Welcome to Learning Event 6 Programme Supported By

Welcome & Introduction Re- Introduce the teams ask to confirm if any new members today : Wolverhampton (Stacey Robinson) Stevenage (Siobhan) Sheffield (Veena) Sunderland (Laurna) Stoke (Helen Barlow – new) Nottingham (Alison) Re-Introduce – Core team & Research team – Jo and Steve Confirming the main messages for today Building on the Collaborative we have started Learning from the first small steps of all our PDSA cycles and RESEARCH DATA RETURNS Recognising that SHAREHD (like the rest of the NHS Organisation) is using Quality Improvement to : identify what can be improved articulate the change / test what works and why but also what does NOT work and why There are multiple views on what is good, what is important, what is relevant Need to understand there are multiple angles and there is always improvements that can be made BUT – key importance is WHY are we doing this Do the numbers really matter ? What matters is that sharing care with the patients is the right thing to do. This is not the start or the end but a culture change to make Continuous Improvement and Shared Care the norm. Please feel free to tweet as we go along @sharemydialysis #whyidosharedcare

The Vision For people who receive dialysis at centres to have the opportunity, choice and information to participate in aspects of their treatment and thereby improve their experience and their outcomes.

Your Quality Improvement Network Team Support Shared Vision “We will support you to look after yourself” Communication plan Resources Teams = HCPs & Patients Nurse coaching Co-production Peer support Peer assist Reflective learning Co-design Learning events & workshops Action learning Liz Hill-Smith 27/01/2016 That "change support" I mention in last slide underpins each of these. Shared Vision needs to be shared with the "money and resource" people, the Team needs to include them, Comms plans needs to hit their buttons etc. Although you can choose your sites to ensure this sponsorship is there at the start, ongoing effort will be no doubt be needed to maintain and embed this through the project duration. Patients competitive about their bloods – motivation, open days, patient Adapted from : Improvement collaboratives in health care. Health Foundation 2014.

Scaling Up Implementation – SHAREHD Programme Overview & Status Engaging front-line teams through local refinement and implementation Engaging patients through co-production Learning Events Research Collection

Since the Last meeting One Day Senior leaders Course ‘What I tell my Patients’ Article Single Session with WAVE B Wolverhampton local Article KQUIP regional Day Programme Video Task Summary Sheet data collection (July) Home HD pilot study protocol Drafted Toolkit & Roadmap EDTNA @ Kracow Testing Local Sustainability Plans Submitted Proposal for 3rd Wave

HF Scaling Up Videos on Utube https://www.youtube.com/watch?v=uexo0zE6rpM 3 mins 24 seconds

Before the next meeting Conferences : National Kidney Federation 14th October Home Therapies Conference 28/29th Sept (break out session) Research : October collection of composite questionnaires Reporting : 6 monthly Health Foundation Report Health Foundation Interim Evaluation Report Ask by show of hands who is going to NKF Manchester Home therapies

Todays Agenda

#whyWEdosharedcare ICEBREAKER Wolverhampton Sunderland Nottingham Sheffield Stoke Stevenage Wolverhampton #whyWEdosharedcare Heart of England Guys & St Thomas As a team 2 minutes to fill in the A3 form & Nominate a spokesperson Complete the #whyWEdosharedcare Manchester Leeds Bristol York

#whyWEdosharedcare it promotes a partnership approach to care it encourages patients to move away move from being passive recipients of care to being active participants in care “patients are happier because they have greater flexibility with their treatment and more control over their lives” “it shows patients that it’s not the end of their life and proves to them they don’t have to be dependent on someone else” “it is extremely fulfilling to see a patient achieve more than they ever thought they could” it promotes a partnership approach to care “it frees me up to concentrate on other aspects of patient care” it challenges the culture #whyWEdosharedcare

DEEP DIVE Tania Barnes

You told us that you were interested in several areas for discussion… Using technology to co produce (D4D) Getting data back to the patients Making Time to do shared care Setting future service standards Use of social media for promotion and networking End to end care with shared care Sharing of a full renal case study using QI Deep Dive Areas

Deep Dive: Creating Time Regular barrier is ‘we do not have time’ Deep Dive: Creating Time Making Time to do shared care

Deep Dive: Creating Time Finding the root causes of the barrier ‘we do not have time’ CONSIDER… Routine - essential or habit? Expectations of patients and staff Creative roles and utilising opportunities Creating a service to meet current needs What is our rationale for doing what we do? Identifying waste – could use QI techniques to do this if required and would like support to do so Using Time & motion actually can identify areas where we do waste time that giving some though to what needs to change and how either to process or envrionment can help to improve and save time. Challenge ‘why’ if you have always just done it this way why – is it really needed and can it be simplified to get the same result ? How to prevent – can you prevent loss of time due to external circumstances ie transport late – resource delayed for whatever reason.

