Dear Colleague,

It has been a busy start of the year for the Programme! We have expanded the QA team, visited 11 teams across England and Wales and will be visiting eight more soon. 19 new teams joined the QI Collaborative in the first of our regional waves, which began in Exeter in March. We look forward to meeting more teams on our travels over the next few months and working with you all to keep driving further improvements in paediatric diabetes care for children and young people and their families.

Megan and Heather

QI and QA Leads for the National CYP Diabetes Quality Programme

QA update

Expanding the team…

We are pleased to welcome Eva Anjoom-Zaman to the team. Eva is joining the team as Peer Review Researcher and will meet many of you in her role as Peer Review Manager. Eva previously worked for the Royal College of Psychiatrists for the Accreditation Network for Community Mental Health Services.

Updates:

The Programme Manual has been updated – for a copy of the latest version please see www.rcpch.ac.uk/diabetesquality.

Self-Assessment 2019

The Self-Assessment submission for 2019 will launch in early June. This has been timed to open once the NPDA submission has been closed. We will soon be contacting Clinical Leads to ensure we have the correct users for when the platform opens; please respond promptly so we can ensure your access is correct. There are very few changes to the system from last year: respondents will be asked to amend anything that has changed since the 2018 submission and confirm the information is correct – you will not need to re-enter all answers. The submission will need to be signed off by the Clinical Lead and Medical Director. As with the 2018 round, there will not be a requirement to upload supporting documentation and evidence, however it is expected that this is available if requested. The 2018 External Verification identified several instances where policies and documents were not available despite being marked as compliant on the Self-Assessment and we must emphasise the importance of having the supporting evidence accessible. The 2019 External Verification will take place later this year and selected MDTs will need to upload the documentation by the stated deadline.

Peer Review visits

We are in making final preparations for visits between May and July and looking forward to travelling the country to visit services and meet more teams. Thank you to the services we have already visited – we have met so many dedicated teams and received amazing hospitality. Below is some feedback which describes the positive impact arising from the visit. We’d also like to say a very big thank you to everyone who has volunteered as Peer Reviewer. We appreciate the time you have taken out of your very busy schedules to prepare, visit and of course travel considerable distances in some cases. The visits could not happen without you

It was a valuable and insightful process, and certainly a welcome one in terms of helping our team think about the way we function and what can or should be improved.

Very good. The peer review team were very helpful and listened to all our concerns. They looked at all the work we had prepared. Complimentary when appropriate but the main task of the team was to try and help influence areas where we were struggling to meet peer review guidelines.

Useful. Nice to be able to say what we do and what we are proud of, but also good to get backing for the developments we need to make.

and we are grateful for your enthusiasm, professionalism and expertise. For those who have not been able to join a visit, we will be seeking Reviewers for the next group of visits soon – please keep an eye out and get your requests to us. We realise a few of you have volunteered, but we have not yet been able to allocate you to a review – there has been an excellent response from some staff groups and it’s not been possible to give everyone their preferred option but we are monitoring responses and will do our best to make sure everyone is given the opportunity. Please do keep responding so we know which visits you are able to attend.

Feedback from MDTs

After each Peer Review visit, MDTs are encouraged to complete a short questionnaire about the experience. We have included some feedback below as well as advice from teams for colleagues who are preparing for their visit.

Top tips from teams who have been visited:

Prepare as much as you can in advance. Be proud of the work you have done and share this with the team. Welcome the peer review process and the team of experienced professionals who can help you to develop your service further.

Be prepared and make sure you let the peer review team know of all your achievements and triumphs over the last 12 months. View it as a positive experience.

Be open and honest, focus on positives but share your concerns. Have an explicit team plan for preparation.

Relax, be honest and use the review to help you provide the best service for the children and young people you care for.

Be honest and upfront with both the successes and challenges the team faces.

Think about what key things you would like to get out of the process ahead of the review.

Ensure as many managers and Trust leads are involved in the process as possible and attend the senior sessions…This is a really good opportunity to hear about the challenges your team face and to hear the feedback from the review team. This helps with engagement in moving forward with service development. It also ensures that senior team hear about the good work the team does as well!

Helpful and encouraging. The peer review panel acknowledged our team's hard work. They also provided insights into areas we

could develop and gave recommendations.

