Need to know
For #TeamEEAST Last updated: 07 May 2024 at 01:50
This month, we talk to Emma De Carteret, Director of Corporate Affairs and Performance, and Simon Chase, Deputy Director of Clinical Quality.
In this episode we revisit the Demonstrating Impact Workstream and discuss how EEAST has been better utilising data to improve out workplace and services.
You can listen to this episode here -
Podcast Transcript
Julie Hollings
Hello and welcome to the Fit for the Future monthly podcast. This is the second time that we're revisiting the Demonstrating Impact work stream and I’m going to be talking to Emma De Carteret, executive director of corporate affairs and performance, and Simon Chase, deputy clinical director for quality and safety, and they're going to demonstrate to us how the work stream’s been developing and some of the really good results we're seeing coming out of that.
I'm just going to start by asking Emma - can you remind us what the demonstrating impact work stream is focused on and what we're going to talk about here today?
Emma De Carteret
Thanks Julie and hello everybody. Yes, so the demonstrating impact work stream sits within the Fit for the Future program and is intended to help us get to the point, as an organization, where we are consistently using the right information to make the right decision at the right time effectively to bring about the right change. So we're talking about how we use the huge wealth of information that we have across the organization across all teams and all departments and how we're using that to make sure that the decisions that we take and the actions that we put in place are the right ones to address any issues and challenges that we've got in terms of delivering the work that we're trying to achieve and that's really important.
The other piece that comes out of the demonstrating impact work stream is knowing for certain through the information when we should celebrate success. So when things are going in the right way we don't have to focus on putting more and more actions and more and more improvements in place. So we are focused on the areas that we need to focus on to improve but that also really importantly for our staff and for our patients that when something is going well that we celebrate that success today.
Obviously we had the first the first podcast talk very much around outlining what the work stream was and when we did that podcast we explained that the big first phase was around training and support and conversion of our information and our data to a process that made it far easier to use that information - so using the making data count training and statistical process control. And that's why I'm really pleased that today we've got the opportunity to have a conversation with Simon from an infection prevention and control perspective to talk through the early examples that the IPC team have got in terms of how this change to our data use has influenced and impacted the actions that they've taken.
Julie Hollings
Lovely, well thank you very much Emma. Thank you for that introduction. I'm going to turn to Simon now.
Simon can you talk me through a little bit about the training? When did you first do the training?
Simon Chase
Thanks, Julie. It's probably two parts, the training. So, personally, I did my training quite recently and that was through the NHS and the national team, where we were able to go on to their live webinars, which they also provide on a recorded basis. It's completely free and was extremely useful, I think from memory there's probably seven actual sections that you can go through but there's predominantly two that are most key for us - So that's the introduction and then there's a section around how we use the SPC charts. What we mean by that is the ‘statistical process control’ charts, but I'll call them SPC going forward for now just for ease. The actual team SPC has obviously been around a long time, so within the clinical team and certainly my portfolio I have the quality improvement team and we know that SPCs form heavily within that training as well. So everyone who's been through the quality improvement training that we put on in-house will also have had access and that's a number of the clinical team including the IPC lead and that was why we chose to really probably be the front runners when we first started to move to present these figures and charts in a different way. It probably leaned towards us because we have been using them in the quality improvement team for some time.
Julie Hollings
Lovely, thank you, Simon. So, how did you find the training?
Simon Chase
So, personally I found it really useful for two things. One, it was very informal. There was the opportunity to ask questions throughout, they last about 60 minutes from start to finish, and once you sign up to the training you have the ability to sign up and add yourself to a forum. It's completely free, I would absolutely recommend everyone to do that because signing up to the making data count forum enables you to access all of the materials at any time. You can then go back, you can download those, there's a powerpoint presentation or you can download the whole transcript and just review the videos in addition to that on a regular basis.
Usually, I would say two or three times a week people will post information onto the forum and there'll be other live events that will be going on. So, for people who want to actually expand around and keep up to date with SPC or making data count I certainly found it really useful. And it's not just do the training and that's it - you can continue to use that and it's completely free and open to all of us and it's something I've certainly recommended to my team and my heads-of departments to keep them involved and look at what's changing as we go forward.
Julie Hollings
Can you just remind us how people can sign up for that Simon, because it sounds very useful?
Simon Chase
So, anyone can sign up to the making data count dashboard. So what you need to do is you'll need to go on to the future NHS website, so it's future.nhs.uk, and then forward slash ‘making data count’. If you haven't got an NHS England login, it's your generic login that can be used across all their platforms. You will be asked to sign up to it but anyone with an EEAST NHS email address can do that. It doesn't take long to set your account up but once you have that account you just go through the making data count link and then you have the ability to sign up to their dashboard. It's very user friendly, there are other educational videos on there other than making data count. I can't remember the whole suite of information that's available but you can sign up to more than just making data count but yeah the website you need is future.nhs.uk forward slash making data count.