Flexible PATIENTS time You can “Create” Time Maximising use of The Golden 15 minutes CREATIVE STAFFING SOLUTIONS Roles / Rota / Shared Care Sister Flexible PATIENTS time

Deep Dive - Discussion How Have We Made Time ? AND / OR How Can We Make Time ? Stevenage & Nottingham Bristol & Heart of England Sheffield & Manchester Wolverhampton & York Sunderland & Leeds

Sharing how we have worked with time How to maximize our time? Deep Dive - Discussion Stevenage & Nottingham Bristol & Heart of England Sheffield & Manchester Wolverhampton & York Sunderland & Leeds Sharing how we have worked with time How to maximize our time?

MADDY Warren

Patients please go to Room behind reception COMFORT BREAK – 15 mins Patients please go to Room behind reception with ANDY

WAVE B Tests of Change Share & Reflection Paul Harriman

SHAREHD Global Aim Remember that the aim of the analysis is to understand the system well enough to generate your THEMES for improvement. The SHAREHD Global AIM is : We aim to increase the uptake of shared care in centre based HD patients. The process begins when a patient is offered the choice of different types of dialysis and ends when the patient ceases in-centre dialysis treatment. By working on this process, we expect patients to be encouraged to take on more dialysis tasks themselves . For Health workers to enjoy more working in the dialysis units The Percentage of patients doing 5 tasks is expected to increase. It is important to work on this now because: We want to improve the dialysis experience and outcomes for patients It is supported by the NHS 5 year plan / STPs that encourage Patient centred choice, self care and empowerment. REMEMBER The VISION For people who receive dialysis at centres to have the opportunity, choice and information to participate in aspects of their treatment and thereby improve their experience and their outcomes.

End2End linkup Global Aim - Sustained Change Primary Drivers Secondary Drivers Change Ideas Measures PDSAs PDSA 1 Environment Design Sustain  SHARED CARE Patient Engagement PDSA 3 Increase numbers Staff Engagement Increase Health & Safety Education Increase hand washing PDSA 2 Identify barriers Weekly monitor PDSA 1 How to measure Improvement Ramp See Generic SHAREHD driver diagram on the wall

PDSA Share and reflection Approach Each wave B team will share their progress (5 mins) Floor discussion and questions (3 mins) Share & reflection for non presenting teams (2 mins) Use the forms provided on your desk – as a team discuss and document … What is your learning from listening to each of WAVE B teams PDSA tests of change Could you consider this to be a test in your unit ? Why ?

WAVE B - PDSA Share What did you PLAN to do Did you DO this ? What does this mean STUDY ? Any thoughts on next ACTION ? ORDER & PDSA objectives : Manchester – Target Weight Ultra Filtration Heart of England – Ask Me Armbands York – Pre-Treatment Observations Bristol – Washing hands pre-treatment Guys – Staff Workshop & Patient Focus Leeds – Staff Engagement

Guy’s team Our plan: Staff: Data analysis revealed the following: Staff survey to understand their current views of SHAREDHD Workshop for staff to discuss their views - engage, motivate and inspire…. Patients: Talk to the 10 patients who expressed an interest in home HD to take this forward - engage, motivate and inspire…. Target the patients are doing more than 5 tasks & aim to move them forward - engage, motivate and inspire…. Encourage all patients to move from 3 to 5 tasks - focus on preparing pack as the next task after hand washing - engage, motivate and inspire…. Data analysis revealed the following: 1/3 of our patients are doing more than 5 tasks 10 patients expressed an interest in home HD the majority of patients are doing weight, BP and hand washing

LUNCH 12:45 – 1:30

WOLVERHAMPTON – Big Share Stacey Robinson

Evaluation Research Feedback Steve Ariss & Sonia Lee

Sustainability

Defining Sustainability: Evaluation Context (fixed and changeable) Surroundings Attitudes/abilities Experiences Needs Mechanisms Behaviour Theories of change Activities to achieve outcomes Outcomes Patterns of outcomes Different contexts = different effects of mechanisms OUTCOMES BEHAVIOUR CONTEXT

