Presented by Linda Leighton-Beck

Transforming culture: making everyTransforming culture: making every opportunity count (MeOC) in Grampiany ( )

• Linda Leighton-Beck - Public Health• Catriona Sutherland - Aberdeen Royal Infirmary (ARI)• Heather Stuart – Public Health/ARI• Jenni Haxton - ARI• Dorothy Ross-Archer – Public Health

Contact: linda.leighton-beck@nhs.net

Of innovation and integrationOf innovation and integration...

• Importance of ‘volume to value’Importance of volume to value • Maximising value from every interaction• Adaptive approachesAdaptive approaches• Learning as we go• Involving persistenceInvolving persistence• Seeing innovation as a process ‘otherwise

di idends ill not be achie ed ’dividends will not be achieved.’

Transforming culture: (MeOC)Transforming culture: (MeOC)

• Our intention• Our approach• Our progressOur progress• Our learning

Our intentions the big challengesOur intentions - the big challenges

• How we harness untapped partner ‘power’ to• How we harness untapped partner power to transform prevention and self-care?How public and third sector partners enable• How public and third sector partners enable people to optimise wellbeing, using available assets including their own?including their own?

• How we win hearts and minds of early adopters?

Specific challengep g• How busy staff build on proof of concept to maximise

wellbeing opportunity of 400,000 OP appointments?

• Optimum = 46 staff x 11 different OP clinics

• Each having brief conversation and/or signposting 10 patients per day = circa 100,000 new opportunities forpatients per day circa 100,000 new opportunities for change per annum

• If 1 in 20 go on to make a change circa 5,000 people will be improving their wellbeing.

Issues for busy NHS staffIssues for busy NHS staff– Person centred patient care & quality – Improvement – e KSF

MeOC– Revalidation– Health Promoting Health Service

MeOC

– Healthy Working Lives– Health Inequalities– NHS Grampian Clinical Strategy

Keeping it simple!Keeping it simple!

OOur 3 tier approach

1 Brief1. Light touch conversation

2 Specific2.Specific conversation e.g. work/employability/alcohol p

3 Complex3.Structured wellbeing conversation – complex needs

3 ComplexEach tier: signposts to enable people to live well

fuses learning from Keep Well, NHS England’s uses ea g o eep e , S g a d sMaking Every Contact Count & NHS Grampian’s proof of concept

Our approach example initiating conversationOur approach – example - initiating conversation• How do you feel about your wellbeing? (scale 1-5, Not

good Ver good)good - Very good)

• How important is it for you to improve your well• How important is it for you to improve your well-being? (Not important - Very important)

• Is there anything I can do to help you with that?

M OCMeOC

Our approach it d bilitOur approach: capacity and capability

• Awareness training individualised for clinic area• Orientation training individualised• Checklist for negotiation with clinical areas• Shadowing arrangements • Protocol and simple data capture• Provision of update information• Problem solving ...

MeOC

Our approach capacity building 11/15 9/16Our approach: capacity building 11/15 – 9/16• Making Every Contact Count (MECC) training

Mod le 1 138 completed*Module 1 – 138 completed*Module 2 – 104 completed*

• MeOC Awareness training (managers) – 28• MeOC Orientation training (staff) - 93

**Also includes other early adopters

Our approach d i tiOur approach: governance and communications

• NHSG MeOC Oversight Group 2016• Governance integrated within sector arrangements

• Overall communication approach agreed• NHS News• NHS Grampian Upfront• Chief Executive Report to Board• GP Sub, Area Medical Committee• Each Health & Social Care Partnership• Modernisation, Pharmacy and Oral Healthy• Association for Voluntary Organisations etc

Our approach - transformation by contagiony g

•Innovators•Early adopters

•Everyone doing a little

•Critical massT f ti

y g

Transformation

Our progressProof of concept 2012NHS Grampian Annual Quality Conferences 2013 & 2016

Our progress

NHS Grampian Annual Quality Conferences 2013 & 2016Scottish Public Health Faculty Conferences 2013 & 2016NHS Grampian Director of Public Health Annual Report 2014NHS Grampian Director of Public Health Annual Report 2014Public Health Sustainability Fund 2015Aberdeenshire HSCP Integrated Care Fund 2015Aberdeenshire HSCP Integrated Care Fund 2015Aberdeen City HSCP Transformation Board 2015 NHSG MeOC Oversight Group 2016g pAlliance Self Management Regional Workshop 2016NHSS National Annual Conference 2016E-health data captureNHS Grampian Clinical Strategy 2016- 2020

Our progress: E healthOur progress: E health

O r progressOur progressOutpatient Clinics Aberdeen Royal Infirmary Clinic COutpatient Clinics, Aberdeen Royal Infirmary Clinic C,A,B,D,E,F,G

