NIHR CLAHRC. for Northwest London. Annual Report Northwest London. Collaboration for Leadership in Applied Health Research & Care

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1 NIHR CLAHRC for Northwest London Collaboration for Leadership in Applied Health Research & Care Northwest London Annual Report 2009 In partnership with Northwest London Academic Partner Host Organisation

2 CONTENTS Foreword Forewords Director s Statement NIHR CLAHRC for Northwest London CLAHRC Overview Moving Forward THEMES Collaborative Learning and Delivery Patient and Public Involvement Evaluation Acute and Chronic Research Themes Fellowship The CLAHRC Approach Web Reporting Tool Hosting the NIHR CLAHRC for Northwest London and the Health Innovation and Education Cluster (HIEC) puts Chelsea and Westminster NHS Foundation Trust at the fore front of research and innovation. The Trust s double excellent rating demonstrates our success in improving the quality of care we provide. The CLAHRC focus on accelerating the implementation of evidence based research and innovations into practice strongly supports the core work of our Trust and expands our research portfolio, placing a greater emphasis on translational research. The CLAHRC s focus on patient and public involvement matches our ambitions to put the patient at the centre of everything we do. I look forward to the seeing the continued progress of the NIHR CLAHRC for Northwest London over the forthcoming year. Heather Lawrence Chief Executive of Chelsea and Westminster Hospital NHS Foundation Trust PROJECTS Community Acquired Pneumonia Chronic Obstructive Pulmonary Disease Medicine Management Human Immunodeficiency Virus (HIV) Case Management for Long Term Conditions Round 1 Project Teams Cross Project Lessons Roll Out of Round 1 Project Teams Selecting New Projects GOVERNANCE Organisational Structure Core Team Finance Our Partners Parallel Research Projects Key Outputs In this challenging economic climate it is essential that the NHS continues to innovate and use research evidence to steer improvements in the design and delivery of health services. Developing the first Academic Health Science Centre (AHSC) in the UK at Imperial College Healthcare Trust, and having our status ratified by the Department of Health, is evidence of our success at using world-class research to drive improved standards of care. Providing the academic lead for both the CLAHRC and the HIEC supports our AHSC vision to bring clinical and academic management together in a way that is unprecedented in the UK. The NIHR CLAHRC for Northwest London is a key component of our vision to improve services, by using the latest evidence based tools and methods to improve the quality of the care we provide. The NIHR CLAHRC for Northwest London aligns research evidence, improvement science and service delivery. The combination of AHSC, HIEC and CLAHRC continues to place northwest London at the heart of research, innovation and service improvement in healthcare in the United Kingdom and internationally. Professor Stephen Smith Principal of Faculty of Medicine, Imperial College London and Chief Executive of Imperial College Healthcare NHS Trust 03

3 NIHR CLAHRC for Northwest London Director s statement I feel privileged to lead the NIHR CLAHRC for Northwest London. At a national level the nine CLAHRC s provide a unique opportunity to bridge the gap between producing world class research and innovation to delivering those benefits consistently to patients and providing world class health care. The core CLAHRC team is now at full strength and brings together a broad range of talents to work closely with our healthcare, academic and community partners. The NIHR CLAHRC for Northwest London has produced some early outputs and importantly has active engagement with all primary and secondary care healthcare organisations in Northwest London. The Community Acquired Pneumonia (CAP) care bundle is being implemented on 5 secondary care sites and a new Chronic Obstructive Pulmonary Disease (COPD) care bundle has been developed to support the latest National Guidelines. As these service Professor Derek Bell Director NIHR CLAHRC for Northwest London interventions are implemented, we are monitoring the on going improvements and are confident our evaluations will demonstrate a better patient experience. All projects are currently working on their engagement of patients and members of the community. Since April 2009 we have hosted three sector-wide learning events designed to support the staff involved in the five initial research projects. The projects span nine sites, with over 70 multidisciplinary team members involved. To date over 300 staff and members of the public have contributed directly to the shared learning and outcomes. Over the last year the NIHR CLAHRC for Northwest London has built a strong foundation. We do not underestimate the challenges ahead but are encouraged by the support we have received from all staff, our academic and non-academic partners, patients and members of the community. We would like to thank them for their hard work and their direct contribution to the success of the CLAHRC to date. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Northwest London was established in October The CLAHRC is a 10 million award from the NIHR with a further 10 million in matched funding contributed from partner organisations. The NIHR CLAHRC for Northwest London is designed to support the NHS more effectively deliver the latest evidence based research into practice.... Context The way in which care is delivered is rapidly changing to cope with increased demands, an aging population and new technologies, drugs and treatment pathways; all of which must be managed within an economic downturn. As the number of options and types of care available steadily increase, patients are often required to participate in complicated treatment pathways that cross many interfaces of care both between organisations and professional groups. At the same time, public expectation of the quality of care in health services is rising, and information regarding health services and health problems is becoming more readily available. Whilst patients expect high standards of care and treatment wherever they access the NHS there are well described variations in care and clinical outcomes dependent on where and when services are accessed. OUR VISION... Patients should experience a seamless journey with consistent delivery of the highest quality evidence based care. We believe this can only be achieved by: Understanding care from the perspective of patients and carers through engaging patients and members of the community with the design and development of care Bringing research more rapidly into everyday practice, utilising rapid-cycle research, improvement methodologies and rigorous evaluation of clinical and cost effectiveness Adopting industrial standards of quality in the NHS through utilising information to drive evidence based implementation and support evidence based practice How care is organised is increasingly recognised as a key determinant for high-quality care, and has been shown to influence both patient outcomes and experience. The speed at which organisations adopt new medical evidence or technologies has also been shown to directly influence inequalities and variations in quality of care. Increasing staff capacity to implement change and improvements across professional and organisational boundaries. We believe the NIHR CLAHRC for Northwest London is in a unique position to realise this vision

4 CLAHRC Overview CLAHRC has support from all healthcare organisations within northwest London to develop, implement and spread good practice across the sector with the aim to lead and influence the broader health and social care agenda. Aims... Improve the delivery of innovative research to provide the highest quality of patient care Devise and evaluate a systematic approach for the rapid adoption of clinically effective interventions Develop a model for the conduct and application of health research that is transferable across the NHS Develop research capacity and capability across northwest London. 5 interlinking themes have been designed to deliver these aims: Research Themes 18 new projects will be delivered through the Acute and Chronic Care Themes. Acute Care addresses the needs of acutely ill patients, where interfaces represent the transfer of care between individuals or organisations Chronic Care addresses the needs of chronically ill patients, where interfaces represent the ongoing collaboration between different individuals and organisations. Implementation Themes The Implementation Themes are cross-cutting and support the delivery of the Research Theme projects. Collaborative Learning and Delivery -a systematic training and development programme for the multi-professional research teams to support project delivery and knowledge mobilisation between teams and organisations Patient and Public Involvement - a programme to engage and empower a wide range of patients and members of the public to influence and lead the design and development of health service research and improvement Evaluation a robust and on-going evaluation of all aspects of the CLAHRC programme, at project, theme and overall programme levels, feeding back evidence to drive success These five themes are linked to drive the delivery of high impact projects across northwest London and build research capacity within the local health economy at all levels. Integration of CLAHRC Research and Implementation themes Partners... The programme is driven by the commitment and engagement of the CLAHRC partner organisations and staff, bringing together those responsible for providing and commissioning care with patients and local communities. This unique partnership is essential to build sustainable solutions, identify priority areas for work and to support the delivery of improvements across northwest London. The partnership forum is chaired by Professor Martyn Partridge, with representation from all partners. This forum has proved invaluable in providing advice and as an effective communication platform. Members of the medicine management project team CLAHRC Methodology... The CLAHRC aims to develop synergy between research, improvement and service delivery, drawing on expertise from research and improvement methodology and management research to inform project support and development. In doing so the CLAHRC combines the rigour of research with the pragmatism of improvement methodology to support the goals of evidence based implementation and evidence based practice. Our programme utilises rapid cycle a research approach, allowing iterative feeding back of evaluation results to drive the development of the programme, themes and projects. Shared Learning and Knowledge Mobilisation... Through prospective evaluation CLAHRC aims to understand not just the outcomes of the project but the context and mechanisms that contributed to project achievements. This will help create transferable knowledge about the success factors and challenges projects faced to support the roll-out of projects to other healthcare settings. The partnership forum and Collaborative Learning and Delivery events are designed to maximise shared learning and knowledge mobilisation between project teams and organisations. Infrastructure and Support... A core team of staff have been employed to drive the CLAHRC programme, providing expert support and advice to project teams, designing and coordinating training and development opportunities, supporting evaluation and information analysis and patient and public involvement

