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The journey -

This year-long programme looked at caesarean rates across the NHS south central region in order to identify reasons for variation in practice.  The programme team worked directly with five maternity units whose caesarean section rates were below a benchmarked norm.  In each case they undertook an in-depth investigation into why they were performing particularly well.  These investigations were presented as case studies on best practice and shared with all participating trusts at networking events. Alongside the case study investigations, the team developed a regional normal birth pathway.  

Outcomes

All the units in the programme were able to work on areas of improvement in practice and by the end of the programme everyone was able to share examples of specific improvements.  The process of identifying and sharing best practice reduced variation and raised standards across the region.  A final report summarised the learning from the programme. As well as driving up clinical standards, the team also noted a maturing of attitudes and behaviours as a result of the programme.    

Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn   X Children and young people Acute care
Planned care   X Mental health Long-term conditions End of life
 

Information, tools and techniques used

The programme used an appreciative inquiry approach, focussing on best practice.  It was led by a clinical director.  

Geography

The programme covered maternity units in the NHS South Central region.  

Timescale

This was a year-long programme which took place in 2010 – 2011.

Contact details and further information

Nicky Mason, Midwife Consultant: nicky.mason@institute.nhs.uk [post_title] => Sharing best practice in reducing caesarean rates [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => sharing-best-practice-in-reducing-caesarean-rates [to_ping] => [pinged] => [post_modified] => 2013-01-16 15:25:05 [post_modified_gmt] => 2013-01-16 15:25:05 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3413 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 3412 [post_author] => 8 [post_date] => 2013-01-16 15:21:54 [post_date_gmt] => 2013-01-16 15:21:54 [post_content] =>

The journey -

The aim of the Normalising Birth programme was to address the clinical variation in deliveries across the 11 acute trusts in the South East Coast region. It was important in the early stages to develop a clear understanding of why the variation in birth intervention (primarily Caesarean sections) existed, and to identify those units who were performing well. From here, best practice could be spread. Care providers have been pressurised to respond to data on Caesarean rates by lowering them, however, this data was regarded by the project manager as a somewhat blunt indicator of the quality of maternity care. The vision was to explore this clinical variation in more meaningful ‘sub-groups’. A detailed exploration was seen as a potentially powerful tool for initiating change and improvement across the region.  

Outcomes

A significant achievement of the programme is a unique dataset which now exists, illustrating the regional clinical variation in intervention, at a more meaningful level of detail. Trusts are now able to look at their own performance in direct comparison to that of other trusts, something which has provided additional clarity in analysing their own performance and working culture. The development and use of this data has been instrumental in helping trusts to learn collaboratively and share best practice, for example in supporting or advising other units facing similar challenges. A further achievement has been the increase in enthusiasm for new, larger projects arising from the collaborative nature of the programme and resulting increase in confidence created through the group process.  

Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn X Children and young people Acute care
Planned care   X Mental health Long-term conditions End of life
 

Information, tools and techniques used

No specific change model was followed, although elements of the PDSA (Plan, Do, Study, Act) cycle were used.   Clinical network meetings were facilitated by staff from NHSI specialising in the maternity pathway. The clinical group also provided invaluable peer support for each other, sharing tested methodologies in the process.  

Geography

All acute trusts in the South East Coast area (Kent, Surrey and Sussex) were involved.

 

Timescale

The project ran from April 2010 until March 2012, when funding came to an end.  Information is still added to the programme’s database however, and this continues to be analysed.  

Contact details and further information

Normalising Birth was led by Tony Kelly tony.kelly@bsuh.nhs.uk

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The journey -

The Wessex Deanery appraisal and revalidation service programme’s purpose was to set up and run a comprehensive medical appraisal service; appraisals were previously carried out by the PCT.  The aim was to deliver consistent and effective medical appraisals and support to doctors and, by doing this, to drive quality improvements in patient care.  Doctors were given an annual opportunity to have protected time with an expert colleague to review and reflect on their performance and practice. The deanery’s appraisal and revalidation service has aimed to create a culture change in the perception of appraisal and revalidation based on the belief that doctors will get more out of the process if they put more in and have better trained and supported appraisers.  

