co-producing change: what we have learned from ... · co-producing change: what we have learned...
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Co-producing change: What we have learned from implementation science and knowledge mobilisation
• Cheryl Grindell, Clinical Researcher /Physiotherapist, CLAHRC YH Royal Hallamshire Hospital, Sheffield
• Jennifer Harris, Senior Physiotherapist, Doncaster & Bassetlaw Teaching Hospitals
• Carley King, Neighbourhood Clinical Quality Lead, Leeds Community Healthcare Trust
• Daniel Wolstenholme, Core Project Manager, NIHR CLAHRC YH
CSP and implementationInspire Workforce data model
The cost of falls
What happens next??
• what is knowledge mobilisation?
• A practical exercise
• case study: NOISELESS
• case study: Way Forward
• reflections
what is knowledge mobilisation?
what is knowledge mobilisation?
• 60+ K* models & frameworks
• Traditional view of linear, rational, instrumental process
• Current evidence shows complex, social and relational process
(Davies, Powell, Nutley, 2015)
what is knowledge mobilisation?
Knowledge producers Knowledge users
what is knowledge mobilisation?
• Mindlines
(Gabbay & Le May, 2004)
Co-production
Emotional Mapping
• Think about each step of your journey today: from where you
woke up to sitting down at the opening lecture
• Write each step on a separate post it note
• Stick them across the timeline on your table
Emotional Mapping
• Agree the ‘touchpoints’ across the top of your table’s sheet
• ‘touchpoints’ are where you interact with another service or
individual, (family, the hotel, train, taxi driver etc)
• Now move your post its up or down on the sheet to illustrate
positive or negative emotions associated with that touchpoint
- what is knowledge mobilisation?- case study: NOISELESS- case study: Way Forward- summary
Reducing noise at
night on a hospital
ward: A Co-design
service improvement
study (NOISELESS)Translating Knowledge into Action Theme, NIHR CLAHRC YH
Prof Angela Tod
Dan Wolstenholme
Cheryl Grindel
Remi Bec
NOISELESS Background
• Huddersfield University and Huddersfield and Calderdale NHSFT
• Noise levels on MAU measured over 3 month period.
• Results showed levels above that recommended by WHO during day and night
• Staff, patient, family and friends feedback • Observations
Workshop 1
Shared experience
Lived experience
Normal nights
Hospital nights
Volume vs ‘irritatingness’
Workshop 1
I shared a room with a very confused and
disruptive patient who urinated everywhere and
kept getting up. He was provided with a gadget
which made an extremely loud noise like a
CLAXON! Asking him to sit down. Other things
like nurses and patients coming and going, no-
one lowered their voices. The lights were on
and the door was open. Having OBS done.
Loud nebuliser in the room.
A man shouting half the night. Doors banging.
People in and out. Bleeps bleeping. Loud
talking. I feel terrible.
A patient was snoring and my partner kept ringing
up.
The lights were on in the room and
the Dr was coming in and out of
the room all night to see another
patient.
Noise Bingo
Workshop 1
Shared experience
Lived experience
Normal nights
Hospital nights
Volume vs ‘irritatingness’
Workshop 1
Shared experience
Lived experience
Normal nights
Hospital nights
Volume vs ‘irritatingness’
Workshop 1
Context
Shared experience
Lived experience
Normal nights
Hospital nights
Volume vs ‘irritatingness’
Workshop 2
Outputs of workshop 1
Testing noise impact reduction in sim lab
Ideation against themes (Ideo method
cards) forced association wilder ideas
reducing the impact of noise on patients
reducing the noise made by humans
reducing the noise created by technology (buzzers)
reducing the noise created by furniture (doors, bins etc.)