“[Although it was a] challenging peer review [I] am sure the team will have gained such benefit from the RCPCH attending and from our feedback too. I think [the Peer Review Manager] did a brilliant job of keeping it professional, realistic and upbeat and as well as that, [they] kept us on task and focused too throughout which was easier said than done! It’s been a total pleasure to do the reviews.” – Peer reviewer

Feedback from Peer Reviewers

Hello, my name is Alison Ashworth and I am a Dietitian Peer Reviewer. I

would like to share my experiences of being a Peer Reviewer. I attended

Induction training in October 2018 and since then have been involved in 2

Peer reviews and have one planned in June. I would love to do more if

time and Team Leaders allowed. The Training was an excellent

introduction to how a Peer review runs and the paperwork but it is only when you are involved in

one that I feel I have understood the exact process and my role within it. Unfortunately, or

fortunately, my Clinical Team had already had our Peer Review before I had had the pleasure to

do one. I feel that the experience of being Peer Reviewed helps you to be empathic and

supportive as a Peer Reviewer, understanding the hard work that is done and the pressure any

review puts on people. The first time, I read every document I received (and there were plenty);

making comments on things that stood out for me that I wanted more clarity on. For the second

review there was less to read but my style had developed to look for more positives and

concentrate more on the Dietetic team. Any apprehensions I have had have been mainly around

having to give negative feedback to people working hard doing what they think is the best thing

for patients. The Peer Review Managers from the College have been excellent leaders and

managers of each of the reviews I have done, making the process an exciting challenge rather

than a stressful event. I have learnt to concentrate on people, learning the names of the Peer

Reviewers and Clinical Team before the review; finding out the types and numbers of patients. I

have learnt to listen to different opinions and ways of working and develop my questioning style

to being open, honest and supportive. I would encourage everyone to consider being a Peer

Reviewer, it has developed me as a person, my team through the learning I have gained from

others and in turn shared resources and learning with others.

Peer Reviewer Induction Training

We are still keen to expand the number of Reviewers, particularly Dietitians and Psychologists (but all MDT staff groups are welcome). If your service has signed up to the Programme and you or your colleagues are interested in being a Peer Reviewer but have not been able to attend one of our previous induction sessions, please get in touch. Please contact the team for further details of dates, a role profile and application form.

QI Update

The first round of applications for the regional waves of the QI Collaborative closed on 25th

February 2019. 19 new teams involving over 220 healthcare professionals across England

and Wales will take part in the first 3 regional waves based in Exeter, Manchester and Bristol

starting from March 2019.

They will join the 14 teams currently participating in national Waves 2 and 3 of the QI

Collaborative. It is great to have a total of 43 NHS Trusts/Health Boards now in the

collaborative with almost 520 healthcare professionals working in paediatric diabetes units

across England and Wales using QI methodology to drive improvement.

Applications will open for the second round of regional waves of the QI Collaborative based

in Winchester and Darlington in June 2019. Keep checking our website for further details of

how to apply closer to the time: www.rcpch.ac.uk/diabetesquality

We are excited to see our teams continue the QI journey by sharing their work at upcoming

training events in new waves of the collaborative, as well as presenting at meetings and

conferences on the national and international stage. Good luck to the paediatric diabetes

teams from Sheffield Children’s Hospital and Leeds Children’s Hospital, who have been

shortlisted for the BMJ Awards 2019 in the Diabetes Team category for their QI work!

Join us for the QI Symposium at the RCPCH Annual Conference in Birmingham on Monday

13th May and look out for our poster presentation on the improvement journey so far at the

ADA 79th Scientific Sessions in San Francisco in June 2019.

Future QI dates for your diary:

The second round of applications for regional waves in Winchester and Darlington will

open on our RCPCH website in June 2019.

The third round of applications for regional waves in Newmarket, Sheffield,

Birmingham and Leicester will open on our RCPCH website in March 2020.

Improving HbA1c and quality of life in our cohort of children and young people

living with diabetes (CYPD) “At the start of our QI journey, we had a caseload of 173 CYP living with diabetes and our overall HbA1c was above the national average, meaning that we were an outlier in the NPDA 15/16. The team identified several areas where we could make improvements, we used a fishbone diagram to prioritise our efforts. A third of our patients used continuous subcutaneous insulin infusion (CSII) as their treatment option. We identified that these patients had a higher mean HbA1c than those patients on multiple daily injections (MDI), whereas we would have expected better outcomes. The impact being that these patients had increased risk of both short- and long-term complications that could be reduced. We started our project with an aim to 'Improve HbA1c for all patients using CSII within 1 year'. At our first meeting, we looked at the causes of the problem and identified the following:

Unclear and informal internal process, both for commencing and ending CSI

Inconsistency in the team message to patients and families regarding expectations for pump use and outcomes

Gaps in patients’ knowledge/education We started with four PDSA cycles to address each area of concern;

1. Pump refresher 2. Pump demo 3. Pump support plan (PSP) 4. Pump start up process

Outcomes from our QI project have been positive. We have achieved 100% annual attendance at pump refreshers; pump demo has released time from team commitments as well as enabling a consistent message to be given to patients; 20 patients have been started on a PSP and have seen an average reduction of 10.6mmol/mol at 3 months; pump start up process has meant that all patients are now aware of expectations from the start of their treatment.”

Debbie Blissitt, Paediatric Diabetes Dietitian and QI Champion The Hillingdon Team