Outcomes

The deanery now delivers about 2,000 medical appraisals per year through about 200 medical appraisers, delivering consistent and valuable appraisals across different healthcare models. It runs appraiser training and support that was described as “exemplary” by an external quality assurance report. Also, by collating and sharing the educational needs highlighted by appraisals, the deanery has created a sharper focus for educational provision. It has also trained appraisers in mentoring skills and created a separate cohort of trained mentors for support and remediation work. The change has also brought closer alignment of medical educators with doctors and has reduced cynicism about the appraisal system and its value.  

Patient setting

In-patient   X Out-patient   X Community based   X
Mental health   X Chronic illness   X Cross-systems   X
 

Clinical area

Staying healthy  X Maternity and newborn  X Children and young people   X Acute care   X
Planned care  X Mental health   X Long-term conditions   X End of life  X
 

Information, tools and techniques used

No information available.  

Geography

The geographic area is principally the Wessex Area plus the Channel Islands with national networks across the UK.  

Timescale

Following three years as a pilot the project was mainstreamed into the Wessex Deanery GP school in April 2010.  

Contact details and further information

Dr Susi Caesar, Service Lead: susi.caesar@wessexdeanery.nhs.uk
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The journey -

Responding to a lack of internal capability and capacity, nine PCTs came together to collaborate on obtaining specialist analytical support to gather and use data.  This data covered three areas: understanding the health needs of the population; informing service redesign; and indentifying performance indicators to manage providers following commissioning.  The programme team decided to contract a third party to deliver this support: Tribal (now known as Capita).  

Outcomes

Overall the programme has demonstrated good return on investment, although it has proved somewhat less good value for larger PCTs with more internal capability. Over the last year, the scale of the contract with the third party supplier has been reduced as PCT’s understanding of which tools and services will be most useful to support clinical led commissioning has grown. Learning includes a richer understanding of what’s good to provide locally, what at a mid-size geography and what at scale; and that better information and analysis is not enough. In order to use information effectively, change management must also happen.  

Patient setting

In-patient Out-patient Community based
Mental health Chronic illness Cross-systems   X
 

Clinical area

Staying healthy  X Maternity and newborn   X Children and young people   X Acute care   X
Planned care   X Mental health   X Long-term conditions   X End of life  X
 

Information, tools and techniques used

The programme has mainly involved the provision of analytical tools and services to give commissioners access to new types of information. However, an important part of the programme has been to support PCTs in accessing and interpreting this new information to support decision making and to drive intelligence-led commissioning.  

Geography

The programme involved the nine PCTs of the NHS South Central area, which stretches from Milton Keynes to the Isle of Wight.  

Timescale

The third party supplier was contracted in 2010 for four years.  This has now reduced to three to coincide with CCGs going operational in April 2013.  

Contact details and further information

Alan Thompson, Programme Manager, South Central PCT Alliance: Alan.thompson@hampshire.nhs.uk

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The journey -

The High Impact Pathways programme was developed to reduce patient waiting times in NHS South Central to 18 weeks, a target set by the Department of Health. A more creative, sustainable solution had to be devised which would enable the ten primary care trusts across the region to meet this target. The programme aimed to inform and share knowledge across the trusts. Based on the principles of LEAN, (an improvement methodology which focuses on process improvement, reduction of waste and efficiency), the programme involved an undertaking from each organisation involved to re-design and commit resources to three self-selected patient pathways. The scale and transformational nature of the programme was considered highly innovative. Experts from two external management consultancies were employed, in the early stages, to provide leadership for the first of the pathways and later to offer guidance to NHS staff moving into leadership roles. The focus was primarily on quality and the change became embedded across the PCTs as a new way of working.

Outcomes

The programme achieved a significant saving in patient waiting times. Perhaps more significant is the step change in how those involved perceive improvement itself. The project lead has described how ‘the scene was set for a new sense of improvement culture’, with the principles of LEAN methodology becoming embedded. The most significant achievements have been attributed at a local level to strong project leadership and a cultural climate which was receptive to change. Although ultimately not all of the High Impact Pathways were implemented, the overriding feeling is one of an increased appetite for streamlining, reducing waste and standardising processes.

Patient setting

In-patient   X Out-patient   X Community based
Mental health Chronic illness Cross-systems   X

Clinical area

Staying healthy   X

Maternity and newborn  X

Children and young people  X

Acute care  X

Planned care  X

Mental health

Long-term conditions

End of life

 

Information, tools and techniques used

The programme used the principles of LEAN methodology to improve efficiency in all areas.

Geography

Across the ten primary care trusts within South Central.