MaxillofacialMaxillofacialPre-assessment

O t ti t D G ’ H it l El iEye Clinic Peter Brunt Clinic

Woodend Hospital Outpatients

ITU Outpatients Dr Gray’s Hospital, Elgin

Woodend Hospital Outpatients

Kildrummy Day Hospital Antenatal Screening

y y p

Moray HSCPAberdeenshire HSCP Aberdeen City HSCP

Our progress - granular markers - one yearOur progress granular markers one year• 17 clinical areas involved• All 3 HSCPs and Acute on board• Pharmacy & Public Dental Service, respiratory and

dermatology clinic tests of changeM OC h i li i• MeOC champion per clinic

• Champion Clinic• Training• Training• Audit

– Benefits of Health Card survey– Benefits of Health Card survey – Staff survey – Patient surveyPatient survey

• OP Team shortlisted for GRAFTA

Rem em ber in

That ’s r ight , I r em em ber . I t hink it was called Cash in

Transforming our culture – everyone doing a little....

Hi Bet t y, f it like? Did you have a good weekend?

No, John ( m y son- in- law) was t old t o clear his desk on Fr iday. He has been wit h hi s company f or t h l t 12

t he lif t going up t o Clinic G t her e was som et hing adver t ised. iI tment ioned help wit h benef it s

your pocket . I t hink t hey would have in t hat place at t he concour se beside t he l t h hweekend? t he last 12 years

so I don’t know what t hey will do now

wit h benef it s, debt , CV et c, might be wor t h get t ing inf or m at ion

clot hes shop, Will you com e wit h m e at lunch t im e?

Stimulating wellbeing conversations- example

Our progress: casesOur progress: cases• Light touch conversation - Mrs Anderson – signposted

to ‘brilliant resource’ loose coat!to brilliant resource , loose coat!

• Specific work conversation - Mr Ritchie - returns to pwork within a few days.

• Structured conversation/wellbeing check - Mr Angus –felt ‘heard’, committed to changes supported by social worker

• More• More…MeoC

Our Progress: Staff survey (5 days)Our Progress: Staff survey (5 days)

• Per day 11 staff each had 5 conversations & signposted 3 y g ppeople

• Per week 55 x 5 = 275 conversations + 33 x 3 = 99• Per week 55 x 5 = 275 conversations + 33 x 3 = 99 signposted.

• Top reasons for conversation – smoking, giving necessary information on wellbeing, developing rapport, diet/weight

• Most challenging aspects: money worries, starting conversation, some patients not interested

• Best conversations....

Our progress: patient survey (5 days)Our progress: patient survey (5 days) • 60 respondents• 50% had MeOC conversation, 94% felt at ease• 39% expected to be asked about their health39% expected to be asked about their health• 55% felt listened to and able to talk freely; 42%

felt supported 3% felt ill at easefelt supported, 3% felt ill at ease• 35% given information or signposted• 88% felt wellbeing conversation was helpful• Comments• Comments....

Our progress: patient survey benefits of healthOur progress: patient survey - benefits of health card

14 d t• 14 respondents• 50% had wellbeing conversation• 45% given benefits card• 80% indicated helpful80% indicated helpful• 100% indicated informative

73% ld t t h lth i t f i f ti• 73% would contact healthpoint for more information• 50% expected to be asked about their health

Our Progress resourcesOur Progress - resources• 1.5* dedicated staff short term• Early adopters• MECC modules & materials• MeOC website link• Video• Benefits of health• Wordle• Top Tips• Scenarios & Case Studies• ‘Hymn Sheet’.....

http://www.hi-netgrampian.org/people-networks/public-health-directorate/health-inequalities/making-every-opportunity-count/

Our learningOur learning• Realistic expectations: staff capacity, ownership,

confidence service challenges timeframesconfidence, service challenges, timeframes• Creating feasibility, acceptability and evidence• Tenacity persistence and long game• Tenacity, persistence and long game• Positive indirect impact on staff and their families• Variation in needs and opportunities for clinical areas• Variation in needs and opportunities for clinical areas• Gap between training and ‘conversion’

P ti t fil t & f i ti• Patient profiles, nature & range of signposting• Sustainability

R d i & C it Pl i• Read across: primary care & Community Planning Partners

Concluding remarksg• Acceptability, feasibility & transferability of tier 1

F ti i i h t & i d• Focus continues winning hearts & minds • Strong voices, pragmatic public health• Granular markers important for journey • Keep it simple, permissive, organicKeep it simple, permissive, organic• Enables everyone to do a little - big difference

Early adoption informing clinical strategy• Early adoption informing clinical strategy• Other services on board...

Together we can and we will MeOCTogether we can and we will MeOC!!

Th k !Thank you!