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Evidence based innovation - pop up uni, 3pm, 2 september 2015

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Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.

Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.

This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.

More information is available online: www.expo.nhs.uk

Published in: Healthcare
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Evidence based innovation - pop up uni, 3pm, 2 september 2015

  1. 1. Evidence based innovation Dr Robert Varnam Head of general practice development, NHS England robert.varnam@nhs.net @robertvarnam
  2. 2. w ww.england.nhs.uk #Expo15NHS @robertvarnam The founding principles of UK primary care are admired the world over, and rightly so. General practice is a jewel in the crown of this country. Right now, general practice feels in a bad place. Constrained, hemmed-in and, to some, marginalised. Whatever the state of things in your part of the country, in general, I think it’s fair to say that, at the very least, general practice is currently constrained from delivering its full potential. We need to see increases in funding, a growth in the workforce, and improvements to premises. Without those, existing services may not be sustainable. Overview  Common pitfalls  The GP Access Fund experience  Five top tips
  3. 3. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam 1. Common pitfalls
  4. 4. w ww.england.nhs.uk #Expo15NHS @robertvarnam Call to Action on General Practice “What needs to be done to promote, support and sustain the adoption of effective innovations?” a) Finding innovation b) Implementing change c) Unease about innovators & innovations d) Concern about causality bit.ly/c2aGP
  5. 5. w ww.england.nhs.uk #Expo15NHS @robertvarnam Call to Action on General Practice “What needs to be done to promote, support and sustain the adoption of effective innovations?” a) Finding innovation b) Implementing change c) Unease about innovators & innovations d) Concern about causality bit.ly/c2aGP
  6. 6. w ww.england.nhs.uk #Expo15NHS @robertvarnam Call to Action on General Practice “What needs to be done to promote, support and sustain the adoption of effective innovations?” a) Finding innovation b) Implementing change c) Unease about innovators & innovations d) Concern about causality NHS Change Model bit.ly/c2aGP
  7. 7. w ww.england.nhs.uk #Expo15NHS @robertvarnam Call to Action on General Practice “What needs to be done to promote, support and sustain the adoption of effective innovations?” a) Finding innovation b) Implementing change c) Unease about innovators & innovations d) Concern about causality bit.ly/c2aGP
  8. 8. w ww.england.nhs.uk #Expo15NHS @robertvarnam Unease about innovators & innovations The innovators • Whacky / unappealing • Too brainy • Too creative • Too hard working Admirable but not me
  9. 9. w ww.england.nhs.uk #Expo15NHS @robertvarnam Unease about innovators & innovations The innovations • Experimental / unfinished / risky • Too niche • Too context-specific Interesting but not for me
  10. 10. w ww.england.nhs.uk #Expo15NHS @robertvarnam Call to Action on General Practice “What needs to be done to promote, support and sustain the adoption of effective innovations?” a) Finding innovation b) Implementing change c) Unease about innovators & innovations d) Concern about causality bit.ly/c2aGP
  11. 11. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam The innovation itself is not enough
  12. 12. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam 2. GP Access Fund
  13. 13. w ww.england.nhs.uk #Expo15NHS @robertvarnam About the GP Access Fund Aim: “to help improve access to general practice and stimulate innovative ways of providing primary care services” • Wave one: Apr 2014 • £50m • Wave two: Apr 2015 • £100m Applications from practices covering nearly 2/3 of the population of England
  14. 14. w ww.england.nhs.uk #Expo15NHS @robertvarnam About the GP Access Fund 57 schemes ~100 ‘federations’ 2500 providers 18m patients Wave one: Apr 2014 Wave two: Apr 2015
  15. 15. w ww.england.nhs.uk #Expo15NHS @robertvarnam An example of this in practice at the moment is the Prime Minister’s GP Access Fund. Now covering a significant proportion of the country, practices in this are implementing quite wide-ranging redesign of their services, acknowledging that extended hours are only one part of good access. The practices participating in this programme are already beginning to implement many of the transformational changes envisaged by the Five Year Forward View. This is generating valuable learning about the specific changes required, including the ways in which the system can make progress easier and more sustainable. Innovations being tested
  16. 16. w ww.england.nhs.uk #Expo15NHS @robertvarnam Schemes' initial plans for measurement Three broad approaches: a) External academic unit b) Project manager time set aside c) No detailed plan Wave one: 4/20 schemes had dedicated budget for measurement
  17. 17. w ww.england.nhs.uk #Expo15NHS @robertvarnam Inputs from innovation support programme • Webinars • Workshops • Advice from evaluation team • Coaching from NHS IQ • Team reviews • Direct conversations … modest success
