Workshop 1 - Report
‘The Broughton Believers’
V2
‘The Broughton Believers’
• Kirstine Farrer - Head of Innovation and
Research (Senior Academic Sponsor)
• Tina Dixon - Senior Manager Innovation &
Improvement Team Leader
• Anna Cowley – Operations Manager
• Hayley Hart - Senior Innovation and Research
Officer
• Frazer Meadowcroft - Innovation &
Improvement Manager
V2
What are we trying to accomplish?
• Aim• To improve patient engagement by 15% from 2015-16 baseline by 31st
March 2017 across the Broughton neighbourhood with the following
service:
Influenza vaccination programme for at risk adult patients
(>65yrs/<65yrs at risk/pregnant women/Carers)
• Objective• To understand the barriers to engagement with the Flu Vaccination
programme for “hard to reach” adult groups (defined as 2 or more
consecutive non attendances for Flu Vaccination in previous season)
• Use a QI methodology to conduct tests of change to identify the best way
to work with hard to reach patients to improve uptake of Flu vaccination.
• Take “lessons learned” and apply to other areas of non-engagement,
identified by the neighbourhood as Cervical Cytology & Long Term
Condition Reviews.
V2
Why Flu Vaccination?
• Immunisation has been shown to reduce the incidence
of severe disease including bronchopneumonia,
hospital admissions and mortality (Wright et al., 1977;
Mangtani et al., 2004).
• Flu is a key factor in NHS winter pressures (Public
Health Flu Plan, 2015)
• Influenza vaccination reduced the likelihood of
prematurity and smaller infant size at birth associated
with influenza infection (Omer et al., 2011).
• Pregnant women should be offered inactivated
influenza vaccine as the risk of serious illness from
influenza is higher in pregnant women (Pebody et al.,
2010).
V2
Why Flu Vaccination?
• Broughton neighbourhood below both CCG and
national average for all at risk adult flu
vaccination, with a downward trend overall in
2015-16 season:
– Broughton 38%
– CCG average 47%
– National average 52.8%
• Risk of lack of sufficient staff resource if increase
uptake, and shortage of Flu vaccine.
V2
Expected Outcomes
• Quality Improvement Facilitator to work alongside practices
to understand demographics and previous culture of flu
vaccination attendances
• Baseline data to be used to inform progress, with
measurement at monthly intervals during flu season (Sept
2016-Feb 2017)
• Increase in uptake from baseline across all groups
(>65,<65yrs at risk, Pregnant women & Carers) by 15%
• More appointments needed to vaccinate more people- may
be less of an issue as difficult to quantify staff time taken to
chase hard to reach groups in previous years.
• Monthly monitoring of uptake from beginning Sept 2016 –
February 2017.
V2
Baseline Data 2015-16
65 and overs
Neighbourhood
Practice Code
Practice Name
At Risk (<65)
Pregnant Women
Carers
2014/15
2015/16
Trend
2014/15
2015/16
Trend
2014/15
2015/16
Trend
2014/15
2015/16
Trend
Broughton Neighbourhood
66.7%
64.7%
È
42.9%
33.6%
È
28.3%
26.8%
È
33.0%
26.9%
È
Salford CCG
75.3%
73.8%
È
50.2%
42.8%
È
40.4%
37.7%
È
40.4%
34.4%
È
National
72.7%
71.0%
È
50.3%
45.1%
È
44.1%
42.3%
È
V2
How do we know change is an improvement?
How do we know that change is an improvement?
• 15% Increase from 2015-16 baseline data across
all adult at risk groups by end March 2017
• Better patient engagement with the service
(obtain patient feedback)
• Monitor monthly vaccination rates & monthly
invites across the neighbourhood
• Risks-Insufficient vaccine available/lack of
sufficient resource to vaccinate patients/adverse
publicity/Influenza outbreak triggering uptake.
V2
What changes can you make?
• Initial Activities:
• To understand reasons for non-engagement in last Flu
Vacc season
• To establish any commonality across the various groups
e.g. Language/cultural barriers
• Boundaries:
• Need to recruit a QI Facilitator to work in the
neighbourhood to undertake tests of change
• Project encompasses neighbourhood of 9 practices
which will be challenging operationally
V2
Broughton Believers Driver Diagram
Primary Outcome
Primary drivers
Secondary drivers
•
To improve
engagement with
Flu vaccination
programme of
“hard to reach*”
groups across
Broughton
neighbourhood by
15% from 2015-16
baseline by March
2017
Education
•
•
•
•
Call & recall tailored to
patient need
Coding
Admin workflow
Info from other agencies
•
•
•
Admin systems
*defined as >2
consecutive invites
in last Flu vacc
season
•
Service delivery
•
•
•
•
V2
Patient Families/carers
education/awareness
Self Management
GP staff education
Admin Staff training
Communication across
organisations and within
practices
Locations
Timescales
Appropriate staff
Patients/Families/Carers
C
A
P
A
B
I
L
I
T
Y
B
U
I
L
D
I
N
G
Key activity
• Project assessment score (0.5 - 5.0)
(see next slide for criteria)
May Jun
Score
Jul
Aug
Sep
Oct
1.5
V2
Nov
Dec
Jan
Feb
Mar
Apr
Improvement Science for Academics Project Progress Assessment Scale
Apply these criteria to your improvement project. Select the definition that best describes the progress of your project.
Please note that assessments are progressive. All elements of a 3 must be satisfied before rating your project with an
assessment of a 3.5 or 4. Evidence for your assessment must be documented in your monthly report.
Project Progress Score
Operational Definition of Project Progress Score
0.5 - Intent to Participate
Project has been identified, but the charter has not been completed nor team formed.
1.0 -Charter and team
established
A charter has been completed and reviewed. Individuals or teams have been assigned, but no work has been
accomplished.
1.5 - Planning for the project Organization of project structure has begun (such as: what resources or other support will likely be needed, where
will focus first, tools/materials needed gathered, meeting schedule developed).
has begun
2.0 - Activity, but no changes Initial cycles for team learning have begun (project planning, measurement, data collection, obtaining baseline
data, study of processes, surveys, etc.).
2.5 - Changes tested, but no Initial cycles for testing changes have begun. Most project goals have a measure established to track progress.
Measures are is graphically displayed with targets included.
improvement
3.0 - Modest improvement
3.5 - Improvement
Successful tests of changes have been completed for some components of the change package related to the
team’s charter. Some small scale implementation has been done. Anecdotal evidence of improvement exists.
Expected results are 20% complete. See note 1.
Testing and implementation continues and additional improvement in project measures towards goals is seen.
4.0 - Significant improvement Expected results achieved for major subsystems. Implementation (training, communication, etc.) has begun for the
project. Project goals are 50% or more complete. See note 2.
4.5 - Sustainable
Data on key measures begin to indicate sustainability of impact of changes implemented in system.
improvement
5.0 - Outstanding sustainable Implementation cycles have been completed and all project goals and expected results have been accomplished.
Organizational changes have been made to accommodate improvements and to make the project changes
results
permanent.
Note 1: This may mean either that a) 20% of project numeric goals have been met or b) each measure is showing 20% improvement towards
goal.
V2 met or b) each measure is showing 50% improvement towards target
Note 2: This may mean either that a) 50% of your numeric goals have been