5 Moving Forward The NIHR CLAHRC for Northwest London has had an active and successful first year. The Team The core team is established and the CLAHRC funds over 20 full-time research and support staff working at Chelsea and Westminster Hospital, Imperial College London, the London School of Hygiene and Tropical Medicine and the NHS Institute for Innovation and Improvement. See page 34. Partner Organisations All 25 founding partner organisations have contributed directly through projects or through the quarterly Partnership Forum, and five new NHS and commercial organisations have joined the CLAHRC partnership. See page 37. Projects Five Round 1 projects launched in April 2009 across nine sites, involving 70 multi-professional staff. Ten additional Round 1 project teams will start in April 2010 to support the spread of successful interventions. See page 21 Seven potential projects for Round 2 have been selected through the CLAHRC peer review process and range from mental health and sickle cell disease to telemedicine. See page 30 Round 3 projects will be identified through working closely with our partners to determine local priorities and projects that will have a high impact. Building on the success of Round 2 selection we will align strategic planning with NHS London, the AHSC and Biomedical Research Centres and Units to close the translational gap. See page 31. Web Reporting Tool The CLAHRC has developed a Web Reporting Tool in collaboration with Imperial College Department of Computing. Project teams will continue its development throughout 2010 to increase functionality and usability to support project delivery. See page 22. Collaborative Learning and Delivery and Community Engagement Events To date these events have attracted over 300 delegates, and delegate numbers are projected to double in 2010/11. See page 10. Patient and Public Involvement 2009/10 saw the re-establishment of the Northwest London Patient and Public Involvement Network. In the coming year the network will continue to develop, building working relationships with the Local Involvement Networks (LINks), other community groups and research networks. A bespoke training course for effective patient and community representation will be piloted and evaluated. See page 12. Fellowships In 2010 the CLAHRC will provide a Fellowship programme to support locally driven research or improvement projects based on the NHS Institute for Innovation and Improvement and Institute for Healthcare Improvement fellowship programmes. See page 17. Securing the Future Ganesh Sathyamoorthy and Dr Julie Reed are leading the work to build a sustainable infrastructure within northwest London. To achieve this the CLAHRC will need to secure further research income. See page 38. The NIHR Family and the Northwest London Landscape Northwest London hosts a wealth of NIHR organisations including a Biomedical Research Centre, Biomedical Research Units, Research Design Service and the Comprehensive Local Research Network. These organisations are part of the NIHR family and have distinct yet synergistic healthcare research roles. Other key organisations we will work with include: NHS London, Academic Health Science Centre, Health Innovation and Education Cluster, commissioning and provider organisations. The CLAHRC has a pivotal role in promoting joint working across the local health economy. In 2010 the CLAHRC will consolidate relationships with the NIHR Family and other partners to close the translational gap. THEMES Collaborative Learning and Delivery Patient and Public Involvement Evaluation Acute and Chronic Care Fellowship CLAHRC Approach Web Reporting Tool Imperial College, Queens Lawn 08 09

6 THEMES Collaborative Learning and Delivery What is the Collaborative Learning Delivery theme? Project Marketplace, CLD Learning Event September 2009 The Collaborative Learning and Delivery (CLD) theme is designed to support front line staff and project teams overcome the difficulties in implementing research and innovation in the NHS The CLD theme acts as a conduit for research evidence and best practice derived from clinical research, management research and improvement methodology The theme provides support for project teams, researchers and the public through a series of quarterly collaborative events The theme is designed to be responsive to the needs of project teams with bespoke training sessions provided where necessary.... It was useful to get a sense of what everyone else is doing and be inspired by possibility. Feedback from CLD Learning Event September 2009 > Virtual Learning Environment > Virtual Faculty Project Teams Bespoke Training and Support Project Delivery Collaborative Learning and Delivery CURRICULUM CLD Events Shared Learning and Knowledge Mobilisation Mentorship Programme Fellowship Programme Monthly Training and Support Project Delivery What have we achieved? Three successful Collaborative Learning and Delivery events with over 200 attendees Bespoke training events delivered by national experts in improvement methodology, sustainability, measurement for improvement and project management Shared learning through networking, the project marketplace and cross project initiatives including improvement challenges A core curriculum combining learning from clinical improvement and management research to support translational research. Seven curriculum components for successful implementation What are the plans for the future? Future Events and Training Four CLD events are planned for 2010 in January, March, July and September. To support Round 2 project teams preparing to start in April 2010 a two day residential will be held in February providing protected time for the teams. On March 30th 2010 the first joint CLD event for Round 1 and Round 2 project teams will support knowledge transfer between the two cohorts. Virtual Learning Environment A virtual learning environment is being developed to allow all CLAHRC members to meet and share knowledge & resources online. The virtual environment will provide flexible access for staff and community members to meetings and events across northwest London. Virtual Faculty The CLAHRC faculty consists of all who contribute to the teaching, training, mentoring, coaching and advisors to the CLAHRC programme and project teams. A virtual environment will provide a place for the virtual faculty to meet and to share knowledge and experience with CLAHRC members. Collaborative Learning and Delivery Events... The. CLD events bring together all project team members and other representatives from partner organisations. The full day events combine plenary lectures with interactive workshops and pilot innovative methods to support networking and knowledge mobilisation. Objectives include: Creating an exciting, interactive and friendly day to share knowledge and learn from experts Ring-fenced time for project teams to work together Learn about innovative ideas from a wide range of sectors Challenge the way you think about healthcare Practical workshops to encourage new thinking and practice new ideas and concepts. The CLD event was beneficial to see that there are others facing the same struggles and dealing with similar issues to me in different ways. Feedback from CLD Learning Event September 2009 CLD Learning Event July

7 THEMES Patient and Public Involvement What is the Patient and Public Involvement theme? The Patient and Public Involvement (PPI) theme provides a unique opportunity to engage the community in research, evidence based practice and service improvement Patients and the public have a right to influence decisions and can play a role in speeding up the translation of research evidence into everyday practice by identifying where and how care and services could be improved Our approach identifies the PPI opportunities for individuals and groups to influence our work and promote CLAHRC activity that is relevant to community needs and priorities Our goal is to implement and simultaneously study different approaches to involvement. Over time this will maximise the range of opportunities available for the community to directly contribute to improvements in health and social care, in collaboration with staff We will evaluate engagement activity to gain a better understanding of how best to engage patients and the nature and impact of their involvement. Emotional Mapping Exercise, CLD Event July 2009 A reward of PPI is having greater knowledge in order to advocate at policy level & shape policy to help patients. Feedback from SDO Event, October 2009 Emotional Mapping Exercise, CLD Event July 2009 What have we achieved? Aims of the PPI Theme... Build on and develop methods to best understand patient needs and opinions including how to work closely with local networks Increase awareness among patients and the public of healthcare research and service design and how they can be actively engaged Develop an induction programme to empower lay representatives to become actively involved in healthcare research and improvement Actively engage members of the local community in research projects in the design, delivery and dissemination stages to ensure outcomes are patient focused. After this event I will try to overcome conflict between research and service delivery, to ensure focus on change, improvement and patient benefit Feedback from SDO Event, October 2009 Community Engagement Launch event - February 2009 Representatives from the community, research networks and health services described their aspirations and concerns for the CLAHRC programme. Participants proposed collaborative PPI work with existing networks to: Build on and develop best practice Minimise duplication activities Demonstrate impact including benefits to patients. Northwest London PPI Network This network has been re-established to develop a stable and sustainable platform for PPI. The network brings together PPI leads from across the sector and is chaired by the CLAHRC PPI lead, Rachel Matthews. Early outputs include the development of an evaluation framework to inform understanding of the role and impact of PPI. Effective Patient and Community Representation We are working with InHealth Associates to pilot a learning and development programme which provides guidance on how to use personal experiences to drive change within the NHS. Round 1 Projects Our Round 1 teams are exploring methods to collect and measure the experience of patients and are testing tools from the Experience Based Design toolkit developed by the NHS Institute of Innovation and Improvement. We have successfully recruited Patient and Public Advisers to support the Round 1 projects. They have challenged the speed of progress and help the teams to remain focused on the benefits of their work for patients. The Expert Patient SDO CLAHRC Learning Together Event NIHR CLAHRC for Northwest London led the organisation of the SDO event with NIHR CLAHRC for South Yorkshire. It was attended by over 60 representatives from all nine CLAHRCs to explore perceptions of PPI and to share knowledge and information. A report of the event has been produced and a CLAHRC PPI network has been established to address key issues raised at the event