Workshop 2
Recap outputs of workshop 1
Testing noise impact reduction in sim lab
Ideation against themes (Ideo method
cards) forced association wilder ideas
-
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
silicon head phonesnc
wax foam headphonesmusic
white pink music
Beeping
Door/bin
talking
trolley
Average noise reduction by type of noise and
approach
Workshop 2
Recap outputs of workshop 1
Testing noise impact reduction in sim lab
Identify all sources of noise in each theme
Ideation against themes (IDEO method
cards) forced association ➜ wilder ideas
Reducing impact of noise
on patients
Ear Plugs Patient sleep
pack (PSP), staff ward
sleep pack
Prototype creation
Reducing noise made by
humans
Noisy shoe silencers,
awareness of staff noise
(magic ear), snoring (nasal
strip)(PSP)
Test
Reducing noise created by
technology (buzzers)
Reduce volume on pumps,
reduce volume on call
buzzer, reduce volume on
phones
Test on prototype night
(curfew)
Reducing noise create by
furniture (doors, bins etc)
Soft close bins, identify
noisy equipment (PSP),
soft close doors
Test
Patient involvement
/impact
Reporting poor sleep, do
not disturb signs (PSP),
sleep hygiene (PSP), eye
mask PSP
Test
Prototype development
KEEP NICE
& Q UIET
(10 pm - 7am)
Prototyping day
Prototyping Night
PLEASE KEEP
NOISE DOWN
Quiet Time: 10:30pm - 7am
SL EEP WELL
• Ward ‘noise champion ‘pack
• Mini noise audit, Service
Improvement project
• Stripped down patient pack
• Eye mask
• Foam ear plugs
Final iteration
KEEP NICE
& Q UIET
Q uie t Time : 10 :3 0 pm - 7am
SL EEP WELL
Questions
http://clahrc-yh.nihr.ac.uk/our-themes/translating-knowledge-into-action
The project
• The CSP: how can we support members
to implement guidelines more effectively?
• Linked with NIHR CLAHRC to
understand challenges and establish new
approaches to implementing evidence-
based guidance
• 74.4% of Doncaster residents are
classified as carrying excess weight¹
Phase 1:
Staff and patient experience gathering
Phase 2: Workshops
Guiding
Principles
Supporting
principle
Journey
stages
Final ideas
1. Prompting conversation
2. Communication theory
3. Weighing and measuring
4. A new healthy-living service
5. Hospital environment
What? Idea 1:
Mention
health and
wellbeing
check in
appt letter
Idea 1:
Self-
complete
health and
wellbeing
support tick
box
Idea 5:
Healthy
living
promotion
Idea 3:
Test ‘weigh
in’ at physio
clinic
Idea 1:
Prompts
including
positive
language
about
weight
Idea 2:
Prompts
including
learning
from
Physios
Idea 4:
A service
spec tier 2.5
weight
watchers
plus
Idea 4:
Consistent
branding,
web links
(via ipad)
and paper
resources
Why?
When?
Phase 3: Co-design
sessions
Shift from ‘Weigh’ to ‘Way’
• Why target only
weight?
• ‘Make Every
Contact Count’
Pre-appointment and check-in:
Readiness for change and prompting
conversation
Hospital environment:
public health information & signposting
Weighing and measuring:
Informed advice and signposting
Consultation:
Prompting conversation, building rapport
and informed signposting
Information and signposting:
Access to expertise
Prototype clinic
“Receiving [Way Forward]
information was good way
to discuss some lifestyle
issues that I wouldn’t
normally ask about”
Increase size of ipad /
interactive screen
“This is all part of
being a healthcare
professional”
Need space for patient
name/ id. no.
/signature and date
both sides of form
Need to consider
options to
weigh/measure
patients with
mobility issues
“Healthy lifestyle advice is
part and parcel of
physiotherapy – it should
be routine”
“Physical health and
physiotherapy go hand in hand”
“Physiotherapy and
healthy lifestyles are
all bound together”
Pre and post (prototype test)
compliance with NICE Guidance on
Obesity
0
10
20
30
40
50
60
70
80
90
100
Patients weight Patients height Waistcircumference
Patients BMI Patients physicalactivity levels
Benefits ofhealthy life style
discussed
Signposting/referral tohealth promotion
services
Percentage compliance with NICE guidelines
Revised documents
Celebration event
Thanks to all the staff and service users who have contributed their time
Questions
Reflections & conclusions
Thanks
• @Wolstenholme_d
• @cherylgrindell
• @jenharris1981
• @carleytheking