Written by Tara Donnelly on 13 September, 2016
The Academic Health Science Network’s Atlas of Solutions in Healthcare launches today, bringing together great ideas on tackling variation, as Tara Donnelly explains.
We have a great tradition of invention in healthcare in Britain; from William Harvey describing blood circulation in 1628, the discovery of antibiotics, the smallpox vaccine, DNA and sequencing, inventing the CT and MRI scanners, conducting the first blood transfusion and having more Nobel laureates in medicine and physiology than any country other than the US, which is five times our size. But I’d argue that discovery is one thing: it’s high time there was a Nobel Prize for spread.
Spread – by which I mean at scale adoption of an innovation – is the way we will move from unwarranted variation in the NHS; from pockets of poor performance contrasting with beacons of excellence, often in a single geography, to improvement at scale to touch many more lives.
Tara explains the AHSN Atlas website to Simon Stevens
Watson and Crick
It’s time to get serious about spread.
We could stop innovating right now and there would be a good sized backlog of evidence to implement. I believe that we should focus now on systematic application of what we know works; the proven innovations that the research tells us is effective, that in many cases the National Institute for Health and Care Excellence has declared good practice, and now make them common practice across the NHS.
Spread is not simple and indeed it can be tough. The results from an innovation need the application of local intelligence to work elsewhere. The science of spread tells us that to emulate the success of others’ changes is likely to require time, energy and resources. Networks need to be effectively activated. Leadership judiciously selected. Hearts as well as minds persuaded. Data is often essential. Implementation engineering skills are needed to support staff make changes that are sustainable.
The “Right Care” movement is demonstrating significant unwarranted variation between CCG populations which ought be more similar. This work and the excellent NHS Atlas of Variation provides a helpful diagnostic on where to focus. Within acute care, standardisation of clinical pathways has been central to improvements such as enhanced recovery after surgery, and exactly the same benefits exist elsewhere; the trusts linking with Virginia Mason, Intermountain and IHI are hearing at first-hand about the centrality of this. What we now need to do is rigorously apply the solutions to the variation we diagnose.
The atlas provides a range of examples, from every part of the country, of solutions that have worked. Each solution is pithily written, evidence based and data rich.
But the very first step in tackling variation is understanding what the leading solutions and candidates for spread in fact are, and even better if as an improver you can learn from others who’ve worked in that space, grappled with the same problems and can give tips to avoid wheel reinvention.
This is where learning from across the academic health science networks of 15 organisations covering the 53 million population of England can be tremendously useful. So we’ve brought together examples of great candidates for spread in a new AHSNs’ Atlas of Solutions in Healthcare launched today at the NHS Innovation Expo. This is at atlas.ahsnnetwork.com and can also be accessed on the front page of NHS Improvement’s website, within its improvement directory.
The atlas provides a range of examples, from every part of the country, of solutions that have worked. Each solution is pithily written, evidence based, data rich, with the practical information improvers need to move to spread as well as contacts to follow up where more support would be valuable.
Examples in practice
With the development of five year place based transformation plans, we have a clearer line of sight to the improvement areas each sustainability and transformation plan patch seeks to tackle. Being able to scale up improvement work rapidly will be important if these visions are to be realised, making this atlas a valuable tool in the armoury of advancing the Forward View.
Do have a look at what is working elsewhere. These are just a few of the examples you will find in the atlas:
If you’d like to submit a proven innovation to join the ranks of these solutions, get in touch by emailing firstname.lastname@example.org with your information and evidence in the same format for our editorial board to assess. The deal is that you will need to be prepared to help others seeking to spread your solution. It’s a noble cause as we develop a new British tradition of spread and consistent adoption at scale and pace.
Visit the AHSN Atlas website here.
This article first appeared in the HSJ online on Wed 7 September - Read it here (subscription required)