Emma De Carteret
Thanks, Simon. I think it's really important to outline the future nhs uk website is absolutely brilliant and the sheer level of resources that's on there is fantastic and that's one of the key reasons why we're effectively double running how our staff can access the training. So, we also have the all of the modules uploaded onto our Evolve training system, so if people go on to their Evolve account and type in ‘making data count’, you can access those modules now. Before, when we did our first podcast, we only had those two key modules, that Simon alludes to, available but we're just in the middle of opening up all the rest of the modules so that those people who have recognized that actually this is an area that's really important and really impactful in terms of their work streams, they can now do those through evolve as well. So, there's two tracks in - there's the internal Evolve system, but then there's the future.nhs.uk website, which has more resources, a wider range of resources, that's available to all.
Julie Hollings
Thank you. Yes, the training sounds like a great resource and I guess the 10 million dollar question for me is though - what impact does it have? What have you been able to achieve by learning a new way of doing things?
Simon Chase
Thanks, Julie. Yeah, I mean it's a question that a lot of us would have. You know, we're very pragmatic aren't we in the ambulance service and we want to know, you know, is it worth it? What we're going to get out of it with SPC. So as one of the forerunners, what we found - I'm going to use an example of our infection prevention control monitoring and this is extremely obviously has been very current through the covid pandemic over the last two years. So, previously, before we moved to the SPC charts, we used to usually produce bar graphs or pie charts was usually the most useful illustration that we would use with our IPC audits. So, all of those within the front line from both our 999 service and the PTS service and also our control centres, we all have to provide every month an element of audit around our IPC requirements. So, this can be anything from vehicle cleanliness through to estates cleanliness, so the areas that we're working in, and also uniform cleanliness and these are mandated audits that we need to provide not only internally to our colleagues and our local managers but also externally to our stakeholders and more recently through the CQC core inspection it's one of the areas that they will always look at, so it's really important that we use these tables effectively to help us improve or maintain our performance.
What we found moving [to] an SPC chart from the original charts is that usually your bar charts or your line graphs that we've used in the past would track past performance and it was very difficult sometimes to see whether we were actually improving, maintaining, or actually dropping performance, because what often happens with IPC is that the changes are very small. So, it might be only a few percent, so on a large graph over a long period of time, say 12 months, it might not actually look like we're getting worse but when you actually introduced the SPC chart model and it brought in the variance so you would set your upper limit, what you would want to achieve or go beyond, there was then that lower limit of what you didn't want to drop below and then you would obviously have the trend line where you would try and stay within those two lines. What we found early on was that during covid we maintained the 85% compliance of vehicle cleanliness which was really important but that's the bare minimum, that's the minimum requirement, what we want to do is be able to obviously push that as near 100. When we introduce the SPC charts we very clearly were able to see the variant and the variant even though it was above the lower limit that would set as the minimum it was on a trajectory to drop below that because over a period of six months during 2021 we were we were reducing our performance and until we saw that SPC chart showing us that trend was on the way down, even though it stayed within the normal variant, it gave us, I suppose the best way to describe it, an early warning system that actually we've clocked it we now need to find out why now it could be that we would have not been able to stop it going under the bare minimum.
But what we would have been able to do is understand why that was and that was really important because SPC charts for us are not there to be used as a big stick for staff to say ‘look it's getting worse’. It was more for us to spot there was something happening, we're still within the tolerance required to keep above the minimum, but let's understand, let's be curious, and find out why and actually if it's going to drop below then let's pre-warn people – ‘this is the reasons why’.
So it was really useful for us to one, acknowledge an early warning system - the thing was going in the wrong direction - but two, it gave us time to go and find out why rather than wait for it to drop below the minimum and then probably have to then quite quickly understand why and what you're going to do to put it right.
Julie Hollings
And by getting that early warning, what actions were you able to take do you think, Simon? That you might not have otherwise taken?
