Transcript
Page 1: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org
Page 2: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

Connected Health Cities Programme

Prof. John [email protected]

Gary LeemingChief Technology [email protected]

Dr Amanda LambDeputy Director & Chief Operating [email protected]

Ruth NorrisHead of Strategic [email protected]

Page 3: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

The Problem

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

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“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

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The Learning Health System Cycle

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

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

Challenge # 1

ComplexityChallenge # 3

PerceptionChallenge # 2

Context

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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

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Solution 1: A Multi-Disciplinary Team

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• 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

Page 10: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

Challenge 2: Context

“Surprisingly few frameworks considered the organizational setting.”

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

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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

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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, etcEnsure 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 dataTrusted Research Environment, ability to share research objects

What governance do we have? What governance do we need? Differing local perspectivesEnable 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 MotivationBuild 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

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Challenge 3: Perception

13

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Solution 3: Perception

Higher Aims

Individual priorities

Theory of LHS

Actual learning journey

Electronic Health Record

Actual patient record

Ground truths

View from above

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

Challenge # 1

ComplexityChallenge # 3

PerceptionChallenge # 2

Context

Challenge # 4

Citizen TrustChallenge # 5

FoundationsChallenge # 6

Critical mass

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

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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.

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Challenge 4: Citizen Trust

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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

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https://vimeo.com/284101143

Citizens’ juries

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Page 21: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

Elements of policy

Care Pathway

You are here

WasteInequalityLost opportunity

Elements of policy

Care Pathway

From To

Challenge 5: Front-line innovators require solid foundations

Page 22: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

Challenge 5: Front-line innovators require solid foundations

You are here

WasteInequalityLost opportunity

From To

Page 23: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

The sexy bit The unsexy bit

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

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We need all, not most

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“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

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Involved CitizensProblem ownersData managersPublic Health AnalystsCare Service AnalystsStatisticians Data ScientistsInformaticiansSocial ScientistsHealth EconomistsHealth ServiceResearchersCommunicationsExpertsChief Executive OfficerChief Medical OfficerChief Operating OfficerChief Quality OfficerChief Information Officer

Chief Financial Officer Chief Research Information OfficerChief Medical OfficerPhysiciansNursesHospital StaffSocial Care StaffHealth IT vendorsPatients and familiesSocial WorkerGeneral Practitioner (GP)MinistersRisk ManagementPolicy MakersGuideline developersData guardians

Solution 6: Sustaining critical mass

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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 healthcaresystem 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 and control

“If I don’t deliver this, I let down the group and our shared purpose”

Page 28: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

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

Challenge # 1

ComplexityChallenge # 3

PerceptionChallenge # 2

Context

Challenge # 4

Citizen TrustChallenge # 5

FoundationsChallenge # 6

Critical mass

Challenge # 8

Re-inventing the wheel

Challenge # 7

Spread challenge

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

2019: Making it easier for front-line innovators to safely use data to save lives

Page 29: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

“When initially successful interventions are spread to new

settings, they may fail to achieve the same impact, or

indeed any impact at all.”

“The success of a complex intervention is likely to depend

heavily on its context.”

The Spread Challenge, The Health Foundation, September 2018

Challenge 7: The Spread Challenge

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Solution 7: A pathway-based approach

• Antimicrobial resistance and antibiotic prescribing • Healthy ageing • Alcohol misuse• COPD• Epilepsy • Childhood obesity • Autism • Stroke • Opiate dependency • Supporting community care• Unplanned emergency care• Vulnerable families

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Pathway: Improving the management of stroke

Manchester

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Pathway: Forecasting emergency unplanned care

Durham

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Challenge 8: re-inventing the wheel

Where do we start?What do we do next?

Where’s the best place to invest our resources?

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Solution 8: Blueprints are important, but not sufficientKnow-how is essential

“It is possible, but not accurate, to view the achievement of an LHS at any level of scale, as an exercise in construction from a blueprint. This conceptualization belongs to an earlier era. It fails to recognize that the LHS is a new and fundamentally different type of system”

Friedman CP et al. Learning Health Systems 2017;1:e10020

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Connected Health Cities: Enhance Information Flows for Better Research

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Connecting Communities of Care and Research

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The CHC programme: contributing to delivering policy objectives

“It has been a real catalyst for change pulling Northern partners together. At a geo-political level it has been really crucial to have this investment.”

Contributed to all six

NHS Long Term Plan

policy objectives

Contributed to all six

Department of Health and Social

Care priorities 2018-2019

Page 38: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

“I really enjoy where I am and my job, it’s a different world compared to being in a lab and you can’t see your significant

finding making it to the clinical face for another 20 years whereas here, it will have an impact and I will see that impact whilst I am

still on the project, so yeah, it’s exciting.”

Page 39: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

1. Working with complexity

Multi-disciplinary team3. Perceiving reality

Reveal ground truths2. Understanding context

Diagnose before treating

4. Addressing Citizen Trust

#DataSavesLives & PPIE5. Building quality foundations

Pathway by pathway6. Sustaining critical mass

Listen, learn then lead

8. Avoiding re-inventing the wheel

Blueprints, resources & know-how7. Enabling spread

Making LHS tractable

DataSavesLives: the community for LHS Design, Safety and LearningWe can’t do it alone. We need your help. Join the movement at www.connectedhealthcities.org

9. Curating global learning

Community of practice

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

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

2019: Making it easier for front-line innovators to safely use data to save lives

Working Together for Data to Save LivesFrom waste, inequality and missed opportunities to better care, cheaper care and better outcomes

Page 40: Connected Health Cities Programme - Better Safer Care · 2019-04-01 · Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org

Join the #DataSavesLives movement to make creating LHS easier

Join the movement at www.connectedhealthcities.org via the contact us page

#DataSavesLives@CHCNorth


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