8 THEMES Evaluation What is Evaluation? Evaluation is a key element of NIHR CLAHRC for Northwest London. By ongoing evaluation of the programme we can : Know to what extent we have improved care and demonstrate what difference this has made to patients Know what facilitates or hinders improvement in different settings and feed this information back regularly to inform the direction of the programme Share knowledge effectively between partners and explain to others how improvement can be achieved Develop a systematic approach for the rapid adoption of clinically effective interventions. Layer 3 : Process and Context Evaluation Layer 2 : Outcome Measure Evaluation Acute Data Qualitative Data Primary Data Patient Measures and Surveys A broad range of research methods are being applied by our multi-disciplinary teams, looking not just at outcomes but also the mechanisms used to achieve them and the context in which they are applied. Evaluation encompasses all aspects of the CLAHRC at a project, theme and programme level. Iterative feedback of results is essential to drive improvement and inform programme development. Layer 1 : Self Evaluation Process Mapping PDSA Cycles Improvement Measures Sustainability Measures Patient Experience LAYER 1 Self Evaluation at Project Level Regular evaluation at a project level allows projects to reflect on where they are, the progress they have made and identify further work that will drive improvement. Improvement Measures: Weekly reporting of a small number of quantitative measures allows project teams to assess how well the project is progressing. Weekly reporting is essential to drive improvement on an accelerated timescale, and allows early identification of system and process factors that may affect the impact of the project. Patient Experience: Regular monitoring of patient experience allows teams to assess how the project affects the patient perspective of care. Narrative: Documenting Plan-Do-Study-Act cycles and minutes from team meetings allows qualitative information to be captured regarding the barriers and facilitators to successful projects. Sustainability: Project teams complete the NHS Institute for Innovation and Improvement Sustainability Model quarterly. The model considers 10 key factors for sustainable improvements including process, organisation and staff. Imperial College Business School... LAYER 2 Outcome Evaluation To identify the impact of our work on patients health and well-being, outcome data is collected and analysed for all projects. This data can be used to support longitudinal, cohort or population data analysis to understand the impact of the projects at a local and regional level. LAYER 3 Process and Context Evaluation In a system as large and complicated as healthcare, successful implementation of new and innovative interventions is highly dependent on context. Numerous factors facilitate or hinder successful and sustainable improvement in quality of care. Evaluation of the CLAHRC implementation themes and overall CLAHRC model will add to our understanding of how to support and accelerate the delivery of research into everyday practice. CLD Theme What mechanisms and contexts best support: Project delivery Building capacity and capability amongst frontline staff Knowledge transfer and mobilisation Multi-professional and cross-project working Active involvement of patients in improving care PPI Theme Extent, nature and impact of involvement Lessons for best practice in different contexts Evaluation Use of the Web Reporting Tool and weekly improvement measures Use of healthcare information to drive and inform change Evidence based implementation and practice effects on service delivery Programme CLAHRC methodology CLAHRC network and partnerships CLAHRC infrastructure. Evaluation Partners... The evaluation theme of CLAHRC is supported by multidisciplinary teams from Imperial College London, London School of Hygiene and Tropical Medicine and NHS organizations across the sector. The CLAHRC core team coordinates evaluation by a broad range of partners and provides direct support and advice to the project teams on self evaluation and outcome measures. Imperial College, Department of Primary Care and Social Medicine support interrogation and analysis of data from routinely collected data sets such as Hospital Episode Statistics (HES) and primary care data sets. Imperial College Business School study the organizational development of CLAHRC and how the CLAHRC model functions to help determine success factors. A health economist supports project evaluation and is studying the cost effectiveness of the PPI theme. London School of Hygiene & Tropical Medicine are partnering the CLAHRC to perform a qualitative analysis of PPI 14 15

9 THEMES Acute and Chronic Research Themes The Fellowship Programme Projects are supported through the Acute and Chronic Care Research themes and all projects are supported by the three cross-cutting implementation themes. Facilitated group work, February 2009 All CLAHRC projects aim to improve the patient journey across interfaces of care The projects investigate innovative methods to bring evidence based research in to everyday practice to support the delivery of consistently high quality care. Acute Care addressing the needs of acutely ill patients, where interfaces represent the handing over of care between individuals or organisations Chronic Care addressing the needs of chronically ill patients, where interfaces represent the ongoing collaboration between different individuals and organisations. Projects... The CLAHRC aims to deliver a minimum of 18 new projects within 5 years as part of the Acute and Chronic themes. The programme is divided into 3 rounds of 18 months duration, with new projects starting each year. Round 1 started in April 2009 and has 5 projects working across 9 sites with new Round 2 projects starting in 2010 Each project site has a dedicated team of 8-10 multidisciplinary staff and patients engaged in project delivery. More Than Just Projects The CLAHRC has adopted a project focused model but aims to build sustainable improvements that last beyond the duration of the project and where the staff involved have the capacity and capability to continue improving services. All successful projects, piloted in a single healthcare setting, will be supported in their spread, adoption and adaption to other healthcare settings across northwest London. CLAHRC has funding to support the roll-out of each successful project to three or four new sites. Project teams are brought together through the CLD events to maximise shared learning and knowledge mobilisation between project teams and organisations. This new programme is designed to support the CLAHRC s mission to build capacity throughout the northwest London sector and is based on experience of the NHS Institute for Innovation and Improvement fellowship programme, Institute for Healthcare Improvement (IHI) and Canada s SEARCH programme. Its aim is to develop a range of future leaders in research, innovation and improvement with the authority and ability to advance change in their organisations and beyond, thus building capacity and supporting spread and sustainability in line with CLAHRC objectives. What s involved? Community Engagement Event, February All fellows will undertake a project which is meets both local NHS and CLAHRC objectives. Each fellow will be expected to produce at least one publication based on their project and an evaluation report of their experiences in the programme. All fellows will become part of the CLAHRC faculty and continue to support CLAHRC objectives, for example by presenting their work at events or by providing support and mentorship to fellows in subsequent cohorts... The fellows objectives will be to:... Develop skills and expertise in improvement methodology, action research and evaluation Apply this learning to a specific project initiated and led by the fellow Develop an active network across north west London and elsewhere Promote the implementation of the CLAHRC programme and help the vision become reality Contribute to the CLAHRC faculty and mentorship programme beyond their fellowship tenure. Fellows Support and Development The fellows will attend a three day introductory course and over a period of nine months, spend one day per month (for which CLAHRC will provide a bursary) devoted to their project and networking with their colleagues. Fellows will follow a tailor made programme aligned with CLAHRC s established CLD programme. One step at a time

