the art of involving in health innovation
TRANSCRIPT
The art of involving in health innovation
Tuesday 14 June 2016
Follow the conversation on Twitter at #involvinginhealth
MAC-UK and the INTEGRATE Approach
Co-producing
services with
excluded
young people
in the
community
Zlotowitz, S., Barker, C., Moloney, O., & Howard, C. (2015). Service users as the key
to service change? The development of an innovative intervention for excluded young
people. Child and Adolescent Mental Health. Online Advanced Publication.
doi:10.1111/camh.12137
young offenders have an unmet mental
health need at the time of offence
It’s not just what’s in their head
It’s what’s in their world
How does the INTEGRATE approach innovate around co-production?
Make people
architects of their
own support
How?
‘Community gatekeepers’ broker trust between project and young people
Increased confidence
Valued work role – youth employee
Giving back to their
community
Developing new skills
Community experts
Real Involvement of Statutory Services
+ Centre for Mental Health
Senior Mental Health Practitioner – Full Time
Youth Worker - 0.5 WTE
Project Lead (Mental Health trained) – Full TimeTrainee Clinical Psychologist - 0.5 WTE
Be willing to attend regular mental health training
(1 day per month) and to work in close Collaboration around risk and support
Research & Evaluation
Funding
How has co-production
worked for us?
• Young people provided early reality check
• Changes power relationships
• Harnesses assets and develops a workforce
• Resolves ‘hard to reach’ services issue
• Co-production builds trust
• Builds capacity across systems
• Changes the way statutory services work
• Builds social capital
Challenges?
• Needs a lot of resources – time and people
• ‘Inefficiencies’ in co-production – it is
slower, but more meaningful
• Difficult for NHS and statutory services to
adapt some of the learning – it cannot today
employ people with lived experience
Copyright 2014. All rights reserved.
'Tell me and I forget,
Teach me and I may
remember,
Involve me and I
learn”
Benjamin Franklin
Jude PartridgeConsultant geriatrician
Dept of ageing and healthGuy’s and St Thomas’, London
The changing surgical population
Life Expectancy in the UK
Age in 2014
Men Women
65 18.9 21.4
75 11.7 13.5
85 6.1 7.2
90 4.3 5.0
ONS, 2012
The national context – a wealth of evidence of growing population of older surgical patients
Comprehensive Geriatric Assessment and Optimisation – used widely by geriatricians but not adopted in preoperative setting
“ Preoperative identification and management of multimorbidity, cognitive impairment , delirium risk and
frailty using CGA will reduce length of stay in older vascular surgical patients”
Single centre, randomised control trial
Preoperative CGA and optimisation compared with standard preoperative assessment
Primary outcome - length of stay in hospital
Secondary outcomes – postoperative complications, higher dependency at discharge
Developing the project
Patients and carers
Anaesthetists
Nurses and therapists
Surgeons
‘don’t want multiple visits to hospital’
‘don’t want long hospital stay’
‘don’t want surgery delayed’
‘Want early involvement’
Administrators and managers
‘ need summarised information’
‘avoid confusion for patients’
Feedback Effect
Patients and carers ‘don’t want multiple hospital visits
ethical approval for simultaneous approach, consent and randomisation
Patients and managers
‘don’t want long hospital stays’
informed primary outcome measure
Surgeons ‘keen that timeline to surgery wasn’t lengthened’
informed recruitment from clinic and rapid randomisation
Waiting list administrators
‘wanted clear instructions to give patients’
Informed processes of documentation and communication
Health economists ‘require several variables not routinely collected’
robust health economic analysis
Recruitment
Retention of patient participants
Collaborative clinical decision making
Robust health economic analysis
Future collaborative clinical work
Dissemination and translation into clinical service
(therapy assessment of frailty, substantive jobs)
Future collaborative research work
PLG
Collaborative anaesthetic, surgical, POPS grant
Blinding Database Mixed methods evaluation
1. Patient advocacy helps get others on board
2. Strong patient and relative involvement is crucial
3. Involve all relevant staff groups - clinical and managerial/administrative
4. Keep in regular contact throughout – we made sure we were constantly visible
5. Involve other experts in the design stage -statisticians, health economists etc
GSTT charity Research Into Ageing – British Geriatrics Society
– Age UK Clinical teams and patients at GSTFT
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