The Power of co-production

Nicola Davey

Director of the Quality Improvement Clinic

What is co-production?

A way of working whereby decision makers, experts, citizens or service providers and users work together to create a decision or service which works for them all

• Benefits

• Rules of engagement

• Outcomes

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

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

What can be achieved?

Creation of the UK Paediatric Trigger Tool PTT

Development of measure of harm for Paediatric care

Approach

The Model for Improvement. Langley, Nolan, Nolan, Norman & Provost. The Improvement Guide, Josse Bass, 1996

A UK wide measure of harm for paediatrics 0

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

Aim

What To design and make widely available a tool to measure ‘harm’ in paediatrics

By when Within 9 months

As measured by No. of case note review results posted (on trigger tool portal)

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)

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

Measurement

Triggers 1st cycle 38 triggers

2nd cycle 40 triggers

3rd cycle 39 triggers

Results 7 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%

Outcome

UK Paediatric

Trigger Tool

Results posted on Trigger Tool

Portal

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

What I would do differently next time?

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 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 & citation

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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