10 The CLAHRC approach Delivering sustained improvement in the NHS Implementing change in a large and complex system such as the NHS is often difficult. The CLAHRC aims to support project teams to deliver high impact and sustainable improvements and provide teams with a range of relevant skills and techniques. This section describes the CLAHRC methodology that combines the rigour of research with the pragmatism of improvement methodology to support goals of evidence based implementation and evidence based practice. Collaborative working Engaging a wide range of staff and other stakeholders, including patients and carers, ensures support and buyin to deliver sustainable improvements in care. The project teams are multi-disciplinary and include a range of clinicians, academics, frontline staff and patient and public representatives. Collaborative working is supported by the CLD theme which helps teams understand and value differences and share learning. Understanding the Patient Perspective Engaging patients, carers and members of the community at the design and development stages of healthcare innovation and improvement can provide better understanding of the patient perspective. Ensuring that projects focus on improving patient care helps develop a shared vision and ownership from a broad range of stakeholders and should help to improve the quality of care and the patient experience. This work is supported by the PPI theme which seeks to understand how best to engage patients and members of the public and increase their input into healthcare research and improvement. Model for Improvement The Model for Improvement provides a framework for developing, testing and implementing changes that lead to improvement. The Model for Improvement identifies three key questions that must be addressed prior to starting an improvement project. It is important for all stakeholders to contribute to these questions to ensure the team have a shared vision and objectives. Process Mapping To apply the Model for Improvement successfully it is essential to understand how the current systems and processes work. Process mapping provides a defined approach to understand a process or patient journey. The complete overview of the service helps to highlight potential barriers, target solutions for improvement and define improvement measures. Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Study Plan Do Model for Improvement Rapid Cycle Research The Model for Improvement can be used effectively in a complex health environment. In healthcare it is unusual for the first solution implemented to achieve the best result and hence an iterative process is needed. The Model for Improvement therefore promotes the use of rapid learning cycles that allow ideas to be trialled on a small scale, building on success and learning from mistakes. This iterative model is often referred to as a PDSA cycle (Plan- Do-Study-Act), the 4 stages of the rapid cycle research. The CLD theme provides training and support for teams and individuals to learn about the different methods employed by CLAHRC and use them effectively to drive the progress of projects. Measurement for Improvement To know whether a change has resulted in an improvement it is important to collect relevant measures. These can be quantitative, such as length of waiting time, or qualitative, such as patient feedback on their experience of a new service. Collecting and reviewing measures on a regular basis allows teams to have a better understanding of the impact their projects have and provides a more responsive system to address barriers or unexpected results. Measurement for Improvement is a crucial part of the Study step of the PDSA cycle. Defining, collecting and analysing improvement measures is supported by core staff in the Evaluation theme who have expertise in the use of data to inform and drive improvements. Industry Quality Standards To address issues of inequalities and variation in healthcare it is important that high quality evidence based care is consistently delivered. An understanding of industry quality standards as they apply to high performing systems help teams recognise the variation in care provided and hence work to agree systems with more consistent performance and narrower limits for variation. Analytical tools such as statistical process control (SPC) provide methods to analyse and interpret variations in care. Sustainability THEMES To support the delivery of improvements that are sustained after the lifetime of the project, project teams are asked to consider the 10 key factors which influence sustainability. These 10 factors relate to process, organisation and staff, and scores can highlight areas of potential weakness such as staff training, systems for measuring performance and executive sponsorship to ensure that improvements are sustained. These factors are outlined in the NHS Institute of Innovation and Improvement Sustainability Model which is completed by the teams quarterly. Outcome Measurement NHS Institute for Innovation and Improvement Sustainability Model To identify the impact of project work on patients health and well-being, long term outcome data such as clinical outcomes or cost effectiveness is collected and analysed for all projects. This data can be used to support longitudinal, cohort or population data analysis to understand the impact of the projects at a local and regional level

11 Web Reporting Tool The Web Reporting Tool (WRT)is a bespoke software development designed by the NIHR CLAHRC for Northwest London with Imperial College Department of Computing. It allows the project teams to rapidly see how the changes they make are affecting patient care. Team members log in and enter data from all project sites across northwest London, and view their reports in real time. The reporting tool is an improvement on existing web reporting systems in that it allows simple entry of detailed project-specific information and automatically generates reports and integrates statistical analysis using statistical process control (SPC). Improvement Measures Each project team identifies 5-6 measures to monitor the progress of their planned changes. The measures are reported weekly to generate reports which allow rapid feedback to the teams to monitor the impact of the changes introduced and identify areas for further improvement. The data is presented as a live report with bespoke charts and tables for each project and can be annotated with comments from the team members. The tool s design incorporates automated SPC a collection of statistical tools which provide a rigorous framework for understanding variation in data. Sustainability The NHS Institute for Innovation and Improvement Sustainability Model is available online via the WRT for the project teams to complete. The model describes 10 factors which influence sustainability for each factor team members rate how their projects are performing. The aggregated results are used to identify areas the team can focus on to increase the sustainability of their project. Improvement Leaders Guides NHS Institute for Innovation and Improvement 2007 Project teams using Web Reporting Tool Qualitative Data As teams work through the problems they face, they can record their thoughts and comments on the tool, as well as additional information to qualify the numerical data. This includes recording the planned changes that the team implement, such as their Plan, Do, Study, Act cycles. Measurement for improvement: where a few specific measures, linked to your objectives and aims, demonstrate whether changes are making improvements PROJECTS Round 1 Projects Community Acquired Pneumonia Chronic Obstructive Pulmonary Disease Medicine Management Human Immunodeficiency Virus (HIV) Case Management of long term conditions Cross Project Lessons Round 1 Roll Out Round 2 Projects 20 21

12 Community Acquired Pneumonia Chronic Obstructive Pulmonary Disease PROJECTS A Care Bundle Approach Dr. Sarah Elkin, Dr. Clare Sander, Dr. Ali Sanders, Dr Ruth Brown, Dr. Zulfiquar Mirza, Dr Bobby Mann, Dr. Essam Ramhamadany, Shane Cashin and Sandra Wilson Background Community Acquired Pneumonia (CAP) is the 4th leading cause of death and accounts for 83,000 hospital admissions each year. Despite key recommendations and guidance by the British Thoracic Society and NICE, audits show there is room for improvement. This prospective study aims to demonstrate that rapid more consistent assessment and treatment of patients with pneumonia can show improved patient outcomes including survival, patient experience and complication rates. Setting Imperial College Healthcare Trust ICHT (Hammersmith, Charing Cross and St Mary s Hospital) and West Middlesex University Hospital Trust (WMUH). Achievements... Our multidisciplinary project teams ( 30 members) have used improvement methodology to adapt and successfully launch the CAP care bundle across all four sites. To date in northwest London over 300 patients have been managed using this care bundle approach. Through a continuous review of measures and shared learning the teams are working to embed the care bundle into practice. Within ICHT the guidelines for CAP, sepsis and oxygen are now all aligned. Pharmacy and microbiology have updated local antibiotic guidelines aimed at reducing antimicrobial resistance, hospital acquired infection and Clostridium difficile. PPI Impact ICHT are using components of the Experience Based Design toolkit to interview patients to further improve the patient information leaflet. At WMUH work led by patient engagement is investigating the translation of the patient information leaflet into the common local languages. Adaption and Spread Multisite ethical approval and a refined care bundle package means collaborating CLAHRC organisations can rapidly adapt, implement and evaluate the care bundle to meet local needs. Further Improvement Potential to improve accurate clinical CAP diagnosis coding and to increase reliability of outcome data. What is a Care Bundle?... A Care Bundle is a group of 3-5 evidence based interventions known to improve clinical outcomes. These elements are then grouped together, and when completed within a specified time period should reduce variations in care and improve patient safety and outcomes. CAP Care Bundle Devising and Implementing a COPD Discharge Care Bundle Dr. Nick Hopkinson, Dr. Dilys Lai, Dr. Sarah Elkin and Sandra Wilson Background Chronic Obstructive Pulmonary Disease (COPD) is the 5th leading cause of death in the UK and acute exacerbations are the commonest single cause of hospital admission and readmission with annual NHS costs estimated at 600 million per year. This project aims to improve the safe discharge of patients and improve patient experience. Setting Chelsea and Westminster Hospital NHS Foundation Trust and the Inner Northwest London Care Community COPD group Achievements... The COPD discharge care bundle was designed based on NICE guidelines, a systematic literature review and through collaborative working with staff from respiratory ward and primary care sites and patient engagement through then local breathe easy group. The bundle is designed so at discharge the patient or care giver verify with the nurse they have received all appropriate elements of COPD care against the discharge care bundle. Staff engagement was enhanced using awareness and COPD education sessions. Ward staff are now encouraged to visit the other COPD services including the pulmonary rehabilitation service and inhaler training is part of routine mandatory training. PPI Impact A follow up phone call was incorporated into the bundle after a patient survey suggested this is when they feel most vulnerable and often have to wait a number of weeks before their next scheduled follow up appointment. The patient member of the project team has been key in outlining the benefits of and promoting engagement with the community based COPD services. He represented CLAHRC at the first world conference for patients with COPD which was held in Rome. Adaption and Spread The care bundle will be spread from the local chest ward to the Acute Medical Unit. Discussions are ongoing to adapt and implement the care bundle in other northwest London acute settings. Further Improvement Adapt the care bundle for use in Emergency Departments and Primary Care practices and link to early supported discharge programmes. Compare clinical outcomes before and after the implementation of the care bundle. Inhaler and Smoking Cessation training CLAHRC project team support has helped to raise the morale of staff. Ward Sister and Staff on David Erskine Ward, Chelsea and Westminster Hospital NHS Trust 22 23

