The Impact Accelerator Unit maintains an active portfolio of projects with international reach and significance.
The STarT Back approach: using 9 questions, a clinician can determine whether a patient presenting with back pain is at low, medium or high risk of a poor clinical outcome. This categorisation enables clinicians to select the most appropriate treatment approach. Patients in the low-risk group usually will improve with information and support for self-management, those in the medium risk group are likely to do best if they are referred to physiotherapy and those at high risk of a poor clinical outcome may do best through direct referral to psychologically informed physiotherapy. The IAU has worked with NHS organisations across primary, community and secondary care as well as commissioners, private providers, industry, public health (through the Making every Contact Count programme), patient and public bodies, policy makers, regional and national networks (WMAHSN and CLAHRC) and professional bodies to support the scaling up and scaling out of STarT Back. The IAU’s scaling up strategies have included:
- Developing toolkits to support implementation in general practice/physiotherapy services
- Presenting the case for change at various clinical/commissioning meetings
- Securing funding to enable training in the matched treatment approaches in the West Midlands (xxx physiotherapists trained)
- Developing the business case for change for use by clinicians/commissioners in their business planning discussions
- Supporting audit development for clinical practice to demonstrate the impact of implementation
- Developing IT solutions (including EMIS template) for integrating STarT Back into clinical practice
JIGSAW-E (Joint Implementation of osteoarthritis guidelines across Western Europe) implemented into real-world primary care an approach to improve the quality of care and support for self-management for osteoarthritis in line with NICE guidance. The JIGSAW-E approach uses four key innovations which can be delivered in the way that best suits the local healthcare context: a model consultation; training for professionals delivering the care, a patient osteoarthritis guidebook and quality indicator recording and measurement tools. The JIGSAW-E approach has been rolled out in the UK, Denmark, Norway, the Netherlands, Portugal and Scotland. JIGSAW-E is being tailored for implementation in France, Poland and New Zealand.
The IAU’s approach to implementation internationally has been to:
- Secure funding to support the adaptation/translation of the JIGSAW-E toolkit in each partner country through interdisciplinary communities of practice (engaging academics, patients, clinicians in this activity)
- Developing digital solutions to support implementation in clinical practice (e.g. OA template/OA Guidebook)
- Designing audit solutions to capture changes in clinical practice
- Developing a patient quality indicator that captures patient-reported outcomes
- Adapting models to different local contexts and healthcare needs so that the programme can be led by GPs, nurses, physios, allied health professionals, and pharmacists.
The Keele Pain Recorder app supports patients to record information about their level of pain, pain interference, mood, sleep disturbance, analgesic use, and perceived side effects on a daily basis. Patients can share these data in consultations with their healthcare professionals to provide information that helps with monitoring and managing their pain levels. The app has multiple uses in practice, for example, to establish the benefit of interventions (e.g. starting opioids, steroid injections), supporting patients to identify the start of a ‘flare’ of their pain, monitoring medication adherence and to measure the impact of reducing medication. It is now available to download for free on Android and iPhone and has been approved by 'Our Mobile Health' to be included in the EMIS App Library and the NHS Digital Library.
The heart failure project is developing innovative approaches to heart failure management in primary and secondary care with the aim of reducing the length of stay and supporting patients to remain in the community across Staffordshire. A university-accredited training programme for ambulatory heart failure nurses has been co-created with the clinical teams across the care pathways.
The IAU has supported the ambulatory heart failure team to drive forward innovation through:
- Securing funding to support the development of a masters level training programme for ambulatory heart failure
- Supported training bursaries for clinicians to access the master's module
- Development of an ambulatory heart failure checklist to support early identification of AHF patients in emergency portals
- Partnership with industry to support the development of a digital dashboard to capture impact.
The IAU is delivering ESCAPE pain (Enabling Self-management and Coping with Arthritic Pain using Exercise), an NHSE high impact innovation, on behalf of the West Midlands Academic Health Science Network and in partnership with the Health Innovation Network (HIN).
