ADVISORY & DISSEMINATION BOARD

MINUTES

SCALING UP SHARED Haemodialysis CARE

Date: Monday 27th March 2017

Location: Hazel Room

NORTH HOUSE - Northern General Hospital SHEFFIELD

Time: 14:30 AM – 16:30AM

Attendees :
Paula Ormandy CHAIR
Jon Gulliver
Liz Hill Smith
Tess Harris
Becky Malby
Berni Stribling (via telephone)
Paul Bristow
Martin Wilkie
Mike Nation
Sonia Lee / Apologies:
Hilary Chapman
Helen Crisp
Wendy Tindale
Donal O’Donoghue
Eileen Hall
Item / Comment / Action
1 / Welcome and Apologies:
All the forum introduced themselves and confirmed where they were from.
2 / Minutes of Previous Meetings
The following corrections were requested to the previous minutes :
Page 1 – to include month (December) the meeting was held
Page 1 – correction noted to Tess Harris details
Page 1 – Correction to Liz Hill Smith to show Director :Space Consult UK (note TOR corrected to reflect this also)
Page 3 - Correction to DAFNE
Page 7 – Correction to spelling errors in section 7
Updated minutes will be circulated with these minutes
The ‘previous actions’ table at the end of these minutes show the status of actions from the previous minutes in addition as the minutes were reviewed the following points were noted :
  • BM - Suggested inviting Matthew Mezey to the board in place of Helen Crisp who is leaving the Health foundation – (Action MW) done
  • Prepare a letter to the developed nations summarising SHC and how they can get involved. Suggested recipients or people to ask who the correct recipient would be were Simon Watson, Hugh Gallagher for Scotland along with the website below and the initialNI attendees to the course or Peter Maxwell.
The key question was when was the right time to contact wider Nations as the programme was concerned that they were not in a position to support new trusts which may be the expectation set. It was agreed that understanding who was doing what, how and the level of interest would be great input to the wider understanding / evelautaion of the objectives of the programme, forming a type of control.
3 / Programme Update
3.1 Health Foundation Status report
3.2 High level Plans and milestones in next 6 months
The Health foundation draft report had been circulated prior to the meeting. Key points were presented by SL as follows :
Breakthrough Series Collaborative
  • Wave A teams established including patient partners
  • 2 Learning Events for WAVE A actioned – 2 in planning
  • Social media used for collaboration including twitter, facebook, whatsapp
  • WAVE B teams have been contacted – first event 6th July
Research – High level
  • All 12 sites approval received and baseline data collected
  • HRA approval for evaluation protocol update provided
  • All data returned to Sheffield and entered into database
Communication
  • Some articles produced including lanyards, pens, pencils
  • Programme invited to speak at a number of conferences (see next slide)
  • December Newsletter published
  • Website updated with articles including Patient stories, governance papers, learning event reports and marketplace
  • Status Update letter sent to all EXECs who supported the programme
Governance
  • All boards established included pilot of a Commercial Forum
  • Health Foundation Report in draft
Risks and Surprises
  • Designed the research to be simple but still had issued with data completeness and quality
  • Not all sites achieved 50 target
  • Time away from unit for professionals at learning events must be used wisely
  • Technology limits use of conference calls
Next 6 month Milestones
  • Continue learning events for Wave A *2 Wave B *1 and joint *1
  • Presented at 6 Conferences / information forums
  • Newsletter produced
  • CLAHRC Bite, Protocol and ‘What I tell my Patients’ published
  • Confirmation of strategy for commissioning aspect of sustainability including approach to green book business case
  • Next 2 data points collected and added to the databases for the research data.
  • Efficiency workstream observation methodology to be tested
  • Complete Wave A and commence Wave B patient interviews
  • Programme Theory Themes further developed and evolved against the themes identified
Discussion points raised were as follows :
  • It was agreed that now the data is available should be shared with the trusts to allow them to use it as they preferred to increase their Shared Care uptake as this was a critical component of high performing Health Systems
  • Consider using lego at the learning events or something for delegates to get their hands on and photograph for reference when back at home locations as visualisation of the plan to be followed through is really powerful to ensure it actually takes place.
  • It may be possible to use simple questionnaires with patients just before dialysis to access individuals personal beliefs and barriers
  • Michael West – readiness for change methods could be used to check whether sites are actually ready to accept these changes.
  • Learning journeys between sites would be useful to document and share along with the styles of learning used.
  • Peer assist should continue to be considered as a great tool to support and spread learning for less experienced sites.
  • Question was raised whether the use of the CS-PAM within the programme would be of value ?
(Note – these were suggestions not formal actions) / SL
4 / Key Questions 1 – Sustainability
“How can changes to NICE guidelines, Renal Services Specification and Commissioning approaches support Shared Care to become routine within all units ?”
Discussion points raised were as follows :
  1. Commissioning to embed behaviours – 3 or 4 complementary key criteria are potentially required. Currently the specifications are input driven not output driven therefore a reemphasis during their rewriting may shift this behaviour as it is too easy to say ‘yes we are doing it’ without any real proof.
  2. Need to link with existing guidelines as all the defined words are there just maybe not sufficiently clear at this time to ensure that ALL sites adopt this approach. It was discussed that a balanced scorecard of performance (which is being evolved) may include the PREM/PROM to provide this.
  3. The CRG is revisiting the specifications but any outcome needs to be based on data that is already collected routinely to be successful – the use of the renal registry data was discussed. T was agreed that a feed into the clinical reference group to ensure that the priority of shared care is maintained and projected sufficiently was essential
ACTION : for a timetable of all revisions of guidelines and specs to be devised and disseminated along with contacts for updates.
It was advised (TH) that the NICE guidelines do not have anything in for Shared care or patient experience but that this is unlikely to change until formal clinical evidence is available.
  1. The missing groundswell was suggested to be form the patients and perhaps the programme needed to focus on the patient community – they need to be aware and asking for it from the medical teams that will drive the behaviour change and ensure the service is delivered accordingly. This may mean we just have to spread the word to the patients to make them want/demand it to create the pull.
/ SL/MW
SL/MW
5 / Key Question 2 – Spread
“Are the current SHAREHD programme collaboration tools the best to generate the required reach for dissemination as well as support for local trusts ?”
The use of the following were suggested :
  • Videos to overcome barriers – show you can do shared Care Videos and podcasts – that can go on the website once complete
  • Piggyback on existing networks where possible so as not to create from scratch. Piggy back onto existing networks – NKF, BKPA (PMN – Programme has a 1Hr slot at the Autumn NKF conference)
  • Ensure each tool used has a specific objective it is trying to achieve so that there is structure to the use and it does not become confused
  • Keep revising to make sure the tools used are correct for the objective declared
  • Spread – use free platforms – open up groups
  • Facebook groups – if closed then you are preventing those who may want to get involved but watch form the side lines first form getting involved. Need to have open forums also to include anyone and everyone who may be interested
  • Use free platforms including Slack and Stack
  • Facilities to support people – Stack, Slack, Adobe Spark, zoom, pinterest, linkedin. Adoby Space is quick and easy to use and can be progressed within / as part of the learning events
  • Have a statement of purpose for each group – be clear what the objective is. (ACTION this is included already in the Comms plan but will be updated for each additional tool adopted)
  • Produce a package/ approach that can be disseminated (PMN – This ‘roadmap’ is an output requested by the Health foundation so will be produced however it was planned to be created later in the programme – it is noted that a draft for validation may be useful to produce no learning has started that can be perhaps tested with non- engaged trusts)
  • MN advised that we need to have an approach for sites that want to promote SHAREHD but who are not part of the 12 trusts ie unplanned spread. It was suggested that the use of case Studies and roadmaps could be produced to show the journey of a site from ‘standard’ to shared care as people like examples.
  • List of ambassadorsshould be created and tapped into these when can to keep their interest as well as looking for wider stories and news to share with all other trusts. ACTION SL to create this list along with a strategy for when and how to engage with them)
  • Peer assist would be useful to ensure that sites work together and learn from each other – it was stated that we have done some of this informally but not formally paired teams together.
Unplanned Spread / SL
SL
SL
6 / AOB
  • No additional points raised