13 Medicine Management In a vulnerable patient group - optimising pharmacy input and telephony services Dr. Louella Vaughan, Cathyrn Park, Vanessa Marvin and Anne Joshua Human Immunodeficiency Virus (HIV) Opt-out HIV testing in non-specialist and community sites Dr. Ann Sullivan, Dr Patrick Roberts and Caroline Rae PROJECTS Background Medication related problems (MRPs) cause 5,000 deaths per year in England and have an estimated cost of 750 million. Published data suggests two thirds of patients in the UK do not receive information about the side effects of their drugs prior to leaving hospital. Up to 20% of hospital readmissions may be related to a MRP and poor communication between services is a recognised problem. The project aim is to improve medication management at discharge from acute medical care through improved medication reconciliation in line with NPSA national recommendations. This will be achieved by using increased pharmacy involvement combined with post-discharge telephone follow up from NHS Direct. A risk stratification tool to identify patients at risk of MRPs is being developed. Setting: Chelsea and Westminster Hospital NHS Foundation Trust, NHS Kensington and Chelsea, NHS Direct. Achievements... A single multidisciplinary medication reconciliation form has been introduced on the Acute Medical Unit enabling doctors, nurses, pharmacists and therapists to document and communicate medication related matters clearly. This was developed following an early process mapping exercise which found medicines were documented in several places by the different teams. The introduction of an Electronic Prescribing System coincided with the initiation of the project and work is on-going to ensure the learning is applied to the development of a simplified electronic process. PPI Impact The patient representative has directly contributed to process mapping, planning the initial NHS Direct telephony service and has spoken at CLD and National PPI Events. Initially, 100 patients will receive a baseline medication questionnaire review by NHS Direct to inform the design of the future telephone service and discharge medication management. Electronic prescribing Adaption and Spread The project team provides regular updates to the Northwest London Medicine Management group to share ideas with the potential future spread to partnering sites. The National Patient Safety Agency have expressed interest in initial work. Further Improvement It is envisaged that improving this process will empower patients to have greater involvement in their medicine management and hence improve safety. Background The Human Immunodeficiency Virus (HIV) leads to AIDS (Acquired Immunodeficiency Syndrome). National data suggest that one third of people with HIV infections remain undiagnosed. Late diagnosis is associated with increased morbidity and mortality, a poorer response to antiretroviral therapy and increased health service costs. Current recommendations support testing in alternate settings where the local diagnosed prevalence exceeds 0.2%. This project assesses the feasibility and acceptability of HIV testing in the Emergency Department (ED) and the community. Setting Emergency Department at the Chelsea and Westminster NHS Foundation Trust and a local GP Practice in NHS Hammersmith and Fulham. Achievements... The Multi-disciplinary project team included HIV and ED medical staff, virology, health advisors, nurses and reception staff. Initial testing was between July and November The Model for Improvement (Plan-Do-Study-Act, PDSA) was used to assess the optimal method to distribute the patient information leaflet by the ED Reception staff. Of all the ED attendees aged years, 68% were approached and two thirds agreed to be tested. Work is on going to study alternate models for ED staff to consent and test patients to develop a sustainable model for routine testing e.g. Nurse led. PPI Impact Focus groups and questionnaires were administered to patients pre, intra and post study. Preliminary results show that over 60% of patients found it acceptable to be tested in the ED setting. The red ribbon Adaption and Spread The HIV in non-traditional setting study (HINTS) in ED is co-funded by NIHR CLAHRC for Northwest London and is part of a wider Department of Health study in other acute settings (Medical and Outpatients Department). The learning from this phase will inform adoption in the broader London programme and the roll out to other northwest London settings. Further Improvement Current work is needed to assess other less labour intensive models for consenting and testing in the ED setting using non-specialist staff. A follow-up qualitative survey of 30 patients approached for testing (accepters and decliners) is being completed with a subsequent in-depth interview of patients diagnosed as HIV positive

14 PROJECTS Case Management of Long Term Conditions Round 1 Project Teams Case management approaches for long term conditions in primary care Professor Ricky Barnarsee, Professor Paul Thomas, Dr Ajit Shah, Professor Steven Illife, Val Dunn-Toroosian and Johnny Nota Background The World Health Organization has identified that chronic diseases will become the leading cause of disability by Evidence suggests that intensive, on-going and personalised Case Management can improve quality of life and other health outcomes. The NHS Ealing project aims to establish how communication between different members of the extended primary care team can enhance the work of case managers for patients with Chronic Obstructive Pulmonary Disease. NHS Brent will assess whether protocol-driven case management for patients with Chronic Heart Failure (CHF) by practice nurses and general practitioners improves patient outcomes. Setting NHS Brent (Practices in Willesden, Harlseden, Wembley and Kilburn) and NHS Ealing (Practices in Southall, Acton, Greenford and Northolt, Central Ealing and Hanwell). Community Acquired Pneumonia project team, Imperial College Healthcare Trust Community Acquired Pneumonia project team, West Middlesex University Hospital NHS Trust Achievements... In NHS Brent general practitioners, practice and district nurses, commissioners, academics, patients and carers co-designed a protocol to provide effective case management. Key elements identified to trigger case management included hospital re-admissions, lack of social support or carer availability. The patient is assigned a risk score, which may trigger a clinical and/or a social care intervention. The functionality of the protocol is now being assessed. In NHS Ealing initial baseline measures showed variation in the case load of community matrons and the use of out of hours services. This lead to the development of referral criteria for Community Matrons with new referral forms and clear guidance on how to notify primary care out of hours services. Guidelines are now being developed. In NHS Brent and NHS Ealing a series of participatory workshops were undertaken to support knowledge exchange and shared learning between the two arms of the project. Project Marketplace, CLD Learning Event September 2009 PPI Impact A patient and a carer assessed the protocol as part of the co-design team in Brent. In NHS Ealing, consultation with patients, families and carers highlighted the need for one point of call aimed to improve information, knowledge and specialist advice to maximise patient independence. Adaption and Spread If successful, these models of case management will be rolled out to other general practices within NHS Brent and Ealing. The Commissioning Director within NHS Brent is keen to incorporate the findings of the case management project in other areas that require complex case management. Further Improvement Improvement The implementation of the protocol and guidance is now being assessed in Brent and Ealing respectively. Patient reported outcome measures including number of health and social care contacts will be collected. NHS Ealing will explore the feasibility of coordinated data-gathering and feedback through practiced based learning. Chronic Obstructive Pulmonary Disease project team, Chelsea and Westminster Hospital NHS Foundation Trust Human Immunodeficiency Virus project team, Chelsea and Westminster Hospital NHS Foundation Trust Medicine Management project team, Chelsea and Westminster Hospital NHS Foundation Trust Case Management project team, NHS Ealing and NHS Brent 26 27

