connected health cities programme - better safer care · pdf file 2019-04-01 ·...

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  • Connected Health Cities Programme

    Prof. John Ainsworth Director [email protected]

    Gary Leeming Chief Technology Officer [email protected]

    Dr Amanda Lamb Deputy Director & Chief Operating Officer [email protected]

    Ruth Norris Head of Strategic Relations [email protected]

  • The Problem

    http://www.thenhsa.co.uk/app/uploads/2018/11/NHSA-REPORT-FINAL.pdf

  • “An integrated health system in which progress in science, informatics, and care culture align to generate new knowledge as an ongoing, natural

    by-product of the care experience, and seamlessly refine and deliver best practices for

    continuous improvement in health and healthcare.”

    www.ihi.org www.p4mi.org

  • The Learning Health System Cycle

    Flynn et al., Learn Health Sys. 2018;2:e10054.

  • 2000s: People, data, methods From can’t to can

    Challenge # 1

    Complexity Challenge # 3

    Perception Challenge # 2

    Context

  • Challenge 1: Complexity

    “It is not individual factors that make or break a technology implementation effort but the dynamic interaction between them”

    Greenhalgh T et al. J Med Intern Res 2017;19:e367

  • Solution 1: A Multi-Disciplinary Team

  • • Digital Health − Salford Lung Study – largest clinical trial in the UK involving

    9,000 patients.

    − Health eResearch Centre (HeRC) & Farr Institute - developing

    new methods to generate scientific insights and healthcare

    innovations, bringing statisticians, software engineers and

    computer scientists together with clinicians.

    − CityVerve – Internet of Things & Smart Cities technology for

    improving health

    − ClinTouch and CF HealthHub – App supported health care

    • Applied Health Research − Connected Health Cities – Applying Learning Health Systems to

    15m populations.

    − Patient Safety Centre – Using data to deliver safer care

    • Precision Medicine – Machine Learning − Psoriasis (PSORT) – differentiating between two forms of

    psoriasis to improve treatments.

    − Stoller Biomarker Discovery Centre – digtial phenotyping

    − Molecular Pathology Innovation Centre (MMPathIC)

    Some of our research highlights

  • Challenge 2: Context

    “Surprisingly few frameworks considered the organizational setting.”

    Greenhalgh T et al. J Med Intern Res 2017;19:e367

  • Problem:

    The health and social care system is facing

    unprecedented levels of change in policy and

    funding, the shifting and ageing demographics of the population served, and ever-increasing workforce pressures. Health and social care staff need to be able to plan ahead and tackle

    these challenges

    Solution:

    Through producing statistical models to create a predictive

    planning approach, this will allow healthcare organisations and GP practices to use their

    existing data to help to more accurately predict demand and improve

    service delivery design

  • Learning health system opportunity: Project leader:

    Judging what is true Deciding what to do

    Perceive the critical factors in a situation Diagnose the biggest challenges to progress Devise a coherent treatment

    The opportunity for a learning health system to transform care

    What are the current outcomes? What are the desired outcomes? What’s holding “us” back? What LHS might transform this

    care?

    Feasibility: technical change framework

    Where are we? Where do we want to be? What stands in the way? How will we safely get there?

    What data do we have? What data do we need? Data availability, quality, etc Ensure have safe havens and

    processes for data flows

    What “tech” do we have? What “tech” do we need? Cost/”perfect”

    system/overwhelmed by scale

    Build with focus on necessary tools and services, and iterate with

    scalable tech

    What methods do we have? What methods do we need? Capability, access to data Trusted Research Environment, ability to share research objects

    What governance do we have? What governance do we need? Differing local perspectives Enable transparency and build

    commitment

    Desirability: behavioural change framework

    Whose behaviour must change to deliver this transformation? Who are the stakeholders? What outcomes do they want? What is our common enemy? What common desired outcome do we share?

    How do people see, think and act?