Simon Chase
Yeah, so because the SPC chart is obviously something that's very visual, one of my roles is that I chair the IPC group within the organization, so I was able to lift this SPC chart out and put it into that group to have a discussion with the make ready leads, with the heads of operations or their nominative representatives, and the IPC team and just, in effect, have a Q and A to say ‘what do you think is causing this?’ and we looked at everything from - had we reduced the amount of audits down to such a small number that the variance was going to show in a bigger way? Because we were doing, you know, before covid we were probably doing nearly a hundred audits a month and that did drop off but only for a few months at the very early time of covid back in 2020. We looked at - did actually covid cause any problems with staffing and that actually was one of the issues - not only did we have issues with people being absent from work due to covid but we struggled to fill the vacancies over covid and certainly towards the end, especially for the make ready teams. So, there were two areas there that we'd identified that were probably causing the reduction in cleanliness because it was mainly around the make ready staff. What that was able for us to do was to highlight it quite quickly and put that forward to the head of estates and make ready to see how we could bolster the make ready team to ensure that whilst we go to, for example, a permanent recruitment, was there a way that we could introduce any sort of short-term measures? So what we were able to do is provide evidence through SPC to say, actually we've spotted the trend, it's reducing, our solution to this is to increase the agency spend on make ready staff for a small period of time and that was for three months and that stopped in effect the reduction. One, it kept us above the minimum line but it also, more importantly, provided us evidence to help a financial decision to be made short term to try and improve that performance
Julie Hollings
Excellent, thank you. So, I think that's a really nice example of how using data which might not feel like the most exciting thing on earth but can lead to some really good improvements for our patients and for our staff at the end of the day. So, thank you, is there anything you'd like to add Emma, in terms of maybe the next steps here?
Emma De Carteret
Yeah, thanks. Thanks, Julie. Thanks, Simon. I think it's a really fantastic example of how a relatively small change in how we look at the information, the information we hold, can make such a big difference both in terms of the type of conversations that you have in both in the IPC team but across different parts of the organization. And I think, most importantly for me, when you said that actually what it did was give us evidence to allow us to make that decision, a financial decision grounded in evidence and that does really nicely link back to that the point of this work stream, which is using the right information to make the right decision at the right time. So, we've made the right decision, we've stopped the reduction, we've made it at the right time because we have maintained compliance with the target, we haven't slipped below the target, we've done something proactively and it reminds me of when we did a number of engagement sessions a couple of months ago around the demonstrating impact work stream and one of the big things that people who joined those sessions said was this work stream will be critical to making this a safer organization, which is more agile, more innovative, but most importantly more forward thinking. So that not looking back at historical performance but looking at what's happening right now and how do we change things moving forward? So a fantastic example, thank you Simon, for sharing.
In terms of next steps, I think there's a couple of things from a demonstrating impact work stream perspective that I want to talk about and then, not wanting to put Simon on the spot, but it would be really good to understand from him what the kind of next steps within the clinical team are in terms of how they continue to use and progress this approach moving forward. But from a work stream perspective the key piece that's happening over the coming weeks and couple of months is the development of, I'm going to call it a sector or a team integrated performance report. In the first podcast we spoke about the board level document that gives us the overview of all of the core pieces of business and what that looks like in terms of SPC and how we track the next phase is that next level down, so teams being able to see. So, for example, Simon spoke about the IPC charts at trust level actually have each team who has a responsibility in an IPC requirement having what their compliance is, for example, so that then it doesn't sit with the corporate team to resolve every problem that if there's a local challenge that can be dealt with by the local management team and their and their staff. And that's happening between with the informatics team between now and the end of September/October time.
The other piece that we're looking at is making sure, and again through the digital team as well as the demonstrating impact team, is how we make sure that the data that we hold is accurate high quality so that we do get to the point where we have one version of the truth and that's really important and it was a really really strong theme that came out in the engagement session. So the informatics and the business intelligence teams are working with other directorates across the organization in terms of making sure we're really clear on what data we hold, how that data is pulled, why it's pulled in that way so that we do only have one consistent data source, if you like, for each of the different things that we're doing. And those two things will combine by the by the end of the year to get us in a place where we actually can track performance and what we are doing about those things that need to continuously improve.
I hope I've spoken long enough to give Simon the opportunity to think about what he wants to say in terms of the clinical team's next steps, please Simon.
Simon Chase
Thanks Emma. Yeah that's given me enough time, thank you. Because there's probably three things that we're looking to do in the future around evolving SPC because this is, you know, the classic. It's like peeling the layers back of that onion so it's multi-layered and it will evolve over time so we're very much on that journey and I think before I go into those three things I just want to say that you know this SPC is a tool and it's really important that we use the tools effectively. It's not going to replace everything so they're always going to be some ways of reporting that you just can't put into an illustration or use a chart for, especially when it comes to patients, so we know that there are certain indicators that are very easily manageable by performance, whether that's time or whether it's our ability to improve someone's care through whether it's, you know, for us clinically how quickly we're delivering care to time critical patients such as in heart attacks or strokes, but for us those three steps, it's around how we can build on the good examples. So I've given one around IPC but we do have others. So we've seen improvements using SPC with our complaints handling and around how we can track both themes around, you know, the types of complaint that's raised but also how timely we are in in trying to address those through to some of the safeguarding metrics, especially that we're looking and I know in the future that there may be wanting to look at podcasts around how we can monitor and track our training and that's one area that we're certainly very interested in improving around safeguarding with the different levels. But for us it's around using the data in a realistic way, so what we want to do is blend it between the quality and the quantitative data and I've given you a couple of examples of around how quantity, you know, how quickly we get to a patient versus how many patients that potentially have a positive outcome, how we can use SPC charts together to start to show that performance is improving or deteriorating, what impact that potentially has on the clinical indicators, and I think that's where we want to go. That's definitely an area that we're moving into.
