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Connected Health Cities Programme
Prof. John [email protected]
Gary LeemingChief Technology [email protected]
Dr Amanda LambDeputy Director & Chief Operating [email protected]
Ruth NorrisHead of Strategic [email protected]
The Problem
http://www.thenhsa.co.uk/app/uploads/2018/11/NHSA-REPORT-FINAL.pdf
“An integrated health system in which progress in science, informatics, and care culture align to generate new knowledge as an ongoing, natural
by-product of the care experience, and seamlessly refine and deliver best practices for
continuous improvement in health and healthcare.”
www.ihi.org www.p4mi.org
The Learning Health System Cycle
Flynn et al., Learn Health Sys. 2018;2:e10054.
2000s: People, data, methods From can’t to can
Challenge # 1
ComplexityChallenge # 3
PerceptionChallenge # 2
Context
Challenge 1: Complexity
“It is not individual factors that make or break a technology implementation effort but the dynamic interaction between them”
Greenhalgh T et al. J Med Intern Res 2017;19:e367
Solution 1: A Multi-Disciplinary Team
• Digital Health− Salford Lung Study – largest clinical trial in the UK involving
9,000 patients.
− Health eResearch Centre (HeRC) & Farr Institute - developing
new methods to generate scientific insights and healthcare
innovations, bringing statisticians, software engineers and
computer scientists together with clinicians.
− CityVerve – Internet of Things & Smart Cities technology for
improving health
− ClinTouch and CF HealthHub – App supported health care
• Applied Health Research− Connected Health Cities – Applying Learning Health Systems to
15m populations.
− Patient Safety Centre – Using data to deliver safer care
• Precision Medicine – Machine Learning− Psoriasis (PSORT) – differentiating between two forms of
psoriasis to improve treatments.
− Stoller Biomarker Discovery Centre – digtial phenotyping
− Molecular Pathology Innovation Centre (MMPathIC)
Some of our research highlights
Challenge 2: Context
“Surprisingly few frameworks considered the organizational setting.”
Greenhalgh T et al. J Med Intern Res 2017;19:e367
Problem:
The health and social care system is facing
unprecedented levels of change in policy and
funding, the shifting and ageing demographics of the population served, and ever-increasing workforce pressures. Health and social care staff need to be able to plan ahead and tackle
these challenges
Solution:
Through producing statistical models to create a predictive
planning approach, this will allow healthcare organisations and GP practices to use their
existing data to help to more accurately predict demand and improve
service delivery design
Learning health system opportunity: Project leader:
Judging what is true Deciding what to do
Perceive the critical factors in a situation Diagnose the biggest challenges to progress Devise a coherent treatment
The opportunity for a learning health system to transform care
What are the current outcomes? What are the desired outcomes? What’s holding “us” back?What LHS might transform this
care?
Feasibility: technical change framework
Where are we? Where do we want to be? What stands in the way? How will we safely get there?
What data do we have? What data do we need? Data availability, quality, etcEnsure have safe havens and
processes for data flows
What “tech” do we have? What “tech” do we need?Cost/”perfect”
system/overwhelmed by scale
Build with focus on necessary tools and services, and iterate with
scalable tech
What methods do we have? What methods do we need? Capability, access to dataTrusted Research Environment, ability to share research objects
What governance do we have? What governance do we need? Differing local perspectivesEnable transparency and build
commitment
Desirability: behavioural change framework
Whose behaviour must change to deliver this transformation?Who are the stakeholders? What outcomes do they want? What is our common enemy? What common desired outcome do we share?
How do people see, think and act?
How must people see, think and act?
What stands in the way of transforming
How might we safely
Limiting Beliefs Enabling Beliefs Beliefs Expand the diameter of trust
Won’t Will MotivationBuild a shared commitment to a
common goal
Can’t Can Behaviours Build capacity and capability
Viability: economic change framework
Where are we? Where do we want to be? What stands in the way of How might we safely
Where is the waste? Where are the savings?Reducing waste and realising
savings?Reduce waste and realise savings?
Who pays what? Who will pay what? A compelling investment case? Obtain initial and ongoing funding?© Applied Health IOnshightsw Limited 2019
Solution 2: Building a diagnosis framework
Challenge 3: Perception
13
Solution 3: Perception
Higher Aims
Individual priorities
Theory of LHS
Actual learning journey
Electronic Health Record
Actual patient record
Ground truths
View from above
2000s: People, data, methods From can’t to can
Challenge # 1
ComplexityChallenge # 3
PerceptionChallenge # 2
Context
Challenge # 4
Citizen TrustChallenge # 5
FoundationsChallenge # 6
Critical mass
2016: How to safely scale the creation and adoption of LHS. From won’t to will
Connected Health Cities
Connected Health Cities (CHC) is a global programme harnessing the power of data for the implementation of Learning Health Systems (LHS) to deliver improvements in both system and patient outcomes through the use of innovative technologies.
Backed by the UK government’s Department of Health and Social Care (DHSC) and led by the Northern Health Science Alliance, CHC has implemented multiple clinically or socially driven care pathways programmes across the health sector.