7 / Summary & Date of next meeting
Agreed to hold next meeting in July but over social media teleconference facilities - perhaps Zoom
Next face to face meeting to be held at end September after the first joint learning event. It was suggested to hold it off site to improve parking issues. Areas to cover at next meeting can be
a)Patient inclusion and how to build a patient groundswell to want SHAREHD
b)Evaluation findings to date

PREVIOUS ACTIONS

No previous Action – table included for future reference.

Meeting date/Section / Action / Status
9/12/16 – 3.2 / SL to update slide to state that patients are ‘seen as passive’ rather than are passive - for future audiences / CLOSED
Slide deck updated by SL and distinction noted by whole programme team
9/12/16 – 3.2 / WT advised that the NHS England Test-Bed Programme had synergies with this programme. She agreed to provide details and contacts for the programme. / CLOSED
Details provided by WT and SL has met with the programme lead.
9/12/16 – 3.2 / PO recommended that the Health Economic Evaluation be peer reviewed in order to ensure maximum credibility for the findings and approach. Action (a) MW to request (b) Evaluation team to do this. / ONGOING SL/MW
a)Request made
b)Specifics of when to be agreed.
c)Ethics approval to be confirmed
9/12/16 – 5.3 / Include in letters to Execs the suggestion that ShareHD can be seen as an exemplar of how to progress solution focused self-management / ONGOING (SL/MW)
Letters drafted to each Trust signatory – PIs given option of sending with own cover letter or it being issued from MW.
Update 23/3. All letter sent to PIS – COMPLETE
9/12/16 – 5.7 / A question was raised if there is a resource implication for NOT promoting and progressing SHAREHD and Shared Care i.e. need to be looking for ‘what’s in it for the trust’ and why should there be investment in this programme to maintain and promote spread. This is currently an unanswered question but could be augmented to the evaluation in terms of quality of life. / ONGOING (SL/MW)
Expect to build on the health economic evaluation work which is at very early stages.
9/12/16 – 5.8 / Discussed ideas and questions about Spread to be framed into questions for the next A&DB review. / CLOSED

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