evidence based innovation - pop up uni, 3pm, 2 september 2015

Evidence based innovation

Dr Robert Varnam Head of general practice development, NHS England

[email protected] @robertvarnam

w ww.england.nhs.uk #Expo15NHS @robertvarnam

The founding principles of UK primary care are admired the world over, and rightly so.

General practice is a jewel in the crown of this country. Right now, general practice feels in a bad place. Constrained, hemmed-in and, to

some, marginalised.

Whatever the state of things in your part of the country, in general, I think it’s fair to say

that, at the very least, general practice is currently constrained from delivering its full potential.

We need to see increases in funding, a growth in the workforce, and improvements to

premises. Without those, existing services may not be sustainable.

Overview

Common pitfalls

The GP Access Fund experience

Five top tips

w ww.england.nhs.uk #Expo15NHS @robertvarnam #Expo15NHS @robertvarnam

1. Common pitfalls


Call to Action on General Practice

“What needs to be done to promote, support and sustain the adoption of effective

innovations?”

a) Finding innovation

b) Implementing change

c) Unease about innovators & innovations

d) Concern about causality

bit.ly/c2aGP




innovations?”





NHS Change Model

bit.ly/c2aGP




innovations?”





bit.ly/c2aGP


Unease about innovators & innovations

The innovators

• Whacky / unappealing

• Too brainy

• Too creative

• Too hard working

Admirable but not me


Unease about innovators & innovations

The innovations

• Experimental / unfinished / risky

• Too niche

• Too context-specific

Interesting but not for me




innovations?”





bit.ly/c2aGP


The innovation itself is not enough


2. GP Access Fund


About the GP Access Fund

Aim: “to help improve access to general practice and stimulate innovative ways of

providing primary care services”

• Wave one: Apr 2014

• £50m

• Wave two: Apr 2015

• £100m

Applications from practices covering nearly 2/3 of the population of England


About the GP Access Fund

57 schemes

~100 ‘federations’

2500 providers

18m patients

Wave one: Apr 2014

Wave two: Apr 2015


An example of this in practice at the

moment is the Prime Minister’s GP Access

Fund. Now covering a significant

proportion of the country, practices in this

are implementing quite wide-ranging

redesign of their services, acknowledging

that extended hours are only one part of

good access. The practices participating in

this programme are already beginning to

implement many of the transformational

changes envisaged by the Five Year

Forward View. This is generating valuable

learning about the specific changes

required, including the ways in which the

system can make progress easier and

more sustainable.

Innovations being tested


Schemes' initial plans for measurement

Three broad approaches:

a) External academic unit

b) Project manager time set aside

c) No detailed plan Wave one: 4/20 schemes had dedicated

budget for measurement


Inputs from innovation support programme

• Webinars

• Workshops

• Advice from evaluation team

• Coaching from NHS IQ

• Team reviews

• Direct conversations

… modest success


The biggest data challenge of all …

Wave one: 19/20 schemes required help. 4 had existing BI systems

Dec 14: guide published, application preparation webinars

Apr 15: welcome pack

Wave two: 37/37 have requested help

General practice

activity data


An exception…


Some of the NHS is ill-prepared to

measure innovation in everyday care,

and some of our baselines are weak.


a) Budget & plan for measurement

b) Know your logic model

c) Measure to inspire and inform

d) Measure in realtime

e) Show it can work elsewhere

3. Five top tips



It doesn’t just happen







3. Five top tips


Innovations’

efficacy

Schemes’

efficacy Funding

Cost-effectiveness


Patient

satisfaction

Staff

assessment

OOH

attendance

A&E

attendance

New extended

hours

appointments

Additional

contact

modes

Other access

innovations

Changes in

care model







3. Five top tips


Innovations’

efficacy

Schemes’

efficacy Funding

Cost-effectiveness


Patient

satisfaction

Staff

assessment

OOH

attendance

A&E

attendance

New extended

hours

appointments

Additional

contact

modes

Other access

innovations

Changes in

care model

Why

should I

commit to

this?

How might

this work

for us?







3. Five top tips



If you’re moving forward, why only look backwards?

#Expo15NHS @robertvarnam

Using periodic averages

105

55

0

20

40

60

80

100

120

Sample A Sample B1st three

month

period

2nd three

month

period

Start Data

vacuum

This is our traditional approach. It is familiar but serves innovation

leaders very poorly.

How do you keep people motivated in

this period? Averages prevent you

learning from variation

Statistical Process Control charts allow you to measure very frequently,

and draw statistically sound conclusions about any change.

97

.3%

C

.I.

Change introduced here

Rapid confirmation that the change was a statistically significant improvement

This kind of analysis can be produced by a wide variety of software.



Benefits for innovators:

Keep staff motivated & curious

Refine the innovation more rapidly

Gather convincing evidence for others in shorter timescale

Test multiple changes (eg phasing / multiple sites)

1 2 3 4

1

2

3







3. Five top tips



• Describe and measure your context (well enough for others to understand

& compare)

• Test in multiple different contexts

• Yourself

• First followers







3. Five top tips


Using data as part of a change strategy

bit.ly/PMCFlessons1

Choosing metrics for innovation

vimeo.com/111923411

Using retrospective case control

bit.ly/NuffieldRetroCaseControl

Logic models

wikipedia.org/wiki/Logic_model

Scaling up innovation

ow.ly/RBxYt

SPC guides

bit.ly/SPCguide1 & bit.ly/SPCguide2

#Expo15NHS @robertvarnam

[email protected]

[email protected]






evidence based innovation - pop up uni, 3pm, 2 september 2015

Healthcare