Challenge 4: Citizen Trust
Solution 4: Creating a Diameter of Trust
• A new approach was conceived centred on building civic digital clusters with clear local benefits and public trust
• To achieve regional critical mass and expand the “diameter of trust”
Trust
You
Elements of policy
Care Pathway
You are here
WasteInequalityLost opportunity
Elements of policy
Care Pathway
From To
Challenge 5: Front-line innovators require solid foundations
Challenge 5: Front-line innovators require solid foundations
You are here
WasteInequalityLost opportunity
From To
The sexy bit The unsexy bit
Solution 5: “Nobody wants to do the unsexy bit”
We need all, not most
“Acceptance by professional staff may be the single most important determinant of whether a new technology-supported service succeeds or
fails at a local level.”
Greenhalgh T et al. J Med Intern Res 2017;19:e367
Challenge 6: Sustaining critical mass
Involved CitizensProblem ownersData managersPublic Health AnalystsCare Service AnalystsStatisticians Data ScientistsInformaticiansSocial ScientistsHealth EconomistsHealth ServiceResearchersCommunicationsExpertsChief Executive OfficerChief Medical OfficerChief Operating OfficerChief Quality OfficerChief Information Officer
Chief Financial Officer Chief Research Information OfficerChief Medical OfficerPhysiciansNursesHospital StaffSocial Care StaffHealth IT vendorsPatients and familiesSocial WorkerGeneral Practitioner (GP)MinistersRisk ManagementPolicy MakersGuideline developersData guardians
Solution 6: Sustaining critical mass
Leading Large Scale Change: A Practical Guide
Commitment, not compliance, sustains critical mass
Compliance goals
States a minimum performance standard that everyone must achieve
Uses hierarchy, standard procedures and threats or sanctions to create momentum
for delivery
“If I don’t deliver this, I fail to meet my performance objectives”
“There is no evidence in the large scale change literature that any healthcaresystem has ever delivered sustained transformational change through
compliance, rather than commitment”
Commitment goals
States a collective improvement goal that everyone can aspire to
Uses shared goals, values and purpose for voluntary
co-ordination and control
“If I don’t deliver this, I let down the group and our shared purpose”
2000s: People, data, methods From can’t to can
Challenge # 1
ComplexityChallenge # 3
PerceptionChallenge # 2
Context
Challenge # 4
Citizen TrustChallenge # 5
FoundationsChallenge # 6
Critical mass
Challenge # 8
Re-inventing the wheel
Challenge # 7
Spread challenge
2016: How to safely scale the creation and adoption of LHS. From won’t to will
2019: Making it easier for front-line innovators to safely use data to save lives
“When initially successful interventions are spread to new
settings, they may fail to achieve the same impact, or
indeed any impact at all.”
“The success of a complex intervention is likely to depend
heavily on its context.”
The Spread Challenge, The Health Foundation, September 2018
Challenge 7: The Spread Challenge
Solution 7: A pathway-based approach
• Antimicrobial resistance and antibiotic prescribing • Healthy ageing • Alcohol misuse• COPD• Epilepsy • Childhood obesity • Autism • Stroke • Opiate dependency • Supporting community care• Unplanned emergency care• Vulnerable families
Pathway: Improving the management of stroke
Manchester
Pathway: Forecasting emergency unplanned care
Durham
Challenge 8: re-inventing the wheel
Where do we start?What do we do next?
Where’s the best place to invest our resources?
Solution 8: Blueprints are important, but not sufficientKnow-how is essential
“It is possible, but not accurate, to view the achievement of an LHS at any level of scale, as an exercise in construction from a blueprint. This conceptualization belongs to an earlier era. It fails to recognize that the LHS is a new and fundamentally different type of system”
Friedman CP et al. Learning Health Systems 2017;1:e10020
Connected Health Cities: Enhance Information Flows for Better Research
Connecting Communities of Care and Research
The CHC programme: contributing to delivering policy objectives
“It has been a real catalyst for change pulling Northern partners together. At a geo-political level it has been really crucial to have this investment.”
Contributed to all six
NHS Long Term Plan
policy objectives
Contributed to all six
Department of Health and Social
Care priorities 2018-2019
“I really enjoy where I am and my job, it’s a different world compared to being in a lab and you can’t see your significant
finding making it to the clinical face for another 20 years whereas here, it will have an impact and I will see that impact whilst I am
still on the project, so yeah, it’s exciting.”
1. Working with complexity
Multi-disciplinary team3. Perceiving reality
Reveal ground truths2. Understanding context
Diagnose before treating
4. Addressing Citizen Trust
#DataSavesLives & PPIE5. Building quality foundations
Pathway by pathway6. Sustaining critical mass
Listen, learn then lead
8. Avoiding re-inventing the wheel
Blueprints, resources & know-how7. Enabling spread
Making LHS tractable
DataSavesLives: the community for LHS Design, Safety and LearningWe can’t do it alone. We need your help. Join the movement at www.connectedhealthcities.org
9. Curating global learning
Community of practice
2000s: People, data, methods. From can’t to can
2016: How to safely scale the creation and adoption of LHS. From won’t to will
2019: Making it easier for front-line innovators to safely use data to save lives
Working Together for Data to Save LivesFrom waste, inequality and missed opportunities to better care, cheaper care and better outcomes
Join the #DataSavesLives movement to make creating LHS easier
Join the movement at www.connectedhealthcities.org via the contact us page
#DataSavesLives@CHCNorth