Health CommitteeWritten evidence from Yorkshire & Humber Innovation and Education Cluster (ETWP 34)

1. Introduction

1.1 This response is provided on behalf of the Yorkshire & Humber Health Innovation & Education Cluster Board (HIEC). Our response addresses several of the key themes of the inquiry.

1.2 The Yorkshire and Humber HIEC is implementing innovation across the region at pace and scale, we are using education to support the adoption and spread of innovation in three theme areas: Long Term Conditions, Maternal & Infant Health & Care and Patient Safety. We have launched innovative educational materials to support the practical implementation of innovation. We have done this to achieve real and sustainable service change to improve quality and/or increase productivity. All NHS organisations and Higher Education Institutes across the region are members and we have worked with them to shape and deliver our work (further information is available at: www.yhhiec.org.uk

1.3 The HIEC programme has supported the development of the existing workforce to deliver the Quality Improvement Productivity and Prevention (QIPP) challenge. Changing behaviours and individual practice is critical to mobilise and equip the current workforce to address this challenge.

1.4 It is hoped that the experience and learning from establishing the YH HIEC can make a valuable contribution to the health committee, particularly in relation to the importance of using education as a mechanism to drive the adoption and spread of innovation and improvement in the NHS.

2. Education and Training Reflect the Changing Nature of Healthcare Delivery

2.1 Education is one of the most important ways to develop the workforce to drive the adoption and spread of innovation in the NHS. Education should draw upon the latest evidence in a way that meets the priorities of the NHS (eg impacts upon quality, safety and productivity).

2.2 Education must draw more heavily upon the latest evidence base, both in terms of content and mode of delivery to ensure that we are maximising the investment in the National Institute for Health Research (NIHR) research infrastructure in the NHS.

2.3 The “journey” from evidence to implementation is a complex one, which requires a wide range of skills: to search and review the evidence base to, identify the need or problem, determine what possible solutions there are, determine how they should be implemented (including consideration of the methods of change), and how to monitor and measure impact. It is important to grapple with this complex journey. We have found that a facilitated approach is the most effective way to do this. For example, we have developed a facilitated programme underpinned by education resources to support an increase in the number of women discharged from labour wards breast feeding, to increase normal birth and to reduce caesarean sections.

3. Multi-Professional and Multi-Disciplinary Leadership and Accountability

3.1 Education commissioning should not only focus on the provision of skills for staff, to support the workforce to be able to adapt and change to meet new service demands, it is vital that education supports the workforce to innovate for themselves within their own environment, so that they are empowered to deliver tangible and sustainable improvements in services. For example, we have developed a team based approached that facilitates clinical teams to address “problems” in their current work. This approach has yielded significant impact, one of the teams that we worked with increased the number of clinicians conforming to NICE guidelines for feverish illness in children from 14% to 90% during a 20 week facilitated support programme.

3.2 The new system provides an opportunity to maximise multi-professional learning, particularly for post registration learning and CPD. For example, the networks could think more creatively about professional doctorates, as a pre-cursor to joint academic/NHS posts across the professions (not just for medics). This could be supported by NIHR investment where a joint approach has been agreed that support delivery of NHS services and of NIHR Portfolio studies for example.

3.3 The “journey” from evidence to implementation is a complex one, which requires a wide range of skills to search and review the evidence base to: identify the need or problem, determine what possible solutions there are, determine how they should be implemented (including consideration of the methods of change), and how to monitor and measure impact.

3.4 A key barrier to adoption and spread is insufficient adaptation to local context. Top-down enforcement of innovation priorities is not successful. Adoption and spread must always be linked to local priorities. For example, we are working with organisations to implement technology rapidly. This is a facilitated programme underpinned with business support resources along with an online module.

4. High and Consistent Standards of Education and Training

4.1 Shared learning supported by metrics can be collected to draw out generic lessons regarding adoption and spread. We have found this to be important to maintain momentum and to enable teams to undertake other improvements in a rigorous way.

4.2 Our education materials increase knowledge, but focus also on how to implement the knowledge into practice. We have found that training staff to deliver innovation focussing on an issue they are living through in order to learn a new approach is very effective. This learning can then be applied to other issues which creates sustainable change skills in the organisation.

4.3 An innovative approach to both the method and content of the education facilitates spread and increases impact. We have not viewed the development of education resources as an isolated activity, but have taken a wider view about how the education would underpin developments across a system. For example, we are working with every maternity and neonatal unit across the region to deliver increases in breast feeding and reduction in caesarean sections.

4.4 Evidence based innovation and implementation of research findings must be seen as crucial to the business of the NHS and therefore the NHS work. We have designed, shaped and delivered our work collaboratively and have co-created our resources to ensure they are relevant and are in a language that is appropriate to the audience. We are also working outside formal education commissioning as it can be difficult to quickly address new or emerging priorities. For example, we are working with a private company to develop an online module to support professionals to change the behaviours of patients (to adapt to technology and tele-health service provision) that will be available across Yorkshire and the Humber free of charge. This has happened relatively quickly and will be available in April 2012.

5. Developing and Re-skilling the Existing Workforce

5.1 Driving innovation through education is important to achieve spread at and scale. Using education as a tool to develop the workforce maximises the benefits from integrating evidence and research findings. With >60% of the NHS budget used to fund workforce (NHS Choices, 2010), it is critical that the workforce is equipped and skilled to spread innovation in their practice.

5.2 Our approach has been to train staff to deliver innovation focussing on an issue they are living through in the course of their work in order to learn a new approach which can be applied to other issues. This approach provides staff with the skills to implement innovation and manage the change associated with it. This means our approach can lead to sustainable changes in organisations.

5.3 Driving innovation through education is a way to ensure that the workforce is able to implement and spread innovation in a sustainable way; we have developed several creative ways of achieving this.

5.4 Facilitating collaborations between sectors and establishing partnerships is critical to achieve spread at scale. New innovations do not necessarily require new networks, engaging with existing networks and communities with a focus on working together to support service change is important.

5.5 Partnership working is critical to ensure appropriate understanding of both the problem, and the development and implementation of the solution. Buy-in from both senior leaders and staff on the ground is crucial to ensure sustainable change.

5.6 To achieve improvement across the system requires a coordinated strategic approach to priorities across a patch. The YH HIEC has achieved real change as a result of bringing different stakeholders together, we have focused on growth and improvement rather than compliance and standardisation.

5.7 Whilst there is a requirement to demonstrate a strategic and operational resonance with national objectives, there is a delicate balance between national standards/objectives and local ownership and control. The key to success is local engagement and relevance.

5.8 The workforce must be able to support both the “new” research, invention or innovation as well as the adoption and spread of existing (but not yet implemented) ways of working. The priorities for adoption and spread must resonate with the challenges of the workforce and the NHS, as well as being sufficiently adaptable to local context. This requires education around innovation science, improvement science and change management.

6. Conclusions

6.1 Education is a key vehicle to deliver transformational change in the way that the existing workforce deliver the priorities of the NHS, as well as shaping the new workforce throughout their pre-registration training.

6.2 Education plays a critical role in supporting the adoption and spread of evidence based and innovative practice in becoming “the norm”. Education that empowers the workforce to innovate for themselves in their own environment is important to deliver tangible and sustainable improvements in the services they deliver.

6.3 The adoption and spread of innovation must be commissioned, not just the innovation. There is a significant “journey” between innovation and implementation, it is important that the “journey” is systematically managed and facilitated to create real service changes.

6.4 The approach we have taken was carefully designed to ensure that we were working across disciplines and sectors, as such our approach is easily transferable to public health and/or social care.

December 2011

Prepared 22nd May 2012