We also want to get staff within our team to start to trust the data, you know. I'm usually an optimist but I was quite pessimistic when we were asked to come up and look at how we would transform our way of looking at data because it is quite technical until you get your head around some of the terminology. So for us the next steps in the clinical team is around understanding the narrative. So when it talks about a special cause for concern you know those concerns can be positive or negative, it's just about taking your idea away from that concern means a bad thing. What it really is, it just means that something's outside of the norm that you've decided on what the norm is. So I talked earlier about an upper and lower limit, special cause for concern usually means that you've gone outside what you classed as the normal limits, so again it's about understanding and trusting the data. And the third area is around, you know, trying to use the data more effectively. So in clinical currently we have a number of reports that we send internally both to our colleagues in operations and other departments, we send regular reports to board and other committees, and also external both through the contract but also to regulators. This is an absolute ideal opportunity and I know Emma you touched on it earlier where you want to use one version of reporting and this is something that we're very keen, so it will help us become so much more efficient because we'll be able to concentrate and produce one set of reports using a methodology that can be used across multiple forums. So there are next steps that we're aiming to push forward over the next few months.
Emma De Carteret
Thanks, Simon. Really really useful. I have one question from a from a lead for the demonstrating impact work stream perspective, if I may.
Obviously, we've got all of this work on going and you guys are doing work in the local team to improve but is there anything you can think of that would help teams, either your team or the rest of the organization, to continue on this improvement journey in relation to demonstrating impact that you don't think is already happening through the work stream?
Julie Hollings
Well, I found the case study that Simon gave very compelling, so I'd like to see more case studies and the impact, so the fact that more resources were put into make ready as a result, for me brought it alive. So I would like to see us using those examples maybe hearing from people from the make ready team and other parts of the organization about positive impacts this is having. We actually use the SPC charts in some of our comms metrics including the leadership message and I agree it's a useful tool. I'm really interested in how we can start using it as a trajectory now and set some further targets.
Emma De Carteret
Thanks Julie. And we'll definitely look at kind of publishing some case studies. I think it's a really good one, it can be it can be a challenge to everybody in the demonstrating impact work stream that when we have seen something like that we do a bit of a publication piece so people can see in real terms the difference it's making.
Simon Chase
Thanks Julie. yeah and I'd say for me mine's more holistic for the staff and possibly our users. So, at the moment we've talked a lot today about how, and when I mean users I mean the patients and their families, is that if you have some background knowledge of the ambulance service or you're living and breathing it, and I would put our staff in that, some of that's going to be able to relate to what we're presenting. So, I wonder whether we need to just think about how, if we start to produce this in some more outward-facing documentation, we probably need to think about, we have to assume that people won't understand what they're trying to say, so how can we have some user-friendly, you know, literature or a small video or something, you know, even if it's an animation to help people understand that if they went onto our website and they downloaded say the annual report or a board report that there's actually a quick and friendly user guide to say here's an introduction to SPC charts, this is how we're using them and why. So it's more, I think, for people who might not have the background or have done the training to have a whistle stop tour of what we're trying to use those for.
Emma De Carteret
It's a really good point, Simon. And it reminds me of a conversation I had with my team around the annual report that we've just finished, that we've just got ready for publication, because we've made the decision to not this time convert to the SPC type charts this time around for that very reason because we need to figure out what impact that will have in terms of people understanding the data that we provide. So, I will link up with the national team actually from a making data count perspective to this because I'm sure they will have some public facing guidance and if not they will be perfectly placed to help us to develop something for everybody for the good of being able to publish stuff in a way that everybody can understand, so really good, thank you.
Julie Hollings
So, thank you Simon and Emma. It's been really good to hear about how a better use of data is helping the Trust make changes to improve outcomes for our patients and we look forward to seeing more happening in this space in terms of making it really forward-facing and engaging for our patients and the communities we serve. Thank you.
Published 23rd August 2022