Timescale

High Impact Pathways was implemented over the course of one year, beginning in late summer 2007. This included an initial period of engagement at executive level and training, primarily for project managers.

Contact details and further information

Peter Loomes led the project. For any queries around the National Dementia Strategy please contact Julie Kerry on 07925 448319 or julie.kerry@southcentral.nhs.uk

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The journey -

This year-long programme looked at caesarean rates across the NHS south central region in order to identify reasons for variation in practice.  The programme team worked directly with five maternity units whose caesarean section rates were below a benchmarked norm.  In each case they undertook an in-depth investigation into why they were performing particularly well.  These investigations were presented as case studies on best practice and shared with all participating trusts at networking events. Alongside the case study investigations, the team developed a regional normal birth pathway.  

Outcomes

All the units in the programme were able to work on areas of improvement in practice and by the end of the programme everyone was able to share examples of specific improvements.  The process of identifying and sharing best practice reduced variation and raised standards across the region.  A final report summarised the learning from the programme. As well as driving up clinical standards, the team also noted a maturing of attitudes and behaviours as a result of the programme.    

Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems
 

Clinical area

Staying healthy Maternity and newborn   X Children and young people Acute care
Planned care   X Mental health Long-term conditions End of life
 

Information, tools and techniques used

The programme used an appreciative inquiry approach, focussing on best practice.  It was led by a clinical director.  

Geography

The programme covered maternity units in the NHS South Central region.  

Timescale

This was a year-long programme which took place in 2010 – 2011.

Contact details and further information

Nicky Mason, Midwife Consultant: nicky.mason@institute.nhs.uk [post_title] => Sharing best practice in reducing caesarean rates [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => sharing-best-practice-in-reducing-caesarean-rates [to_ping] => [pinged] => [post_modified] => 2013-01-16 15:25:05 [post_modified_gmt] => 2013-01-16 15:25:05 [post_content_filtered] => [post_parent] => 0 [guid] => http://clients.electricstudio.co.uk/tvhiec/wpcms/?post_type=improvement-science&p=3413 [menu_order] => 0 [post_type] => improvement-science [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 8 [max_num_pages] => 2 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => 1 [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => 1 [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => [is_privacy_policy] => [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_favicon] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 4dcb925d1ee54ba0dfd9fb9cd189adff [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) ) [1] => derp )

Category: Maternity and new born

Sharing best practice in reducing caesarean rates

The journey – This year-long programme looked at caesarean rates across the NHS south central region in order to identify reasons for variation in practice.  The programme team worked directly with five maternity units whose caesarean section rates were below a benchmarked norm.  In each case they undertook an in-depth investigation into why they were […]

Posted on Jan 16th Cat: , , , Tags: Comments: Comments are off for this post

Normalising Birth programme

The journey – The aim of the Normalising Birth programme was to address the clinical variation in deliveries across the 11 acute trusts in the South East Coast region. It was important in the early stages to develop a clear understanding of why the variation in birth intervention (primarily Caesarean sections) existed, and to identify […]

Posted on Jan 16th Cat: , , , Tags: Comments: Comments are off for this post

Wessex Deanery Appraisal and Revalidation Service

The journey – The Wessex Deanery appraisal and revalidation service programme’s purpose was to set up and run a comprehensive medical appraisal service; appraisals were previously carried out by the PCT.  The aim was to deliver consistent and effective medical appraisals and support to doctors and, by doing this, to drive quality improvements in patient […]

Posted on Dec 28th Cat: , , , , , , , , , , , , , , , , , Tags: Comments: Comments are off for this post

South Central PCT Alliance

The journey – Responding to a lack of internal capability and capacity, nine PCTs came together to collaborate on obtaining specialist analytical support to gather and use data.  This data covered three areas: understanding the health needs of the population; informing service redesign; and indentifying performance indicators to manage providers following commissioning.  The programme team […]

Posted on Dec 28th Cat: , , , , , , , , , , , Comments: Comments are off for this post

High Impact Pathways

The journey – The High Impact Pathways programme was developed to reduce patient waiting times in NHS South Central to 18 weeks, a target set by the Department of Health. A more creative, sustainable solution had to be devised which would enable the ten primary care trusts across the region to meet this target. The […]

Posted on Dec 28th Cat: , , , , , , , , , , Tags: Comments: Comments are off for this post