    How must people see, think and act?

    What stands in the way of transforming

    How might we safely

    Limiting Beliefs Enabling Beliefs Beliefs Expand the diameter of trust

    Won’t Will Motivation Build a shared commitment to a

    common goal

    Can’t Can Behaviours Build capacity and capability

    Viability: economic change framework

    Where are we? Where do we want to be? What stands in the way of How might we safely

    Where is the waste? Where are the savings? Reducing waste and realising

    savings? Reduce waste and realise savings?

    Who pays what? Who will pay what? A compelling investment case? Obtain initial and ongoing funding?© Applied Health IOnshightsw Limited 2019

    Solution 2: Building a diagnosis framework

  • Challenge 3: Perception

    13

  • Solution 3: Perception

    Higher Aims

    Individual priorities

    Theory of LHS

    Actual learning journey

    Electronic Health Record

    Actual patient record

    Ground truths

    View from above

  • 2000s: People, data, methods From can’t to can

    Challenge # 1

    Complexity Challenge # 3

    Perception Challenge # 2

    Context

    Challenge # 4

    Citizen Trust Challenge # 5

    Foundations Challenge # 6

    Critical mass

    2016: How to safely scale the creation and adoption of LHS. From won’t to will

  • Connected Health Cities

    Connected Health Cities (CHC) is a global programme harnessing the power of data for the implementation of Learning Health Systems (LHS) to deliver improvements in both system and patient outcomes through the use of innovative technologies.

    Backed by the UK government’s Department of Health and Social Care (DHSC) and led by the Northern Health Science Alliance, CHC has implemented multiple clinically or socially driven care pathways programmes across the health sector.

  • Challenge 4: Citizen Trust

  • Solution 4: Creating a Diameter of Trust

    • A new approach was conceived centred on building civic digital clusters with clear local benefits and public trust

    • To achieve regional critical mass and expand the “diameter of trust”

    Trust

    You

  • https://vimeo.com/284101143

    Citizens’ juries

    https://vimeo.com/284101143

  • Elements of policy

    Care Pathway

    You are here

    Waste Inequality Lost opportunity

    Elements of policy

    Care Pathway

    From To

    Challenge 5: Front-line innovators require solid foundations

  • Challenge 5: Front-line innovators require solid foundations

    You are here

    Waste Inequality Lost opportunity

    From To

  • The sexy bit The unsexy bit

    Solution 5: “Nobody wants to do the unsexy bit”

  • We need all, not most

  • “Acceptance by professional staff may be the single most important determinant of whether a new technology-supported service succeeds or

    fails at a local level.”

    Greenhalgh T et al. J Med Intern Res 2017;19:e367

    Challenge 6: Sustaining critical mass

  • Involved Citizens Problem owners Data managers Public Health Analysts Care Service Analysts Statisticians Data Scientists Informaticians Social Scientists Health Economists Health Service Researchers Communications Experts Chief Executive Officer Chief Medical Officer Chief Operating Officer Chief Quality Officer Chief Information Officer

    Chief Financial Officer Chief Research Information Officer Chief Medical Officer Physicians Nurses Hospital Staff Social Care Staff Health IT vendors Patients and families Social Worker General Practitioner (GP) Ministers Risk Management Policy Makers Guideline developers Data guardians

    Solution 6: Sustaining critical mass

  • Leading Large Scale Change: A Practical Guide

    Commitment, not compliance, sustains critical mass

    Compliance goals

    States a minimum performance standard that everyone must achieve

    Uses hierarchy, standard procedures and threats or sanctions to create momentum

    for delivery

    “If I don’t deliver this, I fail to meet my performance objectives”

    “There is no evidence in the large scale change literature that any healthcare system has ever delivered sustained transformational change through

    compliance, rather than commitment”

    Commitment goals

    States a collective improvement goal that everyone can aspire to

    Uses shared goals, values and purpose for voluntary

    co-ordination