Evaluation themes: Sustainability Staff Retention (champions, knowledge, skills…) Organisational support Training/competencies Attitudes Concept of time Delayed ‘payback’ for training Training for ‘complex’ tasks Pressure times (getting on and coming off) Normalising shared care Resilience

Sustainability – Interview Findings 10 staff at 5 SHAREHD sites Early findings on the Sustainability theme from the interviews were that shared care is often seen as an addition or extra work, which is the first thing to stop when pressure increases. Phases such as below were used : ‘fits and starts’ ‘lost momentum’ ‘used to do a lot…then it dropped off’ What this shows is that Shared Care is not embedded into the culture. Some things that the interviews suggested might help included : Support from senior management Staff retention: Shared care ‘Champions’ Consistency in training Staff with positive attitudes towards shared care Time to teach both staff and patient shared care 2 minutes to think about it in your team ? How confident are you that you are making changes to improve the delivery of Shared Care How confident are you that you can (continue to) make changes to improve the delivery of Shared Care Use the Decision Matrix to help as a tool to direct questions to bring other along too.

Sustainability – Interview Findings 10 staff interviewed across 5 SHAREHD sites Early findings on the Sustainability theme from the interviews were that shared care is often seen as an addition or extra work, which is the first thing to stop when pressure increases. Phases such as below were used : ‘fits and starts’ ‘lost momentum’ ‘used to do a lot…then it dropped off’ What this shows is that Shared Care is not embedded into the culture. Some things that the interviews suggested might help included : Support from senior management Staff retention: Shared care ‘Champions’ Consistency in training Staff with positive attitudes towards shared care Time to teach both staff and patient shared care How confident are you that you are making changes to improve the delivery of Shared Care How confident are you that you can (continue to) make changes to improve the delivery of Shared Care Use the Decision Matrix to help as a tool to direct questions to bring other along too.

Sustainability – Team Discussion In order to promote sustainability… What do you do? What could/should you do? Individual Level: e.g. Job descriptions, Roles, Staff competencies Unit Level: e.g. Routines, Audits, Pre-dialysis Service Level: e.g. Directorate policy & procedures (Five minutes on each level) Ensure mention of Habits is included here

Sustainability Feedback Group Feedback Would you like to trial the local Sustainability template ? Contact Paul Laboi or Sonia Lee

MARKETPLACE

Approach Core & Wave A team display areas where you can find out about their SHC journey and PDSA cycles Suggest you either – Go round as a team looking and discussing with each site their display or Split your team to go to the separate teams and feed back together Come back together as a team at 3.15 to discuss your findings GRAB A CUP OF COFFEE

Marketplace Team reflection Consolidate the thoughts within your team – Suggested considerations …… Which ideas / activities did you like ? Are there any that you would like to know more about ? Which ideas might work in your local environment and why ? What other learning from each of the WAVE A teams displays? Was this experience useful ? Should we do it again ? How could it be improved Forms provided on your desk for individual reflection and team

Determine your next PDSA Cycle Paul Harriman

Next cycle PDSA Discussion / Support What did you PLAN to do what were your questions, predictions and expected measures ? DO STUDY ACT Support of teams as follows : Andy – Sunderland and Wolverhampton Paul - Bristol, Stevenage and Stoke James – Sheffield Tania - Heart of England and Leeds Sonia – Nottingham and taking photos/copies of PDSAs Paul L – Manchester and York

Sustainability - Habits Easy Simplify, reduce hassle , remove friction Attract Attention, salience, personalisation Social Norms and peer reference Timing Timing affects many behaviours 2 minutes to think about it in your team ? How confident are you that you are making changes to improve the delivery of Shared Care How confident are you that you can (continue to) make changes to improve the delivery of Shared Care Use the Decision Matrix to help as a tool to direct questions to bring other along too.

PDSA Summary QI Wrap Up: Remember regular PDSA steps Look for ways to maintain local momentum Every interaction should be seen as an opportunity to learn – not compelled or bullied but an opportunity to do as much or as little as feel able.

Daily Wrap Up & Next Steps James & Sonia

Event Evaluation Remember these are your events we need your input - Immediate personal Feedback and post on the 2 CAR PARKS What worked well What could be done better Reflective Team Evaluation Please complete on your way home as a team Identify a lead to write up and mail back to me (self addressed envelope provided)

Next Events Action Period Call : 12th OCTOBER 11:30 – 13:00 Action Period Call : 31st OCTOBER 11:30 – 13:00 If you cannot make it please arrange a time that will suit you and your team Next workshop : NOVOTEL 22nd NOVEMBER 2017 Every interaction should be seen as an opportunity to learn – not compelled or bullied but an opportunity to do as much or as little as feel able.