  18. 18. w ww.england.nhs.uk #Expo15NHS @robertvarnam The biggest data challenge of all … Wave one: 19/20 schemes required help. 4 had existing BI systems Dec 14: guide published, application preparation webinars Apr 15: welcome pack Wave two: 37/37 have requested help General practice activity data
  19. 19. w ww.england.nhs.uk #Expo15NHS @robertvarnam An exception…
  20. 20. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam Some of the NHS is ill-prepared to measure innovation in everyday care, and some of our baselines are weak.
  21. 21. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam a) Budget & plan for measurement b) Know your logic model c) Measure to inspire and inform d) Measure in realtime e) Show it can work elsewhere 3. Five top tips
  22. 22. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam a) Budget & plan for measurement b) Know your logic model c) Measure to inspire and inform d) Measure in realtime e) Show it can work elsewhere 3. Five top tips
  23. 23. w ww.england.nhs.uk #Expo15NHS @robertvarnam a) Budget & plan for measurement It doesn’t just happen
  24. 24. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam a) Budget & plan for measurement b) Know your logic model c) Measure to inspire and inform d) Measure in realtime e) Show it can work elsewhere 3. Five top tips
  25. 25. w ww.england.nhs.uk #Expo15NHS @robertvarnam Innovations’ efficacy Schemes’ efficacyFunding Cost-effectiveness b) Know your logic model Patient satisfaction Staff assessment OOH attendance A&E attendance New extended hours appointments Additional contact modes Other access innovations Changes in care model
  26. 26. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam a) Budget & plan for measurement b) Know your logic model c) Measure to inspire and inform d) Measure in realtime e) Show it can work elsewhere 3. Five top tips
  27. 27. w ww.england.nhs.uk #Expo15NHS @robertvarnam Innovations’ efficacy Schemes’ efficacyFunding Cost-effectiveness c) Measure to inspire and inform Patient satisfaction Staff assessment OOH attendance A&E attendance New extended hours appointments Additional contact modes Other access innovations Changes in care model Why should I commit to this? How might this work for us?
  28. 28. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam a) Budget & plan for measurement b) Know your logic model c) Measure to inspire and inform d) Measure in realtime e) Show it can work elsewhere 3. Five top tips
  29. 29. w ww.england.nhs.uk #Expo15NHS @robertvarnam d) Measure in realtime If you’re moving forward, why only look backwards?
  30. 30. #Expo15NHS @robertvarnam Using periodic averages 105 55 0 20 40 60 80 100 120 Sample A Sample B1st three month period 2nd three month period Start Data vacuum This is our traditional approach. It is familiar but serves innovation leaders very poorly. How do youkeep people motivated in thisperiod? Averagespreventyou learning from variation
  31. 31. Statistical Process Control charts allow you to measure very frequently, and draw statistically sound conclusions about any change. 97.3% C.I. Changeintroduced here Rapid confirmation that thechangewasa statistically significant improvement This kind of analysis can be produced by a wide variety of software.
  32. 32. w ww.england.nhs.uk #Expo15NHS @robertvarnam d) Measure in realtime Benefits for innovators:  Keep staff motivated & curious  Refine the innovation more rapidly  Gather convincing evidence for others in shorter timescale  Test multiple changes (eg phasing / multiple sites) 1 2 3 4 1 2 3
  33. 33. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam a) Budget & plan for measurement b) Know your logic model c) Measure to inspire and inform d) Measure in realtime e) Show it can work elsewhere 3. Five top tips
  34. 34. w ww.england.nhs.uk #Expo15NHS @robertvarnam e) Show it can work elsewhere • Describe and measure your context (well enough for others to understand & compare) • Test in multiple different contexts • Yourself • First followers
  35. 35. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam a) Budget & plan for measurement b) Know your logic model c) Measure to inspire and inform d) Measure in realtime e) Show it can work elsewhere 3. Five top tips
  36. 36. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam a) Budget & plan for measurement b) Know your logic model c) Measure to inspire and inform d) Measure in realtime e) Show it can work elsewhere
  37. 37. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam Using data as part of a change strategy bit.ly/PMCFlessons1 Choosing metrics for innovation vimeo.com/111923411 Using retrospective case control bit.ly/NuffieldRetroCaseControl Logic models wikipedia.org/wiki/Logic_model Scaling up innovation ow.ly/RBxYt SPC guides bit.ly/SPCguide1 & bit.ly/SPCguide2 #Expo15NHS @robertvarnam john_taylor@nhs.net robert.varnam@nhs.net a) Budget & plan for measurement b) Know your logic model c) Measure to inspire and inform d) Measure in realtime e) Show it can work elsewhere

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