2. How do we ensure the successful uptake and spread of provider innovation across the NHS?
Chair: Saffron Cordery, Deputy Chief Executive, Director of Strategy and Policy, NHS Providers
Speakers: Tim Horton, Assistant Director (Insight & Analysis), The Health Foundation
Professor Tom Downes, Clinical Lead for Quality Improvement, Sheffield Teaching Hospitals NHS Foundation Trust
Dr Dominique Allwood, Interim Associate Medical Director (QI), Imperial College Healthcare NHS Trust

3. The successful uptake & spread of provider innovation
Tim Horton, Assistant Director, The Health Foundation

4.
The successful uptake & spread of provider innovation

5. The replicability problem
The successful uptake & spread of provider innovation
The replicability problem

6.
The successful uptake & spread of provider innovation
The RIPPLE clinic
A community-based clinic to reduce isolation & anxiety for people with severe COPD
Acts as a catalyst for increased community involvement by blending patient education with social activities
Reduces isolation & anxiety and improves ability to self-manage, potentially reducing admissions

7. Complex interventions are context-sensitive
The successful uptake & spread of provider innovation
Complex interventions are context-sensitive
Organisational systems & culture
Human behaviour & relationships
Dynamism & unpredictability

8. The RIPPLE clinic Some aspects of context…
The successful uptake & spread of provider innovation
The RIPPLE clinic
Some aspects of context…
Depends on relationships with other services – mental health, smoking cessation, etc.
Different transport requirements and recruitment challenges for urban v. rural communities
Clinic social activities evolve around patient preferences (e.g. bingo or yoga?)

9. Different contexts may require adaptation
The successful uptake & spread of provider innovation
Different contexts may require adaptation

10. We asked adopters from Health Foundation programmes…
Have you made adaptations to the intervention during the process of implementing it in your own setting? 
17%
81% No
Yes
Don’t know
94% No
Yes
Don’t know
If so, would you say these adaptations were necessary in order to implement the intervention successfully in your own setting?

11. Adoption is hard work, even when an idea has been successfully piloted
First key message…
Adoption is hard work, even when an idea
has been successfully piloted

12. To adapt, need to know what’s core v. peripheral
The successful uptake & spread of provider innovation
To adapt, need to know what’s core v. peripheral

13.
The successful uptake & spread of provider innovation
The RIPPLE clinic
What might be ‘core’ to making the intervention work?
Does the intervention need to be led by a secondary care team?
Does it matter where the clinics are held?
Do participants need to engage in all aspects of the clinic? (mental health, physical exercise, etc)

14. Innovators can’t always ‘see’ their own context
The successful uptake & spread of provider innovation
Innovators can’t always ‘see’ their own context

15. So early stages of spread are about testing and learning…
The successful uptake & spread of provider innovation
So early stages of spread are about testing and learning…

16. The RIPPLE clinic What did the teams discover?
The successful uptake & spread of provider innovation
The RIPPLE clinic
What did the teams discover?
The clinic didn’t have to be led by a hospital-based team
Clinics had to be in social, not clinical settings
Some aspects (social inclusion) were more important than others (e.g. physical exercise)

17. We asked innovators from Health Foundation programmes…
Would you say you have learned new things about your intervention from adopters’ experiences of implementing it?  No
91%
Don’t know
Yes
90%
Yes No
If so, have you in any way changed how you describe and communicate the intervention as a result? 

18.
The successful uptake & spread of provider innovation
The RIPPLE clinic
“I think we’ve learned from the other sites. I like to think of the project as an ongoing, organic thing that grows and changes…There are things coming out that are making us re-think the model…” Colin Gelder (Consultant) University Hospitals Coventry & Warwickshire NHS Trust

19. Second key message…
As an innovation spreads, adopters generate new learning that can help improve it

20. Challenge to the traditional view of innovation & adoption
The successful uptake & spread of provider innovation
Challenge to the traditional view of innovation & adoption
More balanced division of labour between innovator & adopters
Generation of knowledge throughout the innovation cycle

21. We need greater emphasis on supporting adoption
The successful uptake & spread of provider innovation
We need greater emphasis on supporting adoption
Project management
Relationship building
Training
Data analytics
Realistic timescales
Peer learning
Double running costs
Evaluation

