What does being a vanguard mean to you?
We are really excited about being part of NHS England’s New Care Models vanguards programme as it gives the National Orthopaedic Alliance (NOA) the opportunity to build on and strengthen the Specialist Orthopaedic Alliance’s (SOA) existing model and to make it fit for purpose for a more formal roll out both nationally across orthopaedics and to other specialities.
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
- Readmissions
- Length of stay
- Infection/compilation rates
- Revisions
- Readmissions
How did you go about it?
We have been engaging with our current and potential members to formalise the NOA membership model and we have exceeded our target recruitment of new members 16/17.
Our main focus has been developing a set of standards, protocols and processes for members and a system to support them.
To develop our standards we carried out a literature review to put together information packs covering various aspects of orthopaedics. We are using these packs to provide structured evidence to clinicians to help kick start the work on developing the NOA quality standards. We have kicked off pilots in 7 areas:
- Hip (Arthroplasty and non-Arthroplasty) (overlap with the periprosthetic infection group)
- Knee and soft tissue knee (overlap with the periprosthetic infection group)
- Periprosthetic Infection
- Safety
- Theatre efficiency
- Enhanced Recovery
- Coding and Costing
We have set up a working group for each area made up from our members. They will write the quality standards utilising the information packs and their own experience.
We see the pilot as an opportunity to test our process and information packs and we expect our first set of quality standards to be completed early to mid-February.
We are also looking at:
- Shared Services
- Commissioning
- Coding and costing
- Macro-Economic impact of our project
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 are not launching our quality standards until spring 2017, we have not as yet seen any impact on the way we work, but watch this space…
What has the reaction and what has the level of staff engagement been like?
Everyone we engage with are excited about the work we are doing but as the quality standards have not yet been launched the level of staff engagement is only now starting and our communication lead is working hard to get the message out to all staff and stakeholders using traditional and social media communications.
How would you explain the way your new care model works to members of the local community?
The National Orthopaedic Alliance vanguard provides a framework for improving quality in orthopaedic care in England. It is based on a quality standard membership model founded on evidence based descriptors of ‘what good looks like’ in orthopaedic care.
We are creating tools for providers and commissioners to enable them to consistently achieve quality and efficiency including a clear benchmarking system.
In addition, we will develop flexible contracting mechanisms to ensure that commissioners can adopt the quality assured new model of care in different local health systems.
We are also seeking opportunities to support other specialties in adopting similar quality based membership models to drive improvements in care.
What is already having or what is going to have the greatest impact and value for patients as a result?
Reduction in variation and the introduction of transparent quality standards for orthopaedic care will have a major impact on patients by providing:
- Patient centred care
- Good outcomes
- Good experience
- Reliable, safe processes
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?
Not 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?
To enable us to achieve our key objective of writing and implementing quality standards in orthopaedic care across our membership, we are reliant on the support of our members. 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, but as the membership model has evolved and engagement with our members has increased we have seen this challenge diminish. Our only other challenges have been around resourcing but now the work on our standards has kicked off we are finding this issue is going away as interest in being involved in NOA increases.
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?
We have not yet fully developed our model but it is clear that 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 currently collaborating with vanguards who have expressed an interest in replicating our model and our communication lead has included further sharing of learning in our communication strategy and in particular in our stakeholder management.
What do you think your vanguard and the service it delivers will look like in 12 months’ time?
The quality standards will be in place and driving standardised care in orthopaedics across the NOA membership. NOA membership will have reached its target and will still be actively recruiting enabling us to fund continued development of standards.
The membership based model we have developed will be 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.
Further information
For further information visit: www.england.nhs.uk/vanguards/noa email: [email protected] or follow: @NOA_Vanguard