinical desk workforce and implement Level 1 Falls Assistant Response WAST Framework Ideas into action…
  31. 31. Falls Response Model #ProjectA
  32. 32. Reviewing the WAST framework • In our teams we reviewed the WAST framework • We considered the questions that it raised for own local circumstances • We had an opportunity to ask our WAST colleagues our questions #ProjectA
  33. 33. WAST Respone Model Task
  34. 34. WAST Respone Model Task
  35. 35. The WAST team Q&A
  36. 36. Table No. Question Changes we would make Table1 What outcomes are you anticipating? Triage: If the person can’t be triaged what do you do? Table 3 Which is the barrier in the community services? Upskill clinician fall specialists Table 4 Were your commissioners engaged? Are commissioners here and if not why not? Levels of engagement with commissioners Table 6 Level 2 how do you standardise it? Consistent route for MDT community response ideally 24/7 Table 7 Question how effective is WAST Framework? Include national adverts on how to get up from floor. Table 9 Falls response model level 1 patients do they receive a falls risk assessment – doesn’t meet prevention? More dynamic movement between 1-2-3. Table 10 Question what is the evidence of these interventions? In addition clear separate documentation plans of how to implement the interventions Table 11 What are the limitations? Staffing who can do what? Change staffing levels, we would employ more people to deal with emergencies Table 12 We need more clarification on the MDT elements? Change by using skype or facetime
  37. 37. The teams in action!
  38. 38. Emerging themes We captured themes through the morning for discussion in the afternoon: • Implications for patients, staff and partners • Implications for our collective model • Implications for ambulance services #ProjectA
  39. 39. 1. What's needed at level 1 2. What's needed at leve2 3. What's needed at level 3 4. What education do staff need to deliver the framework? 5. What data is needed and how can we use and share data? 6. Telecare: how can we work better 7. How do we create the case for change with commissioners? 8. Developing a ‘Just’ culture 9. Preventing falls 10. The evidence base 11. How we engage with care homes 12. How we engage with community partners 13. 24/7 service 14. Engaging and building knowledge and confidence We held an “unconference” where participants suggested the themes we should discus and we put a different theme on each table We gave people a choice of what they wanted to talk about based on the emerging themes from the morning. People joined the theme table that interested them most.
  40. 40. Theme Activity
  41. 41. Table No Feedback 1 What’s needed level 1? CFR Co responders, fire fighters, St John, we need to utilise volunteers. Consistency, ensure we quality assure. 2 What's needed level 2? Collecting data and output, designated falls clinicians in the control room. Prioritise who goes with who. 4 What education do staff need? Basic knowledge of falls – causes, level 2 have training to frailty and medication. 5 What data is needed? We looked at patient side, what do they want from a falls service? Without this we cant get the data. We need to start from somewhere. 6 Telecare sectors and digital. Data to inform commissioning decisions and to inform risk. Silent calls when press alarm but don’t pick up when the service calls them. 7 Create case for change for commissioners. Data sharing, information and models across ambulance trusts means we must have a massive evidence base. Raise profile of falls and scale of the problem as there are far more fall calls than people think. 8 Creating a ‘Just Culture’. Sharing feedback staff should be supported, provide skills knowledge and framework to help them do the job better. 9 Preventing falls. Operationalise level 1- WAST model – public health making every single contact count. Unconference actions
  42. 42. Table No Feedback 10 Evidence base. What do we need an evidence base for, enough interest and drive to do something on a national footprint. Need a year research study get real data back going forward 11 Working with care homes. Consistency of commissioning is patchy. Triage tool, can we agree on nationally? Look at the polices too to ensure consistency. 12 Community Partners. Ambulance service need to map against WAST framework to identity any short falls and identity and feedback to build up the plan. Look at community links, ensure pathways are open for communication. 13 24/7 Service. Level 2 gold pathway engagement with CRT, 5 counties all do things differently in Wales so on national scale we need to consider local applicability. 14 Engaging and building knowledge & confidence Patients in conjunction with the ambulance service must be the driver to enable the wider system to engage, development of common messages. Unconference actions
  43. 43. Midwives are the golden thread! They need to be valued and respected. forward. Individual action plans were drawn up by each ambulance service. These will be shared to ensure learnings and connections are implemented Service action plans
  44. 44. We’re going to capture principles from today to improve the experience for people who fall. It’s about commitment not compliance. Helping you to make connections to make improvements and to make incremental improvements. We want to create a document that builds on the WAST Framework for falls as it’s an amazing starting point. We are going to share experience and data to make improvements in falls locally and nationally. Next steps include ensuring falls has the appropriate profile in trusts. We'll be using virtual meetings to connect people together and keep the conversation going. Anna Parry AACE Thinking through next steps
  45. 45. So many engaging and enthusiastic people in one room, This needs to continue with #ProjectA . Big thanks to all of the Horizons staff ,and all the hard work that goes on behind the scenes to make this day. Also thank you to AACE for their support. There are over a1 00 people here today, most of us will know someone at risk of a fall or had a fall, it’s all about the patients. On a recent zoom call Carol Munt said WAST stood for “What a Superb Team” and it’s true! Thank you WAST for their hard work and sharing their framework. We know need to keep on co-creating and keep connecting. How we take what we have learned to start and make the changes. Trusts are now talking to each other and sharing and learning. Lets keep on building on this work and energy. Final thoughts
  46. 46. Volcano Key Themes: • Keeping the patient as the focus • Funding • Implementation Snow Storm Key Themes • Collaborative working • Sharing best practice & information • Keeping up the energy Finale outcomes…….