Janet Davies, Programme Manger, Lancashire and Cumbria Innovation Alliance Test Bed, discusses the challenges of rolling out the test bed programme in the health and care sector and shares ways of overcoming these challenges.
This presentation was recorded at our Digital Health and Care Congress 2017 on 11 July 2017.
I was asked to talk about what are the particular challenges, rolling out a programme in a health and care sector so I’ll tell you a little bit about our programme as I’m talking about the challenges.
So one of the challenges is about the size, range and number of organisations that are collaborating. If we look here, we’ve got our nine innovators. We’ve got the two vanguards of delivery that are delivering, we’ve got our evaluation undertaken by Lancaster University and if I don’t say that they are in the top ten in the country I will, you know I’ll be really severely told off. The governance is done through Lancashire Care Foundation Trust who are the host for the test bed and we also have the Lancaster Health Hub and the innovation agency involved with us. So, where you can see there, as you say the number of organisations that are collaborating, it’s huge.
So, the challenges are, you’re talking to 70 individuals from the organisations, communication pathways are so different, operating systems for IT are different, you’re competing for different priorities, governance including IG, however we manage to do that quite neatly through using an information gateway process, which we have locally, and that really helped with our IG solution.
Healthcare, the lead innovator is a multi-national company. We’ve got SMEs, we’ve got third sector so all the different cultures within those as well, we’re managing. We’re finding in agreeing common goals with individual values and priorities. However, what you can’t argue with is if I think about our statement from Lancashire Care, high quality care at the right place at the right time, every time, nobody can argue with that. So equally, if you’re from another one of the organisations theirs is quality, safety, accountability, you can’t argue with that either. So, if you build on those common values, you’re working towards the right, you’ve got it all going in the right direction and the other thing that is really important is the protection of reputation for all the partners. All the partners are investing heavily in this, but actually you know, each has a reputation to maintain and especially if you’re a company or you’re trying to launch your production, you know that is really important to you, as is the reputation of the healthcare provider.
We have two different care models, as you can see here with our vanguards. So, we have Falcos vanguard which is looking at the neighbourhood teams and referrals into neighbourhood teams; and then we’ve got the better care together model which is the integrated care communities, so we’re working there with the GP super practices so our main practice has about, a patient roll of about 65,000. So, we’re recruiting patients from both different vanguards which is very, very fascinating to see the different that those recruitments are coming through.
So those are the challenges there, different models of care, different care pathways. Then varied interpretation of risk has been really interesting. GPs picking out from their own caseload and managing their own caseload, their view of risk is very different to the care teams in Hans primary care team who are looking after the patients on behalf of the GP. They have a very different view of risk and where that risk sits. So that’s been really interesting.
Recruitment of clinical staff is across the country really. So, the availability of and the lack of and the time taken to recruit staff, and also we’ve got the provider commission arrangements; am I commissioned to do that, I’m not sure if I am and how we have those conversations.
Procurement and commissioning, right from the very beginning, we’ve got to look at now the spread and adoption of test bed technology solutions, so how are we going to role that out?
Partners competing for the same contracts; if you think about the number of people who are in this test bed programme, working together, as contracts come out from wherever it may be for community, you could find that a Lancashire Care is actually bidding for the same contract as Blackpool Teaching Hospital might be, so it’s how do you maintain really positive working relationship while those are going on, and also how we work within the procurement guidelines.
A huge number of initiatives going on especially in our area, so we’re competing for resources, competing for patients and clients, managing evaluation protocols. We’ve got a huge evaluation protocol going on for both vanguards. There’s our huge evaluation going on. We’ve got a healthy new town, we’ve got the STPs, the LDPs, we’ve all that going on so how are we managing all that as well?
How to overcome the challenges, it’s really, it’s a bit like reinforcement with children is this, through the day as we’re building through from this morning with Jocelyn and through everything, it’s like have a longer leading time. It was, and use it carefully. Ensure that the proforma agreements are in place prior to your start, which we had which was an MOU and then we went onto the collaboration agreement. Our collaboration agreement is like War & Peace. It doesn’t need to be. It doesn’t need to be, because the longer you make it the more there is to argue about it. So, if you keep nice, clear, and succinct, the better it is.
Build the programme with an ethos of mutual respect. There are different people bringing different expertise to the table and so what we make sure that we do is respect their expertise, I’m a programme manager expert. So, and I don’t pretend to understand half of the clinical things that go on, but I have clinicians around us who advise that and so we have that mutual respect.
Find common ground with partners and build on it, remember there’s always a solution we just have to find it and find the right individuals, find the right people to talk to who can make a decision. Just factors to find that person. Listen and communicate with all involved and never give up.
Thanks to Lancaster University who as I say, who have helped us with some of the lessons learned evaluation that they’ve done and those are our details for anybody who wants to contact us. We are quite vocal on Twitter so if you want to follow us on Twitter you’ll see a lot of activity going along there and we’d love to hear from you as well.