The IAU has supported the rollout of ESCAPE Pain through:
- A clinical champion working with clinical services to identify the opportunity to embed ESCAPE pain into clinical pathways
- Securing training in ESCAPE pain for clinical services
- Developing pilot sites to explore the opportunity for working with independent services to deliver the ESCAPE pain programme
Several members of the IAU are members of the Q Community and they are working together with the Health Foundation and MIND to consider how best to integrate care for those with chronic low back pain and mental health issues.
The IAU has supported:
- Securing funding to deliver clinical workshops
- The development of a Q community of practice to review a holistic approach
I-SWAP will deliver an Implementation test bed of the SWAP vocational advice intervention (Study of Work and Pain) with employed patients with musculoskeletal conditions who consult with a First Contact Physiotherapist (FCP). This work builds upon two key initiatives led by Keele researchers, the SWAP trial and the NHS England phase 3 FCP evaluation and combines the strengths of both (a stepped vocational advice intervention with associated training materials and tools, and a national network of FCPs in general practices and physiotherapy services). The IAU is supporting the testing of the implementation of vocational advice (VA) for people with musculoskeletal conditions through:
- testing the provision of vocational advice in First Contact Practitioner services (FCP). Training physiotherapists to support patients to better understand the relationship between health and work and the potential obstacles to return-to-work
- Use data provided by patients to look at their work outcomes and see if training physiotherapists to provide vocational advice has improved patients self-reported work outcomes or not.
- Capture feedback from Physiotherapists on providing vocational advice as part of usual physiotherapy care
The National Institute for Health Research (NIHR) has published a document summarising the best evidence for musculoskeletal care and support, in which several NIHR funded studies undertaken by Keele University have been featured. This is called the Moving Forward Review. This document brings together the very best evidence under three main sections: seeking help; getting treatment and staying well. The review highlights the clinical and financial benefit of the interventions which are showcased. It has valuable information for clinicians. commissioners and patients alike.
The IAU is working alongside the Chartered Society of Physiotherapy to explore the implementation of this work across Staffordshire through:
- The establishment of a community of practice to roll out the priority evidence across Staffordshire
- The development of a patient and public version of the Moving Forward review
Keele University is also leading on the rollout of First Contact Practitioners (FCPs) across Staffordshire. FCPs are specialist physiotherapists who assess patients with musculoskeletal conditions in Primary Care. This is intended as a first-contact service, rather patients first seeing their GP, to streamline the patient journey for those with musculoskeletal problems. A recent Staffordshire wide event highlighted the opportunities for such posts.
The use of stories/ narratives has been recognised globally as a way in which people’s experience can be captured to inform the delivery, commissioning and quality improvement of healthcare (The Point of Care Foundation 2017; World Health Organisation 2017). Integrally linked to the practice of patient and family centred care, healthcare leaders have acknowledged that improving patient experience is now a legal requirement and top priority (Health and Social Care Act 2012; Wolf et al 2014). In response to this, frameworks have sporadically emerged to support organisations in their storytelling endeavours. It has been recognised that there is a need for a consolidated body of evidence to underpin practice and support health and social care providers and educators in the entire process of story-telling. By equipping practitioners with an evidence-based tool, all stakeholders in this process (i.e. patients their carers, care staff, managers of services, commissioners, students on health and social care programmes and their tutors can be assured of quality-related outcomes (safety, effectiveness and experience). There is also an increasing recognition of the use of stories/narratives during the implementation of research as the findings from new research are adopted.
Based on a previous study undertaken in the Midlands and East Region by one of the research team it is known that there are a number of frameworks used by organisations that are not in the public domain (McIntyre and White 2014; White 2014). Scoping of the available literature suggests of the publically available frameworks there are limited or no visible accompanying evidence or evaluation validating their development and continued use.
A call out supported by NHS England took place during 2018 to organisations that potentially use stories to improve healthcare. From this request for sharing of information, 5 national and 8 regional frameworks were identified, together with a number of supporting resources e.g. examples of evaluation templates. At the same time, a scoping of the literature took place with the aim of identifying evidence-based approaches to the story gathering process. A toolkit is now being launched from these collated findings with a view to testing the first version following ethical approval in education, research and implementation settings.
We embed implementation research and training into many of our research programmes and fellowships.