©Copyright 2013: Quality Improvement Clinic
The Power of co-production
Nicola Davey
Director of the Quality Improvement Clinic
©Copyright 2013: Quality Improvement Clinic
What is co-production?
A way of working whereby decision makers, experts, citizens or service providers and userswork together to create a decision or service which works for them all
• Benefits
• Rules of engagement
• Outcomes
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What are the benefits of co-production?
• Serves a collective purpose
• Builds on existing evidence base
• Generates more interest and builds active networks
• Pools resources for mutual benefit
• Utilises small scale tests of change
• Reflects learning in each test cycle
• Engages partners across the UK
• Promotes dissemination and spread
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The deal…..
National resource
• Collates evidence base
• Co-ordinates work
• Creates network opportunity
• Analyses & shares collective results
• Designs and promotes national products/services
Local resource
• Provides experience & energy
• Contribute to the design
• Commit to testing & measurement
• Applies ideas within local products/services OR
• Adopts national products/services
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What can be achieved?
Creation of the UK Paediatric Trigger Tool PTT
Development of measure of harm for Paediatric care
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Approach
The Model for Improvement. Langley, Nolan, Nolan, Norman & Provost. The Improvement Guide, Josse Bass, 1996
A UK wide measure of harm for paediatrics0
Clinicians will use the paediatric trigger tool to identify and measure paediatric harm
Work with co-production partners using PDSA cycles to test, refine and produce a UK paediatric trigger tool
Test ideas – before implementing changes
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Aim
WhatTo design and make widely available a tool to measure ‘harm’ in paediatrics
By whenWithin 9 months
As measured byNo. of case note review results posted (on trigger tool portal)
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Co-production steps
• Convene a small steering group
• Describe the proposal
• Recruit co-production sites (Teaching and District General Hospitals)
• Identify resources – internally and for co-production partners
• Schedule and host 3 network meetings
• Publish UK Paediatric Trigger Tool
• Use Model for Improvement (PDSA)- Collect evidence and inputs from experts to inform starting point (Plan)- Undertake PDSA testing cycles (Do)- Analyse findings (Study)- Feedback findings to inform next cycle (Act)- Design next cycle (Plan)
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PDSA cycles
Review international evidence base and current practice
Introduction to use of Trigger Tool
1st consensus on paediatric triggers
1st test of paediatric triggers
Data collection
Review of results from 1st test
Discussion of findings
Generation of ideas for improvement
Development of definitions guide (for consistency)
2nd consensus on triggers
2nd test of paediatric triggers
Data collection
Review of results from 2nd test
Discussion of findings
Generation of ideas for improvement
Streamlining measurement and validating paediatric tool – (trigger tool portal)
3rd consensus on triggers
Refinement of definitions
3rd test of paediatric triggers
Data collection
Review of results from 3rd test
Design and testing of trigger tool data collection form
Production of training materials
Development of business case for case note review resources
Launch of Paediatric Trigger Tool
Evidence from portal of case note review activity
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Measurement
Triggers 1st cycle38 triggers
2nd cycle40 triggers
3rd cycle39 triggers
Results7 trusts
172 case note reviews
148 case note reviews
140 case note reviews
Analysis of trigger specificity after 2nd
cycle (296/330 case reviews eligible)
503 triggers were present (1.7 per case, 95% CI 1.5 – 1.9) 127 adverse events were identified (0.43 per case, 95% CI 0.3-0.6)
Calculation of harm rate
The harm rate was 43%
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OutcomeUK
PaediatricTrigger Tool
Results posted on Trigger Tool
Portal
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Learning points for success
• Identify adopters and champions – recruit to steering group
• Go where the energy is – secure motivated co-production partners
• Keep to the plan – three meetings to maintain momentum, commitment and progress
• Share resource burden – provide central support for network meetings and analysis
• Draw on existing knowledge – use of evidence base, experts in field, other explorers
• Share early findings – share and discuss results at network meetings
• Make measurement easy – develop simple and standardised ways of capturing and analysing results
• Facilitate easy access to resources – documents downloadable via website
• Publicise – launch nationally, follow-up contacts and seek feedback and results
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Secure more internal resources
– Administration
Anticipate and plan response in the event of high levels of ‘pull’
Invest more time on specification for new technology
What I would do differently next time?
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What else can be achieved?
Creation of Paediatric Early warning score charts (PEWS)
A standard template to measure, detect & escalate concerns about children who are becoming more unwell
©Copyright 2013: Quality Improvement Clinic
Copyright & citation
This presentation has been made available to you support your personal learning.
Many of the images in this presentation have been purchased for this purpose and are not available for reproduction.
The citation for this document is: Davey N.J., 2013,The Power of Co-production, Quality Improvement Clinic