15 PROJECTS Cross Project Lessons Roll Out of Round 1 projects Several important factors related to the success of projects have emerged, some are new and some reinforce current knowledge. It is important to ensure that these lessons are used to inform the new Round 2 projects and roll out projects. Early lessons emphasise the need to: Establish the project team early and provide protected time for team building Agree common objectives for each project team with outline timescales Ensure a project manager is identified and in place from the start of the project Provide strong clinical leadership Ensure team meetings occur regularly Ensure baseline measures are collected as soon as possible as this usually highlights the need for change Ensure improvement measures are agreed as soon as possible. CAMDEN Specific knowledge related to the delivery of the programme is discussed under the headings below : L Understanding Improvement Methodology and Research... We have identified the need to reinforce the potential complimentary nature of combining traditional research approaches with improvement methodology. Currently many of the staff involved in care have no direct experience of either research or improvement methodology and clinicians and academics often see them as opposite ends of the spectrum. The acceptance of the need for real time data has been a difficult concept for many to grasp. Culture... Cultural and behavioural barriers to change are recognised areas of concern. The majority of the attendees at CLD events have reported positively on the role of the plenary speakers in challenging their current thinking. During the CLAHRC programme requests have been made for more workshops on leadership, organisational change and improvement methodology to help drive changes at a local level. Patient Representation... Project Level Patient representation has been included in all groups but the degree of involvement has varied between projects. Supporting patient involvement within each of the project is an essential part of the Project Manger role supported by the CLAHRC Patient and Public Involvement and Collaborative Learning and Delivery themes. PHOTO? CLD learning Event, July 2009 Programme Level Part of the role of the CLAHRC programme is to build knowledge and capacity about the role of research and improvement in health care delivery. Work is progressing to expand PPI at a programme level to contribute to an improved understanding of the benefits and optimal methods to ensure active engagement. clear aim for all CLAHRC s A is to expand knowledge and capacity in the value of research and improvement methodology to improve patient care. For the NIHR CLAHRC for Northwest London it is essential that successful projects are identified early and then adopted and adapted in other areas of the local health economy. This will avoid developing projects in silos with no planned means of spread beyond a single area or organisation. To support the diffusion of success all northwest London partners were invited to apply for funding to introduce successful Round 1 projects into their organisations. NIHR CLAHRC for Northwest London has set aside 600,000 for the roll-out of Round 1 projects in 2010/11 and could potentially fund up to 12 project sites with agreed matched funding. Four of the five Round 1 projects are currently being considered for roll out from April 2010 and conversations are being held with the Chief Executives and appropriate departments across the sector. Round 1 site Round 2 site Other participating organisations Location of projects across northwest London The evidence generated by Round 1 projects has identified potential barriers and facilitators to the success of projects including what actually worked to engage frontline staff and identify specific training needs. The CLAHRC will provide support all for all roll out project teams with both implementation and evaluation and through the collaborative learning and delivery theme to ensure the projects deliver maximum impact. Sharing knowledge is important to success and sustainability and the Round 1 projects and Round 1 roll out projects overlap in 2010 by 6 months to maximise learning together and share knowledge

16 PROJECTS Selecting New Projects Round 2 The NIHR CLAHRC for Northwest London model is designed to start a new wave of projects annually. This allows the CLAHRC to be dynamic and responsive to local and national needs and priorities, and not constrained by specific diseases or topic areas. The original Round 1 projects formed part of the bid for NIHR funding, however, the Round 2 projects have been selected through a peer review process with open competition across northwest London. Successful Round 2 Projects Seven successful projects were shortlisted for Round 2 (see table below). Discussions are ongoing to refine projects in line with feedback from the final selection committee. Projects will officially commence on 1st April The CLAHRC team are working in advance with the project teams to achieve this timeline including finalising contractual agreements. Project areas Potential Organisations Project Selection Process Round 2 applications were reviewed through a 3 stage process. Local Screening - to ensure applications are aligned with the minimum CLAHRC selection criteria Peer Review - undertaken in four areas : I) Clinical/Research - to ensure applications are scientifically sound and building on the latest evidence base II) Improvement/Service Delivery - to ensure applications are likely to bring sustainable and transferable improvement III) Commissioning/Policy context to ensure applications are in line with local commissioning and strategic planning IV) Patient/Public Representation to ensure applications are focused on patient needs and improving care from the patient s perspective Final Selection Committee - reviewed the final scores and comments and selected the successful projects in line with national and local NIHR CLAHRC principles. Antibiotic Prescribing Imperial College Healthcare NHS Trust, NHS Ealing Primary Care Trust, Chelsea and Westminster Hospital NHS Foundation Trust Sickle Cell Access to Mental Health services Vascular Risk assessment, treatment and prevention CHF and COPD Telemonitoring Alcohol Dependency Heart Failure NHS Brent Primary Care Trust NHS Ealing Primary Care Trust, Central and Northwest London NHS Foundation Trust NHS Hammersmith and Fulham Primary Care Trust, NHS Ealing Primary Care Trust, NHS Westminster Primary Care Trust Royal Brompton and Harefield NHS Foundation Trust NHS Hammersmith and Fulham Primary Care Trust, Chelsea and Westminster Hospital NHS Foundation Trust Chelsea and Westminster Hospital NHS Foundation Trust Application Process 43 registration of interest were initially noted with 28 full application forms finally submitted. Initial applicants were offered individual feedback with members of the team and 3 workshops were held to support application development in line with selection criteria. Successful Round 2 Applications Successful Round 2 Projects Local Screening Process ALL APPLICATIONS Nominated and selected external reviewers... Peer Review Clinical / Research Improvement Commissioning Patient SUPPORT IN APPLYING FOR OTHER FUNDING SOURCES Core Group and external representatives... Final Selection Commitee Successful Projects Selection Criteria... Potential solutions are identified Service innovations can bring benefits to patients within 18 months Intervention will embrace the involvement of a multidisciplinary team ideally over more than one local provider organisation Opportunities for wider application within the NHS There is a project champion There is an identified project manager. By Organisation Type Clinical Category Submitted Applications Round 2 Selection process Primary care Secondary care Voluntary sector Mental health Academic Access/Health Inequalities Mental Health Alcohol Dependency Cancer Respiratory Diabetes Heart/Vascular Disease HIV Paediatrics Pregnancy/Childbirth Prescribing Other Clinical Projects Projects that weren t selected for Round 2 The CLAHRC will work in partnership with those who were not successful to explore alternative sources of funding or in preparation for submission to Round 3. The CLAHRC and the NIHR Research Design Service (RDS) for London plan to work closely together to coordinate resources and build capacity and improve the quality of future research submissions. 13% 8% 7% 7% 4% 4% 14% 4% 4% 14% 11% 11% Round 3... The selection process for Round 3 projects will begin in April Round 2 has provided an excellent learning opportunity and will further inform our approach to Round 3. Areas which will be explored for Round 3 include: Earlier engagement with commissioners and strategic planning to identify local priorities Increased collaboration with patient and community groups to ensure applications reflect their needs and priorities Increase capacity building across northwest London to improve the quality of applications Increase cross-sector and cross-organisation working to ensure projects can address issues associated with interfaces of care

17 GOVERNANCE Organisational Structure GOVERNANCE Organisational Structure Core Team Members Partner Organisations Finances Linked Research Key Outputs The Core Group The Core Group meets monthly and is responsible for the day to day operational running for the NIHR CLAHRC for Northwest London. The Core Group ensures collaboration and cross theme coordination in the development of the programme and that timelines are maintained. It also develops the programme s strategy and agrees local budget decisions and governance issues. Partnership Forum The Partnership Forum meets quarterly to carry out strategic, operational and communication planning for the NIHR CLAHRC for Northwest London. The Partnership Forum ensures the programme maintains engagement across northwest London and ensures transparent mechanisms for distribution of project funds. It also supports knowledge exchange, adoption and spread of successful projects. External Advisory Group The External Advisory Group meets twice a year in a virtual environment to oversee the overall programme and offer expert advice and assistance. Representatives provide an extensive knowledge base and ensure that the programme remains in line with national and international practice. It also monitors the strategic direction and progress of the programme. Chelsea and Westminster Trust Board As host organisation of the NIHR CLAHRC for Northwest London Chelsea and Westminster Hospital play an important role in monitoring finance, governance and delivery of the CLAHRC programme. The CLAHRC core group reports to this board through the Trust Executive Clinical Governance Committee. CLAHRC organisational structure Chelsea and Westminster Trust Board CLAHRC Partnership Forum Trust Executive Clinical Governance Committee External Advisory Group CLAHRC Core Group SENIOR MANAGEMENT TEAM Chelsea and Westminster Hospital NHS Foundation Trust RESEARCH Research and Evaluation PROGRAMME LEADS OPERATIONS Programme Support PROJECT TEAMS CLAHRC organisational structure 32 33

