1. Welcome to Learning Event 6
Programme Supported By

2. 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

3. 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.

4. 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.

5. 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

6. 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 Kracow
Testing Local Sustainability Plans
Submitted Proposal for 3rd Wave

7. HF Scaling Up Videos on Utube
3 mins 24 seconds

8. 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

9. Todays Agenda

10. #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

11. #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

12. DEEP DIVE
Tania Barnes

13. 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

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

15. 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.

16. 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

17. 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

18. 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?

19. MADDY Warren

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

21. WAVE B Tests of Change Share & Reflection
Paul Harriman

22. 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.

23. 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

25. 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 ?

26. 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

27. 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

28. LUNCH
12:45 – 1:30

29. WOLVERHAMPTON – Big Share
Stacey Robinson

30. Evaluation Research Feedback
Steve Ariss & Sonia Lee

31. Sustainability

32. 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

33. 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

34. 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.

35. 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.

36. 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

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

38. MARKETPLACE

39. 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

40. 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

41. Determine your next PDSA Cycle
Paul Harriman

42. 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

43. 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.

44. 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.

45. Daily Wrap Up & Next Steps
James & Sonia

46. 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)

47. 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.

48. 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.

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

50. Timetable

51. 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

52. Addition slides / handouts for the day

53. 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.

54. 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.

55. 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

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

57. 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”

58. 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