Quality Improvement tool for re-designing healthcare service-user journeys with COVID-19 risk assessment & mitigation

Lead Research Organisation: University of Strathclyde
Department Name: Design Manufacture and Engineering Man


In order to deliver business as normal performance, healthcare care providers will need to reconfigure almost all services (many currently in abeyance) to accommodate the future challenges of covid-19 (For example; pulsed lock-downs, isolation of the vulnerable, new testing & tracing regimes, disrupted supply chains, new working practices & new spatial demands on facilities). Quality Improvement (QI) approaches currently provide a research informed framework of tools for local innovation in healthcare. A wide variety of QI tools currently support NHS QI work, drawn from sectors like manufacturing. Over the last 12 months NHS Tayside has integrated a services of additional QI tools based on Service Design into its QI Programmes. These design approaches work alongside established QI tools to map the service-user (patient) perspective. This proposal describes the development of an online QI tool that will support the challenge of mapping, evaluating and reconfiguring services that take account of the evolving risks & challenges of COVID-19. NHS Tayside will provide the platform for tool development, NHS Education for Scotland (NES) will provide specialist QI guidance & access to wide networks for dissemination. UoStrathclyde will provide service design research expertise. Development will involve: capturing lessons learnt from recently established COVID-19 pathways, integration of proven service design tools with established risk management tools, collation of research into COVID-19 risks and mitigations, synthesis and testing of tool templates and development of online training to deliver the new tool in a QI context. Tool effectiveness will be evaluated. Knowledge gained will be valuable and widely transferable to other service sectors within the service economy, challenged with redesigning & implementing COVID-19 mitigations.
Description During the course of the early stages of the COVID pandemic healthcare teams across the UK were put under huge pressure with the challenges of a new virus, cancelation of elective care, the demands of new ways of working and harrowing patient, family and staff experiences. In order to cope with these multiple demands, healthcare teams across the UK very quickly found themselves working in new ways, interestingly ideas that had been on the drawing board for months if not years were being developed in days and deployed in weeks driven by the exigencies of the pandemic.

UKRI support has allowed NHS Tayside, NHS Education for Scotland and the University of Strathclyde to explore the enablers that supported this step change in innovation and develop a co-design tool to try and capture some of this new perspective on healthcare improvement, as an approach that might survive, when inevitably the system reverted to Business-As-Usual. The resulting Healthcare Ecosystem Mapping Tool takes a systems approach to improvement. This allows any healthcare team to collectively map their ecosystem of healthcare, explore patient perspectives, the policy environment and the activity of peers. This shared visual map can then be used to review challenges, opportunities, the improvement landscape and future ways of redesigning the healthcare system. The approach has been developed in an iterative way through short-life projects with different healthcare teams in NHS Tayside and NHS Greater Glasgow & Clyde. Each team is facing the challenge of redesigning services as the system emerges from COVID. Solutions have been developed for Primary Care, Nursing in Care Homes, Urgent Care, Pharmacy Services and Oncology Services.

As the project concludes this resource will be made available as an online open access resource.
Exploitation Route The tools developed through the project are being translated into a format for use in a variety of different established healthcare quality improvement initiatives.

The methodology was introduced to Cohort 13 of the Scottish Quality & Safety Fellowship Programme in Feb 2022 (40 healthcare practitioners) and has now been deployed in a number of healthcare improvement projects.
Sectors Healthcare

URL http://www.designinghealth.co.uk
Description The tool has been used in the following areas of healthcare improvement: NHS Tayside, Oncology Services have used the tool to help explore the strengths and weaknesses of their current service, this has informed the development of a 2025 strategy for Oncology Services in Tayside which accommodates new service demands NHS Tayside, Care Home Nursing Services have used the tool to explore how healthcare can be improved for care home residents. A key outcome from this work is the design of a new supporting excellence service in healthcare in Care Homes across Tayside. NHS Tayside, Acute Care Services have used the tool to model new ways to organise pathways in Tayside hospitals for Viral (COVID) and non-Viral (Non-COVID) patients. Requirements for infection control are evolving on an ongoing basis. The ecosystem mapping tool has allowed healthcare teams to model different infection control scenarios as they emerge. NHS Tayside, Primary Care Services have used the tool to explore the Urgent Care service in Tayside and how this can be rethought to accommodate constraints on delivery and the needs of patients. The tool has been introduced to cohort 13 of the Scottish Quality & Safety Fellowship programme. A number of the 40n healthcare practitioners on this programme are now using this in their area of healthcare. Examples include Oncology Services at the Cancer department at Nordland Hospital Trust Bodø, Norway.
First Year Of Impact 2022
Sector Healthcare
Impact Types Policy & public services

Description NHS Education for Scotland, Scottish Quality and Safety Fellowship Programme, Workshop, 23rd February 2022. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The Healthcare Ecosystem Mapping Canvas was introduced to Fellows on the NHS Education for Scotland, Scottish Quality & Safety Fellowship Programme. This included 17 Fellows from Scotland, 3 from Denmark, 7 from Norway and 5 from Northern Ireland. A 2-hour workshop introduced the tool and allowed participants to apply it to their own area of healthcare. Follow-up sessions have now been arranged with teams in Northern Ireland and Norway.
Year(s) Of Engagement Activity 2022
Description Participation in an activity, workshop or similar - NHS Education for Scotland, Scottish Quality and Safety Fellowship Programme, Workshop, 8th March 2023 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presentation of ecosystem methodology to SQSF Programme Fellows
Year(s) Of Engagement Activity 2023