18 GOVERNANCE The Core Team The core team is a critical driving force to lead and support the delivery of diverse innovations and improvement projects. They undertake a range of activities including research and education and assist in the presentation, publication and dissemination of results. Team Development The team development programme has been designed to support the core team work effectively to deliver the CLAHRC programme. Four days have been held with topics including Developing a Shared Vision and Understanding Common Values and Effective Working. Other specific sessions have reflected the breadth of the CLAHRC programme such as improvement methodology, sustainability, human dimensions of change, research methodology and public health. These sessions have been essential to develop team working and highlight the broad range of individual expertise and experience. This ensures the team can combine these different skills and optimise the delivery of the research projects and the CLAHRC programme. Professor Derek Bell Director Professor Derek Bell is responsible for leading the CLAHRC programme in line with its vision to accelerate research into practice. He ensures the programme meets all of its aims and objectives and is responsible for developing a CLAHRC legacy for the whole of northwest London. Derek was appointed as the first Professor of Acute Medicine in the UK as part of Imperial College London. Ganesh Sathyamoorthy Head of Operations and Delivery Ganesh Sathyamoorthy is responsible for the strategic development, operational delivery and governance of the programme. He leads the core team whilst maintaining effective partnership working across all key stakeholders. Ganesh has a Masters in the Management of Community Care and built the SDO network from an outline bid to a fully functioning network. Dr Thomas Woodcock Information Analyst Dr Tom Woodcock leads in the development of measures for improvement. He trains and mentors local project teams to ensure effective data collection, analysis, measurement and reporting. Tom undertook his MSci degree in mathematics and obtained a PhD in mathematics in 2008 from Imperial College. Ruth Barnes NHS Institute and CLAHRC Fellow Dr Ruth Barnes is Director of Public Health at NHS Ealing and is undertaking an 18 month fellowship, supported by CLAHRC and the NHS Institute for Innovation and Improvement. Ruth is delivering an improvement project and is supporting the development of the CLAHRC fellowship programme. Ruth has previously worked for the Department of Health and World Health Organisation Regional Office for Europe. Dr Julie Reed Research Strategy Manager Dr Julie Reed provides strategic oversight to all research and evaluation activities, ensuring the research objectives of the programme and individual research projects are co-ordinated and aligned to the aims of the NIHR CLAHRC for Northwest London. Julie holds a Masters in chemistry and PhD in chemical and biomedical research and co-authored the successful NIHR CLAHRC application. Cathal Doyle Evaluation Cathal Doyle co-ordinates research groups to ensure collaboration and synergy between projects. He ensures appropriate mechanisms are in place to facilitate iterative feedback to optimise programme development and research productivity. Cathal has a Masters in Health Research Methods and is currently studying for a PhD at the London School of Hygiene & Tropical Medicine. Gurmail Singh Communications and Marketing Manager Gurmail Singh develops and supports the internal and external communications strategy; he establishes and maintains good relations with partner organisations and the local community. Gurmail holds a degree in Social Anthropology and Ancient History and was project manager for the Health Service Journal. Julie Stacey Project Manager Julie Stacey co-ordinates and project manages all activities of the programme, supporting the Head of Operations and Delivery in delivering the programme s aims and objectives on time and within budget. Julie holds a degree in Philosophy from Lancaster University; is PRINCE2 Practitioner certified and has previously worked in Mental Health Trusts. Dr Karen Phekoo Chronic Care Dr Karen Phekoo supports the delivery of evidence based research projects into practice working with local multiprofessional teams across interfaces of care. Karen has responsibility for the Case Management and HIV Round 1 projects. Karen holds a PhD, MSocSc in Quality Management and Postgraduate diplomas in Management (DMS) and Marketing (Dip.M). Rachel Matthews Patient and Public Involvement Rachel Matthews co-ordinates and facilitates PPI with healthcare research and service improvement. She designs and delivers training to empower lay project team members, and coordinates the Northwest London PPI Network. Rachel Matthews is a registered nurse with extensive experience in PPI and has an MSc in Health Promotion and Health Education. Eric Banner Administrative Support Eric Banner provides comprehensive administrative support to the programme; including organising meetings and events, maintaining the contacts database, and coordinating correspondence. Eric joined the CLAHRC from his role as a data administrator for the Retinopathy Grading Centre. Stuart Green Project Support Stuart Green provides support to a wide variety of work within CLAHRC. Key outputs include preparing a public guide to CLAHRC and developing the framework for the CLD Curriculum and associated CLD event booklets. Stuart is a graduate researcher from the University of Leicester currently reading medicine at St George s University of London. Dr Rowan Myron Collaborative Learning and Delivery Dr Rowan Myron is responsible for coordinating and delivering education and training in research and improvement for multi-professional staff aiming to foster a culture of change and provide a platform for knowledge transfer and shared learning. Rowan holds an MA and a PhD in Psychology. She authored the Whose Decision? report addressing mental health research and service engagement. Jackie Valentine Acute Care Jackie Valentine supports the delivery of evidence based research projects working with local multi-professional teams. Jackie has responsibility for the CAP and COPD care bundle and Medicines Management projects. Jackie has a background in clinical pharmacy. She has extensive experience in service change and improvement programmes in the UK and USA. Kate Walker Project Support Kate provided administrative and project support to the CLAHRC senior management team and patient and public involvement theme. Activities ranged from coordinating and designing materials to producing output reports from key events. Kate obtained a BSc(Hons) in Psychology at the University of Glasgow. Hayley Bray Project Support Hayley Bray provides administrative and project support to the CLAHRC team. Hayley coordinated the Round 2 application process and supports information analysis activities. Hayley graduated with a BSc (Hons) in Cancer Biology and Immunology from the University of Bristol in

