Digital Transformation Workshop at Tameside and Glossop
Background
In February and March this year we ran a two day Digital Literacy workshop with staff from the Tameside and Glossop Integrated Care NHS Foundation Trust. This has been a collaborative piece — colleagues at Health Innovation Manchester have been leading on the project working with The University of Manchester, and with Health Education England providing the funding.
The course is part of a larger ongoing project to drive digital literacy skills in healthcare across the region. As a long time Glossop resident it was so nice to be able to move from an academic environment to be able to work with my local NHS trust — and the people that have provided such good care to my own family.
What we were keen to explore in this workshop was the way in which we could use a training event to feed into a continuous improvement process. Our feeling was that if we could get the right group of people together, add in some training and the freedom to be creative — then new ideas might emerge. Could a course like this generate ideas that could make a patient care pathway better — and make a difference to the quality of care offered in our community?
The first challenge was to find the right group of people. For a first run of our programme we felt we needed to be working with an established multidisciplinary team. The heart failure team at Tameside and Glossop was an obvious choice given the work that they are already doing. It was really helpful that many of the key people were already meeting to decide the key performance targets they wanted to achieve. Working with Stephanie Sloan (Strategy and Business Development manager) and her team we discussed how the course could be a vehicle for them to develop processes to achieve the improvements that the team had already agreed.
The course we delivered is based on well-established training in Health Informatics we deliver at postgraduate level at The University of Manchester. In the course we ask students to develop a model of chronic disease pathway from the perspective of a patient. The patient perspective is really important to us. We have seen on many occasions that health professionals have a strong understanding of their own part of the patient pathway, but less understanding of the whole pathway and how it works for the patient. People are often unaware of the disconnects across different parts of the system that can cause so much frustration to patients (different people asking the same questions, the same tests being repeated in different places, information not being shared between the care team,…). We were fortunate to have two patient representatives from the “Ticker Club” patient group who were able to give their perspectives.
The training starts by providing key background on aspects of data capture, data sharing and human factor challenges in health. For example, we introduce areas of data coding and interoperability standards, and social science frameworks in which to explore the human factor challenges and strategies for continuous change processes. All this training is provided in an on-line training environment to allow easy access to the material when it is convenient for the participants, However, the main learning happens in the groupwork. We ask people to work in small and very multidisciplinary teams to look at mapping the patient care pathway: who are all the people and systems involved, what information gets captures and where, how does information get shared? Once they have that model people can then begin to get a feeling of where there are issues and problems — at a whole system level — and therefore to think about changes that they could make for the better.
Our ambition for the course was therefore two-fold; the first to provide educational resources and training to improve levels of digital literacy amongst the participants and the second to use that new knowledge to make a real difference to care delivered to the community.
The course
We delivered the course over two days, two weeks apart. We had about 20 attendees — but not everyone could make both days. We had a good mix of participants: patient representatives from the “Ticker Club”, nurses (both acute and community), clinicians, GPs, Health Care Scientists, managers and representatives from social care. The course was run at an excellent local conference facility at St John’s Church in Dukinfield.
The healthcare scientists involved were on the Higher Specialist Scientist Training (HSST) programme — a PhD level programme run by the National School of Healthcare Sciences. They are experts in areas of digital health and bioinformatics but have less knowledge of how a chronic care pathway functions at a community level. We could therefore put people into teams with skills ranging from the very technical, to a deep understanding of how the local systems currently function.
As the course progressed it became very clear just what value the patient representative brought to the course. Alan and John between them had worked with more patients going through the heart failure pathway than anyone else in the room. They had a deep knowledge of how the whole pathway functioned and the challenges that patients face. They were also not afraid to ask questions when people drifted into jargon — which helped a lot of other people.
The modelling work was done using state of the art software engineering tools -big pieces of paper and post-it notes (which genuinely are used for state of the art agile engineering process!)
It was really interesting to observe just how big and complex these models became, and the insights it gave participants to parts of the pathway and complexities they were unaware of. This was made very obvious on the second day in which there was a lot of focus on the interface between health and social care — and the issues that this raised for patients in their recuperation — and the need to make this work better.
So, at the end of the day — can a course like this both support digital literacy and help drive improvement? I think the evidence from Tameside and Glossop suggests that it can.
We also had generally positive feedback on the educational material and participants felt they had improved their digital literacy skills. However there are things we would change. Providing the training material online worked well, and so we could have spent less time reviewing this material in the mornings. Participants really valued the interactive time working in teams on the pathway they care about. We can be braver at moving to using a “flipped” classroom model for such courses.
By the end of day two participants had developed nine distinct service improvement ideas, ranging from improving the blood testing processes in A&E, to supporting GPs for more efficient referrals. We also saw the value of the interdisciplinary training and the collaboration that comes from this; having some people in the groups who understood the challenges and problems, and others who understood how things could be made better. Our hope is that at least some of these will be implemented — we will be revisiting in a few months to see whether this has really happened.
We are hoping to run the course again for a second cohort in Bolton where we can test out these refinements to the course. Unfortunately, these plans have had to be put on hold as a consequence of pressures frontline staff are facing due to COVID-19. Somewhat poignantly, this teaching was one of the last times we interacted with students face to face before the lockdown. Yet we believe that with the emerging changes in working patterns, digital literacy and collaboration online with be more important than ever before.
Author
Andy Brass, Professor of Bio-Informatics, University of Manchester
