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Liz Mear: Spreading the adoption of innovation into practice
Chris Gibson: Lessons from military medicine on how to innovate
- Liz Mear: Spreading the adoption of innovation into practice
- LM: Liz Mear
LM: Sometimes what you get across AHSNs we talk about the issues about innovation as a contact sport, we need to get out there, talk to people, see them, support them. So this slide is about our atrial fibrillation campaign. So this is rolling out across all fifteen academic health science networks and we started on this four years ago. We had a high number of strokes. It was really apparent to us that right across our system we needed to start to tackle strokes. So the network got behind that and set a target that we're working on at the moment to identify 85% of people who had atrial fibrillation but didn't know about it and we've managed to get to that and we're on a stretch target of 90% at the moment, but this was a boots on the ground, working on CVD prevention policies, working with all these partners and more. So this is Cheshire Fire and Rescue Service, they're out in the community all the time doing safe and well checks, and they started testing people for atrial fibrillation.
So a lot of our work is about creating a culture that's receptive for innovation. So we've got innovation scouts, or some AHSNs call then 'intrepreneurs'. We've been setting up some innovation centres because we didn't have that in our patch, other people had them already so they don't need to do that. A lot of us run specific matching events to bring people together from universities, from NHS, from local councils, from industry. Across AHSNs we have these communities of practice; the Q's who work on patient safety, a big network right across the country. I've talked a little bit about 'intrepreneurs' and innovation scouts and the clinical evidence champions.
So these are photos of our ambassadors and we have these around our atrial fibrillation programme. Do people recognise Bill Beaumont there? Rugby player and in the north west there is a rugby corridor with about twelve rugby clubs and they are really keen to support family health and men's health. So we had a willing audience there of people who would talk about this and you'll see dotted across the slides there's a number of examples of technology. So people don't just want us to receive a technology or an innovation and not have any choice, they want to adapt, they want to get what works best for them in the system and I think that's been part of our learning.
So one of the barriers was funding for innovations and NHS England has worked really hard to think about how they do fund some fantastic innovations and last year we were rolling out the innovation and technology tariff. So a range of products that were commissioned by NHS England and funded by them. They are free, the barrier has gone, they're great. They make a difference to patients' lives, so we're seeing a lot of uptake as we move forward.
Celebration, one of the things we do well as AHSNs, people might recognise Penny Newman with Health Coaching, Lloyd Humphreys, Patient Knows Best, but these are great innovations and every year we celebrate those with an NIA celebration event, an annual event. The people at the right are the clinical entrepreneurs, those people who are in service who have trained, they want stay innovative, they want to test ideas and have a network round them. Again they have an annual celebration event. And across AHSNs everybody will have their local celebrations and people actually really do appreciate coming together, hearing what other people are doing in their region, learning from their peers and just thinking, actually, I could do that, I'll have a word with them.
So we've got funding across AHSNs from NHS England, we have funding from NHS Improvement to run the patient safety collaboratives and we're also now having funding from the Office for Life Sciences for innovation exchanges. And we were approached by the Office for Life Sciences because they could see we were doing something really good, that we were in a unique place in the system, we were that neutral party in a system that connected all these different parts of it. And we also had a fantastic innovation pathway and we worked with industry, if somebody came to us with a great innovation, so that they could get that to stick hopefully, be introduced and adopted into the NHS and care partners. We've come up with a range of things that we will be doing within innovation exchanges to adopt and spread innovation even further. So we'll be communicating right across systems, bringing people together, talking to them about innovations, putting them in the same room, collaborating. We're going to be doing a lot of real world evaluation. We can build on research trials but it's about very practical innovation being put into practice and evaluated. So this is about collaborating across partners but also collaborating across the network of AHSNs.
We're a vehicle for spread and adoption. We're a vehicle that can have conversations between our self to say, "Actually, why did that work in you patch? How can I get it to work in my patch? Let me chat to you about some of the issues that I've experienced." So this story is continuing. We'll be rolling out NHS England's programmes that the AHSN have come up with themselves, we'll be rolling out innovation exchanges and over the next two years I think the adoption and spread will be phenomenal as we work together to collaborate.