19 GOVERNANCE Finance Our Partners Financial Reporting The CLAHRC submitted its first financial report for the period October 2008 to March 2009 to the NIHR and this was approved. This section updates the CLAHRC finances for the period of 1st October th September 2009 and the report is outlined below. There was an under spend against the original budget of NIHR funding ( 1,451,426) which was predominately due to a lag in recruitment timescales and contract sign-off with partner organisations. The majority of posts are now recruited and this under spend will be non recurrent. Projected budgets are in-line with the agreed +/- 10% criteria. CLAHRC funding October September 2009 NIHR Funding Expenditure Acute Care Research Theme Chronic Care ReserachTheme Patient and Public Involvement Implementation Theme Collaborative Learning and Delivery Implementation Total NIHR Funding Expenditure Total Matched Funding Total CLAHRC funding ThemeEvaluation Implementation Theme Utilising First Year Under Spend 351, , , , ,908 1,182, ,470 2,111,862 The under spend from this period is being used to fund fixed term graduate support posts to provide increased administrative and project support to the programme to ensure programme timelines are met. The posts are designed to be exciting and provide varied training opportunities to support capacity building and create future leaders with a knowledge of healthcare, research and improvement science. Our partners include: Central and Northwest London NHS Foundation Trust Chelsea and Westminster Health Charity Chelsea and Westminster Hospital NHS Foundation Trust Ealing Hospital NHS Trust GlaxoSmithKline Imperial College Healthcare NHS Trust Imperial College London London Ambulance Service London School of Hygiene & Tropical Medicine McKinsey & Company NHS Brent NHS Direct NHS Ealing NHS Hammersmith and Fulham NHS Harrow NHS Hillingdon NHS Hounslow NHS Institute for Innovation and Improvement NHS Kensington and Chelsea NHS London NHS Westminster Northwest London University Hospitals NHS Trust Pfizer ph Associates Royal Brompton & Harefield NHS Foundation Trust The Hillingdon Hospital NHS Trust West London Health & Social Care Alliance West London Mental Health NHS Trust West Middlesex University Hospital NHS Trust NIHR Collaborations Funding has also been identified to support an additional project in Round 2 (seven now to be funded compared to original six). Matched Funding Matched funding is integral to the CLAHRC approach. Matched funding for the first year of CLAHRC is marginally less than the NIHR expenditure. This difference was forecast in our original budgets and is indicative of the phased project start date of April 2009 which contribute a significant proportion of matched funding to the programme. Matched funding will increase significantly in 2010 as greater amounts of funding are matched to support the new and roll out projects in Round 2. Anticipated contributions from all partners are broadly in line with expectations and we are engaged in ongoing conversations with partner organisations to ensure matched funding levels are maintained. NIHR Comprehensive Local Research Network The CLAHRC works closely with the Northwest London CLRN who cover the same geographical area. The CLAHRC is represented on the CLRN board and the CLRN director, Martyn Partridge chairs the CLAHRC partnership forum. Shared aims include the engagement of all healthcare organisations across the sector, aligning strategic planning and patient and public involvement. NIHR Research Design Service The CLAHRC is building a positive working relationship with the new RDS unit for London. RDS supported the selection process for Round 2 projects and will play a crucial role in supporting project teams across northwest London to secure external funding. Shared aims include increasing the number of NIHR funded projects in the sector and building the capacity and capability of staff to apply for and conduct high quality research. National CLAHRC Directors Meeting Directors from all 9 national CLAHRCs meet regularly to discuss the programme including common themes and challenges. This forum supports knowledge transfer and shared learning between the different CLAHRC programmes

20 GOVERNANCE Parallel Research Projects Key Outputs In parallel to the existing CLAHRC themes a number of bespoke projects and collaborations have been identified to support aims and objectives of the programme. Second Health Virtual World The CLAHRC in partnership with Dave Taylor from Imperial College London s new Medical Media and Design Lab (headed by Professor Ara Darzi) are developing and evaluating a virtual platform to support the engagement of patients and public in the co-design and delivery of health services using the Second Life platform. Royal College of Physicians London (RCPL) The RCPL National COPD Audit Team and Clinical Effectiveness and Evaluation Unit headed by Jonathan Potter are working with CLAHRC. The project aims to raise awareness and use of current specialist services for COPD by developing and implementing an education package for patients, carers and healthcare professionals. Chelsea and Westminster Hospital NHS Foundation Trust The NIHR CLAHRC for Northwest London has already been the recipient of a number of external funding awards that contribute to the programme aims: Data Capture and Auto Identification (DACAR) The Technology Strategy Board is funding a consortium of organisations led by Christoph Thuemmler to deliver the DACAR project ( 1.4 million). The aim of the DACAR project is to allow different medical equipment and computers to communicate effectively in a wireless manner to improve patient safety. Patient and Public Understanding of Electronic Data in Healthcare Research The Wellcome Trust is funding a project ( 270k), led by Imperial College, to evaluate the patient and public understanding of the role of e-databases and patient records in healthcare research and increase awareness through active engagement and production of lay orientated information material Effect of community participation interventions on maternal health and HIV prevention A systematic review was commissioned by the World Health Organisation to investigate the evidence from studies that link community participation in health interventions to specific health outcomes. Cicely Marston, London School of Hygiene and Tropical Medicine led the review which was presented in Nairobi in June HaCIRIC The research on CLAHRC s organisational structure and processes, and the impact on the spread and sustainability of healthcare innovation, is informing work within HaCIRIC (Health and Care Infrastructure Research and Innovation Centre), a major EPSRC funded initiative led by Imperial College London. The research allows the development of new insights into the management of innovation within complex environments such as healthcare systems, and the factors and models which help to embed innovation and ensure sustainability. Together with other research within HaCIRIC, the CLAHRC organisational research is in a strong position to generate significant new knowledge on innovation processes in healthcare. Publications Cultural and Behavioural barriers are recognised areas of understanding what matters to patients identifying key patients perceptions of quality, Doyle C, Reed J., Woodcock T., Bell D. (Submitted to Quality & Safety in Healthcare, November 2009) A Report on the Risk Factors for Re-admission and Effective Discharge Planning Strategies for People with COPD, Smith S, Elkin S., July 2009 (currently being peer reviewed before submission) Pay for performance and the quality of diabetes management in individuals with and without co-morbid medical conditions, Millett C; Bottle A; Ng A; Curcin V; Molokhia M; Saxena S; Majeed A. (Sep 2009). J ROY SOC MED. 102: Impact of pay for performance on quality of chronic disease management by social class group in England, Crawley D; Ng A; Mainous AG; Majeed A; Millett C. (March 2009). J ROY SOC MED. 102: Impact of pay for performance on ethnic disparities in intermediate outcomes for diabetes: a longitudinal study, Millett C; Netuveli G; Saxena S; Majeed A. (March 2009). Diabetes Care 32: Trends in cardiovascular admissions and procedures for people with and without diabetes in England, Bottle A; Millett C; Khunti K; Majeed A. (January 2009). DIABETOLOGIA. 52:74-80 Ethnic disparities in coronary heart disease management and pay for performance in the UK, Millett C; Gray J; Wall M; Majeed A. (January 2009). J Gen Intern Med. 24:8-13. International Forum on Quality and Safety in Health and Care, Barnes R, Berlin, March 2009, London Journal of Primary Care Transforming healthcare: a safety imperative, Doyle C., Quality and Safety in Health Care, January 2010 Reports NIHR CLAHRC for Northwest London (An introductory guide), NIHR CLAHRC for Northwest London, September 2009 Collaborative Learning and Delivery Event 2, NIHR CLAHRC for Northwest London, September 2009 Patient and Public Involvement: Getting it right and delivering results, NIHR CLAHRC for Northwest London, SDO Network & NHS Confederation, November 2009 Community Engagement Launch Report, NIHR CLAHRC for Northwest London, March 2009 Economic Evaluation of Public and Patient Involvement, Elena Pizzo, December 2009 (being prepared for submission January 2010) Abstracts Using statistical analysis to identify key drivers of quality from a patient viewpoint, Doyle C., International Forum on Quality and Safety in Healthcare, April 2010 Irreconcilable Differences?: Lessons from a pre trial review of medicines management on an Acute Medical Unit, Vaughan L., International Forum on Quality and Safety in Health Care, April 2010 NIHR CLAHRC for Northwest London: A new approach to using research to drive cost effective high quality health care, Barnes R., Bell D., Doyle C., Reed J., Singh G., International Association of Health Policy in Europe Conference, Presentation, June 2009 From Innovation to Sustainable Improvement factors for success, Bell D., McNaney N., Reed J., European Health Management Association Annual Conference, June 2009 Presentations and Lectures Implementing Care Bundles Across Boundaries, Case Study: the Community Acquired Pneumonia Care Bundle, Garbelli E., Bell D., Care Bundles Conference (Healthcare Events), Jan 2009 A framework to deliver high quality care: Exploiting the synergies between research and improvement, Bell D., London Health 09 (NHS London), November 2009 Collaboration for Leadership in Applied Health Research and Care (CLAHRC): Community Acquired Pneumonia Care Bundle, Bell D, College of Emergency Medicine 2009 Autumn Conference, September 2009 Creating a Culture of Innovation within the NHS, Sathyamoorthy G, NHS Employers Conference, November Master Class in Accelerating Research into Practice, Sathyamoorthy G, Managers in Partnership Annual Conference, November 2009 Marston C, Renedo A, McGowan C, Knox M, Hall V, Effect of community participation interventions on maternal health and HIV prevention: a systematic review. Paper presented at 7th Global Conference on Health Promotion, Nairobi October 2009 Newsletters Articles in local trust newsletters raising profile of NIHR CLAHRC for Northwest London 38 39