22. We asked adopters from Health Foundation programmes…
With hindsight, which of the following changes do you think would have made the biggest difference for helping you to adopt the intervention?
providing more opportunities to share learning
doing more to support readiness
allowing more time to implement
providing more training and support
closer working relationship
nothing
more guidance on the methods
greater freedom to adapt
providing a more detailed written description

23. Some key points for organisational leaders
The successful uptake & spread of provider innovation
Some key points for organisational leaders
New interventions or ideas often have to be adapted to new contexts Just because a provider up the road has done something doesn’t necessarily mean you can ‘lift and shift’ it to your organisation in a few weeks; it may require a journey to build readiness and then adapt, iterate and refine the intervention.
Adoption is hard work and takes time Teams need to be supported to do the hard work of translating innovations into their own setting (project management, clinical backfill, analytics, etc) and they need to be given sufficient time for their work to bear fruit.
Building organisational improvement capability will help The adoption of innovations (as well as in-house improvement initiatives) can be supported through equipping staff with the skills and infrastructure to help them identify opportunities, and test, implement and adapt solutions.

24. Thank you

25. Flow Coaching Academy programme
Tom Downes
Clinical Lead for Quality Improvement
Sheffield Teaching Hospitals
@sheffielddoc
9th October 2018

26. A complex system problem

27. 2003 Toyota Corolla

28. The Big Room
(Obeya)

29. Time from ‘hospital care complete’
to arriving home :
reduction of 40,000 bed days

30. Respiratory medicine 20% reduction in length of stay

32. Team Coaching
Improvement Science QI
Pathways

34. Benchmarking and visits
Flow Coaching Roadmap
Change Ideas
Brainstorming
Change Concepts
Benchmarking and visits
Process/Value Stream Map
Fishbone
Spaghetti Diagrams
Selection criteria & Multivoting
Global Aim
Driver Diagram
Specific aim
Standardise
Themes
‘Post-it Frenzy’
Change idea
Build a Big Room
A P
S D
Define
measures
A P S D
A P S D
Pre-Phase
Coached weekly
meetings
Patient stories
System
data
Reflective learning

35. FCA Northern Ireland
FCA Birmingham
FCA Devon
FCA Northumbria
FCA Bath
FCA Imperial
FCA Sheffield
FCA Yorkshire

36. Growth in number of FCA coaches over the first 5 years

37. The initial spread process as co-innovation
The spread challenge, The Health Foundation 2018

38. Diabetic foot care 25% reduction in length of stay

39. Percentage of patients dying in hospital with a diagnosis of sepsis
May 2016 to January 2018

40. Tom.Downes@sth.nhs.uk @sheffielddoc www.sheffieldmca.org.uk/flow

41. Our experiences of adopting the FCA Model
Dr Dominique Allwood
Associate Medical Director, Imperial College Healthcare NHS Trust
Consultant in Public Health Medicine
@DrDominiqueAllw

42. How it’s worked…….
Adopter went to innovator site to train in the intervention
During 2016/17 six participants went up to Sheffield to train as Flow Coaches
Set up and coaching in three big rooms for past 18 months
Now Faculty on our own programme, training 24 coaches
Innovator has provided materials and guidance for year 1
Sent updated materials to use for the programme delivery
Regular calls between Sheffield and Imperial and Senior lead in set up phase, and between programme lead in implementation phase
Innovator comes out to support adopter to implement
Faculty from Sheffield come to every session for the first year to support roll out
Provide support and feedback to local Faculty
Adopter undertakes local adaptation and learning
Adopter site programme team meet regularly to plan and review
Liaise with other sites to share learning

43. Benefits of being an adopter
Similar success stories to the innovator - but sometimes faster!
An maybe more nuanced ?
Learning from central team and other adopter sites – ‘what to do and what not to do’ = wisdom

44. And also some of the challenges
Adopting from an organisation where culture and understanding is potentially different
Balancing quality assurance with quality improvement
Finding strategic fit in the organisation
Joining up with other programmes of work unique to Imperial (no one can tell you how to do that bit!)
Overcoming local context specific issues
e.g. multi-site working to allow individuals and teams in big rooms to operate across different sites

45. What we value and would like more of to support adoption……
Guidance on ‘process’
Sharing & learning with peers
Evaluation data