- Chris Gibson: Lessons from military medicine on how to innovate
- CG: Chris Gibson
CG: I think this is the context about where we stood within defence medical services; in '95 we were way behind with regard to our performance and our patient care but somehow we managed to create a strategic drift and I think those components, there on the left, were our new concepts and capabilities where we adopted new technology and equipment and I think the training is a really important component of that.
We're going to talk a bit about the imperative for change. We actually have a model that we apply against the problem and then work out what the solutions are. So the steeple of a component where we look at the social, the technical bit, the economic, the environmental, the political, the legal, the ethical - it's all well-known stuff but we apply it all the time because actually the imperative upon us for innovation hits us very hard. I carried that coffin at the front, which was Simon Hamilton-Jewell's coffin, onto the plane in Iraq - he was a really good friend of mine - and that was the imperative for me to make sure that innovation and we got on top of how to stop the trauma killing so many of our people.
One of our bigger drivers was the use of technology. In war it was always trauma and the use of novel haemostatics and tourniquets where the tourniquets were on and tourniquets where off and now we see them not camouflaged or black within our health services but bright orange because doctors may miss a tourniquet. And then, how we looked at coagulopathy and making sure that we put the right amount of fluids into a patient without blowing the clot. All of this we're able to do in the middle of the desert.
Certainly understanding the environment, every war of choice that we've been in has a different set of signature injuries and therefore a different pathway for our patients, whether that be Northern Ireland with its coffee bombs to Iraq with its hidden munitions, to the plastics that are being used in Afghanistan to this day. And in Afghanistan we managed to achieve a 98.6% survival rate of anybody that went in the front door of that hospital. That's the highest survival rate in the history of medicine worldwide. In seven hours of flight away delivering UK standard care, audited by the CQC, like any facility back here. In 2007 we managed to identify the requirement for whole blood and FFP to be carried on our rotary platforms so we were taking the consultants out to the patients, which is a real change in philosophy of care and one to watch out for. Having identified it, we had the bloods in place within 24 hours on the helicopters being utilised and you can see that now ink blotting within our organisation because I believe most of the air ambulances in the UK are now carrying whole blood products.
ADOPTER, this is the acronym that we've created about being agile, decisive, I can focus, politically aware, absolutely tolerant of risks, empowered and rewarded. As I try to take on things in my career, I've looked at it and been swamped by the challenge and therefore I've tried to break it down into bitesize chunks where you can make an incremental gain, and it was Sir Dave Brailsford that talks about incremental gains in Team Sky where they look at just making these marginal approaches to getting it right. But this guy, Colin Powell talks about this principle, the 40/70 principle, which I have adopted myself. He used this to lead the first Gulf War in getting the Iraqi forces out of Kuwait where he basically said, "If I wait for above 70% of the information to come into me I will have lost the window of opportunity," and therefore the precise window is between 40% and 70% of the information to make a rational decision to move your organisation forward.
I think you have to be politically aware, you have to understand what's acceptable to government. When I was given the task of Ebola, I was given the task of doing all the training, setting up the capability, training and then assuring everyone that went out from the UK. When we asked the question of what does success look like to Downing Street, and it was Downing Street that we were asking the questions to, they said we were allowed a less than 1% casualty rate. It was really interesting and we had to apply the rigor to the training to ensure that occurred. We understand what the firm base looks like because it looks the same for you in your organisation I think, where it's slightly risk averse. It has a centralised authority which governs us and it doesn’t give us much freedom of movement in that it doesn't allow mission command to be fully exploited and it has a regulation culture. Where I like to work is in the deployed space. You are given the space to do it and we have great success with it and somewhere in the middle there should be a common ground where work can really go ahead in a much more effective manner.
We get people to do amazing things in the military for a piece of tin. We don’t pay them for delivering excellence, we don't reward them other than doing it in public with something that really matters and therefore when you're creating your innovation programmes, how do you reward your people for delivering excellence? It doesn't need money but it needs a public acknowledgement of the fact and it's really massively important to ensure that occurs.
There's the model, I'm really happy to share it with you, thank you.