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The art of involving in health innovation Tuesday 14 June 2016 Follow the conversation on Twitter at #involvinginhealth

The art of involving in health innovation

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Page 1: The art of involving in health innovation

The art of involving in health innovation

Tuesday 14 June 2016

Follow the conversation on Twitter at #involvinginhealth

Page 2: The art of involving in health innovation

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

Page 3: The art of involving in health innovation

young offenders have an unmet mental

health need at the time of offence

Page 4: The art of involving in health innovation

It’s not just what’s in their head

It’s what’s in their world

Page 5: The art of involving in health innovation

How does the INTEGRATE approach innovate around co-production?

Page 6: The art of involving in health innovation

Make people

architects of their

own support

Page 7: The art of involving in health innovation

How?

Page 8: The art of involving in health innovation
Page 9: The art of involving in health innovation

‘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

Page 10: The art of involving in health innovation

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

Page 11: The art of involving in health innovation

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

Page 12: The art of involving in health innovation

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

Page 13: The art of involving in health innovation

Copyright 2014. All rights reserved.

'Tell me and I forget,

Teach me and I may

remember,

Involve me and I

learn”

Benjamin Franklin

[email protected]

Page 15: The art of involving in health innovation

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

Page 16: The art of involving in health innovation

The national context – a wealth of evidence of growing population of older surgical patients

Page 17: The art of involving in health innovation

Comprehensive Geriatric Assessment and Optimisation – used widely by geriatricians but not adopted in preoperative setting

Page 18: The art of involving in health innovation

“ 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

Page 19: The art of involving in health innovation

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’

Page 20: The art of involving in health innovation

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

Page 21: The art of involving in health innovation

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

Page 22: The art of involving in health innovation

Blinding Database Mixed methods evaluation

Page 23: The art of involving in health innovation

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

Page 24: The art of involving in health innovation

GSTT charity Research Into Ageing – British Geriatrics Society

– Age UK Clinical teams and patients at GSTFT

Page 25: The art of involving in health innovation

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