Mark Brandreth Lead CEO of the NOA CEO, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
What does being a vanguard mean to you? For me, being part of the NOA and the vanguard programme means being given an opportunity to build on and strengthen the individual efforts of orthopaedic providers, so that we can make a real difference to care received by patients nationwide. In short, the work of the NOA vanguard is vital to the future of orthopaedic care across the country.
What problem did you want to solve? The first ‘Getting it right first time’ (GIRFT) report suggested that changes could be made to improve pathways of care, patient experience, and outcomes in orthopaedics – with significant cost savings.
It recommended that key to making these improvements would be to reduce variations e.g.:
• Prostheses costs
• Loan kit costs
• Length of stay
• Infection/compilation rates
• Revisions • Readmissions
One key focus for NOA has been expanding the evidence base for specialist orthopaedic services and advising on what “good outcomes” are in orthopaedic care whilst seeking and collecting examples of best practice and cascading them across member organisations and the wider NHS. We saw this as an opportunity to build on that by developing a quality assured service specification, based on evidence-based clinical quality markers, to support all our members on an improvement journey which will improve outcomes for patients.
How did you go about it? The NOA vanguard’s main focus has been developing a set of quality standards, protocols and processes for members and a system to support them. We have been doing this through input from member organisations across the country. Membership of the NOA brings with it the responsibility to implement these standards but also the support to do so.
In practical terms what difference have you noticed and has the way you work on a day-to-day basis changed at all? As we have not yet launched our quality standards, there hasn’t yet been a major impact in the way we work, but we have been noting feedback through workshops and training.
Just recently, following a one day coding and costing workshop we hosted, a clear learning identified was the lack of coding training available to clinicians across the NOA membership.
To start to address this we have produced The NOA Short Guide to Clinical Coding for Clinicians, explaining the basics and common pitfalls of coding specifically as relates to orthopaedics. It is hoped that this guide – and the NOA quality standards – once they have launched will help to drive real differences in the way providers work on a day to day basis.
What has the reaction and what has the level of staff engagement been like? Many people we engage with, including staff, are excited about the work we are doing. We have been busy meeting with members and potential members through our involvement in roadshows, workshops, exhibitions and meetings. Feedback overall has seen positive as relates to the work the vanguard is doing and the difference it can make.
How would you explain the way your new care model works to members of the local community? The NOA vanguard provides a framework for improving quality in orthopaedic care nationwide. It is based on a quality standards membership model founded on evidence based descriptors of ‘what good looks like’ in orthopaedic care. The NOA wants to improve the services that its members provide and then create a framework (or pathway) others can follow leading to consistent high quality care for patients across the country.
What is already having or what is going to have the greatest impact and value for patients as a result? Ultimately, the NOA aims to improve the quality of care for all patients receiving orthopaedic services across the country, whether that’s in a specialist centre, a district general hospital or a teaching hospital.
By supporting the spread of specialist orthopaedic care over wider areas, the NOA will also help to bring care closer to home for patients. The introduction of the NOA’s set of transparent quality standards will have a major impact on patients by providing more patient centred care and reliable safe processes. In short, patients will fully understand what to expect, by when and know how it will be delivered. By creating more efficient services the quality of orthopaedic care will improve, which is great news for patients.
Do you have any great case studies that immediately spring to mind or can you tell me what your most satisfying day at work has been since becoming a vanguard?
No case studies yet as we haven’t launched our quality standards but again, watch this space…
What do you think has been the most difficult challenge or barrier to overcome?
Implementing change that impacts on all areas of orthopaedic care and challenges the way things have been done over many years involves significant cultural change and this was our challenge at the outset of our vanguard. We continue to work with our growing membership through various types of engagement to address this and ensure we overcome this.
Vanguards are leading on developing new care models that will act as blueprints for the future of the health and care system in England. What advice would you give to anyone looking to adopt your new care model?
To bring about this kind of change you must take everyone with you – providers, users and internal NHS staff. Everyone involved requires clarity around what you are trying to achieve, what you need to get there and who you need to keep informed – and moreover involved in the decision-making processes – along the way. Good and innovative communication is the key to success.
How are you sharing learning?
Replicability is a massive success factor for us, so sharing our learning will be key to this happening.
We are delighted to have recently secured our first opportunity to support another specialty in adopting a similar quality based membership model to drive improvements in care. This specialty area is ophthalmology in partnership with the Moorfields vanguard. The replication project is working to create the UK Ophthalmology Alliance (UKOA), an alliance of provider members in collaboration with stakeholders including the Royal College of Ophthalmologists, the RNIB, the College of Optometrists and Getting it Right First Time.
The UKOA held its inaugural in summer 2017 and has now identified the three themes which its ophthalmology quality standards will focus around – Data and Costs, Quality Standards and Services and Staff.
What do you think your vanguard and the service it delivers will look like in 12 months’ time?
Progress with the NOA to date has been centred on mobilising and recruiting members to help build our quality standards. Development of these standards is well underway and once launched will help ensure patients across the country receive the same quality of patient-centred care and are treated using the same evidence-based, reliable and safe processes.
In 12 months’ time, we expect the NOA benchmarking portal including its quality standards and other data to have launched and be at the heart of NOA’s ambition to drive standardised care in orthopaedics.
We would have also secured further replication partners with the NOA membership model successfully being replicated in other specialties.
From your work so far, what’s your one top tip (or learning) that you could share right now with us that we could learn from and implement within our work areas?
Setting up a model like this one along with a set of quality standards needs careful planning so don’t be afraid to take the time to do that it feels like things will never get started but it makes delivery an easier process.
For further information visit: www.england.nhs.uk/vanguards/noa
email: [email protected] or follow: @NOA_Vanguard