Presentation written by Director of Quality Improvement Clinic, Nicola Davey

1. The Power of co-
production
Nicola Davey
Director of the Quality Improvement Clinic

2. What is co-production?
A way of working whereby decision makers,
experts, citizens or service providers and users
work together to create a decision or service
which works for them all
• Benefits
• Rules of engagement
• Outcomes

3. What are the benefits of
co-production?
• Serves a collective purpose
• Builds on existing evidence base
• Generates more interest and builds active networks
• Pools resources for mutual benefit
• Utilises small scale tests of change
• Reflects learning in each test cycle
• Engages partners across the UK
• Promotes dissemination and spread

4. The deal…..
National resource
• Collates evidence base
• Co-ordinates work
• Creates network opportunity
• Analyses & shares collective
results
• Designs and promotes
national products/services
Local resource
• Provides experience & energy
• Contribute to the design
• Commit to testing & measurement
• Applies ideas within local
products/services OR
• Adopts national products/services

5. What can be achieved?
Creation of the
UK Paediatric Trigger
Tool PTT
Development of
measure of harm
for Paediatric care

6. Approach
The Model for Improvement. Langley, Nolan, Nolan, Norman &
Provost. The ImprovementGuide, Josse Bass, 1996
A UK wide measure of harm for
paediatrics
0
Clinicians will use the paediatric trigger
tool to identify and measure paediatric
harm
Work with co-production partners using
PDSA cycles to test, refine and produce a
UK paediatric trigger tool
Test ideas – before implementing changes

7. Aim
What
To design and make widely available a tool to
measure ‘harm’ in paediatrics
By when
Within 9 months
As measured by
No. of case note review results posted
(on trigger tool portal)

8. Co-production steps
• Convene a small steering group
• Describe the proposal
• Recruit co-production sites (Teaching and District General Hospitals)
• Identify resources – internally and for co-production partners
• Schedule and host 3 network meetings
• Publish UK Paediatric Trigger Tool
• Use Model for Improvement (PDSA)
- Collect evidence and inputs from experts to inform starting point (Plan)
- Undertake PDSA testing cycles (Do)
- Analyse findings (Study)
- Feedback findings to inform next cycle (Act)
- Design next cycle (Plan)

9. PDSA cycles
Review international
evidence base and
current practice
Introduction to use
of Trigger Tool
1st consensus on
paediatric triggers
1st test of paediatric
triggers
Data collection
Review of results
from 1st test
Discussion of
findings
Generation of ideas
for improvement
Development of
definitions guide (for
consistency)
2nd consensus on
triggers
2nd test of paediatric
triggers
Data collection
Review of results
from 2nd test
Discussion of
findings
Generation of ideas
for improvement
Streamlining
measurement and
validating paediatric
tool – (trigger tool
portal)
3rd consensus on
triggers
Refinement of
definitions
3rd test of paediatric
triggers
Data collection
Review of results
from 3rd test
Design and testing of
trigger tool data
collection form
Production of training
materials
Development of
business case for
case note review
resources
Launch of Paediatric
Trigger Tool
Evidence from portal
of case note review
activity

10. Measurement
Triggers 1st cycle
38 triggers
2nd cycle
40 triggers
3rd cycle
39 triggers
Results
7 trusts
172 case note
reviews
148 case note
reviews
140 case note
reviews
Analysis of trigger
specificity after 2nd
cycle (296/330 case
reviews eligible)
503 triggers were present (1.7 per case, 95% CI 1.5 – 1.9) 127
adverse events were identified (0.43 per case, 95% CI 0.3-0.6)
Calculation of harm
rate
The harm rate was 43%

11. Outcome
UK
Paediatric
Trigger Tool
Results posted
on Trigger Tool
Portal

12. Learning points for success
• Identify adopters and champions – recruit to steering group
• Go where the energy is – secure motivated co-production partners
• Keep to the plan – three meetings to maintain momentum, commitment and progress
• Share resource burden – provide central support for network meetings and analysis
• Draw on existing knowledge – use of evidence base, experts in field, other explorers
• Share early findings – share and discuss results at network meetings
• Make measurement easy – develop simple and standardised ways of capturing and
analysing results
• Facilitate easy access to resources – documents downloadable via website
• Publicise – launch nationally, follow-up contacts and seek feedback and results

13. What I would do differently next
time?
Secure more internal resources
• Administration
Anticipate and plan response in the event of high
levels of ‘pull’
Invest more time on specification for new technology

14. What else can be achieved?
Creation of Paediatric
Early warning score
charts (PEWS)
A standard template to
measure, detect &
escalate concerns about
children who are
becoming more unwell

15. Copyright & citation
This presentation has been made available to you support your
personal learning.
Many of the images in this presentation have been purchased for
this purpose and are not available for reproduction.
The citation for this document is: Davey N.J., 2013,The Power of Co-
production, Quality Improvement Clinic