Key Messages Every interaction should be seen as an opportunity to learn – not compelled or bullied but an opportunity to do as much or as little as feel able.

This room is available till 5pm please stay and discuss ideas with other teams or the core team

Timetable

Regional innovation fund KEY PARTNERS Patients and carers Participating acute health care trusts Y & H Regional innovation fund If you have been supported locally Please provide us with YOUR log and we can add it to this wall of fame/ thanks

Addition slides / handouts for the day

Is There a Way to Prevent Quality Improvement Burnout? End-user participation — Active participation of end-users in the design, testing, revision, and implementation of change interventions increases the likelihood of higher perceived value. A change developed with end-user participation is also more likely to be easier to put into practice, thus increasing the chance of sustained adoption. Alignment and planning — Change initiatives aligned with an organization’s goals, values, and objectives and planned to inform end-users and avoid conflicts between projects or priorities are more likely to increase perceived value and achieve sustained adoption. Resource availability — Providing the necessary support and resources to aid understanding and implementation of the change initiative helps end-users adapt changes into their existing workflow. Workload — Interventions that require less effort or improve the current workflow are more likely to be sustainably adopted and reliably performed. Complexity — Interventions that are simple and easy to use are more likely to be sustainably implemented and reliably performed. Perceived efficacy — When people trust the quality and validity of the evidence supporting an intervention, it is more likely to be adopted and results in less change fatigue and cynicism.

Deep Dive Areas The following are areas that you have said you would like to Dive more deeply into : How to create time Hints and Tips for Microteaching Communication & Social Media (KRUK) Technical innovations for SHARED CARE (D4D) Getting data back to Patients – Patient view A renal QI Case Study (Full Fat) End to End – How to involve Pre-Treatment in Supporting Shared Care Service change Guidelines – NICE / STPs / Renal registry Over the next joint sessions we want to cover as many of these as possible either as full 12 or split into smaller groups. If you want other topics covered in the session please let us know.

Support for Teams PDSA time Support of teams as follows : Andy – Sunderland and Wolverhampton Paul - Bristol, Stevenage and Stoke James – Sheffield Tania - Heart of England and Leeds Sonia – Nottingham and taking photos/copies of PDSAs Paul L – Manchester and York

Twitter Follow us and share your thoughts and experiences – we can the retweet to our followers who can the rretweet again.

Advisory & Dissemination Board Meets Approx every 4 months Terms of Reference agreed Key discussion Topics covered rather than general discussion Agenda and minutes available on website: DEC 2016 Discussion Topics Key Questions 1 ; Sustainability “Those executing Shared Care in many cases feel that is it fragile and reliant on key individuals. There is a worry that without these key staff that things could easily revert back to previous ways of working. How can we culturally embed shared care ?” Key Question 2 :Spread “ How can we extend and spread to future renal units in England and the home counties without the implementation of ‘HARD measures which goes against the premise of Shared Care being that patients do what they feel able to - would the imposition of targets invoke the wrong outcomes and put staff and patients under pressure which is counter productive in SHAREHD” MARCH 2017 Discussion Topics Key Questions 1 – Sustainability “How can changes to NICE guidelines, Renal Services Specification and Commissioning approaches support Shared Care to become routine within all units ?” Key Question 2 – Spread “Are the current SHAREHD programme collaboration tools the best to generate the required reach for dissemination as well as support for local trusts ?” Forum Members Donal O’Donaghue Liz Hill Smith Bernie Stribling (DESMOND) Paul Bristow (Kidney Care UK) Tess Harris (PKD) Michael Nation (KRUK) Jon Gulliver (Commissioning) Wendy Tindale (D4D) Hilary Chapman (Chief Nurse) Valantina Karas (HF) Eileen Hall (CCG) Becky Malby Paula Ormandy JULY 2017 Discussion topics Key Question 1 -   “What message best encapsulates Shared HD Care for you ?” Key Question 2 - “Patient participation is essential for Co-Production – what are the challenges and how to facilitate them”

PDSA – NEXT CYCLE Support Sunderland Nottingham Sheffield Stoke Stevenage Wolverhampton ANDY SONIA JAMES PAUL PAUL ANDY Heart of England Guys & St Thomas Next Cycle PDSA Support Manchester Leeds Bristol York PAUL SONIA TANIA TANIA PAUL L