web viewthe addition of comparator or control groups is a substantial development from the single...

Scaling Up Improvement Round 2Full application form

Deadline for submission of the full application:

12 noon, Thursday 1 October 2015

Important information: Any significant changes to the nature of the project or the partnership in the full application from those stated in the outline application will not be accepted and will lead to rejection.

August 2015

The Health FoundationTel: 020 7257 8000www.health.org.uk

http://www.health.org.uk/

Section 1: The Application

1.1 Project title

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE)

The title should be short and descriptive; and should not exceed 15 words.

1.2 Lead organisation

Please note that the lead organisation must be the same as the lead organisation named in your outline application.

Organisation name NHS Greater Glasgow and Clyde Type of organisation NHS Health BoardRegistered address NHS Greater Glasgow and Clyde

Caledonia House140 Fiftypitches RoadGlasgowG51 4ED

Website address http://www.nhsggc.org.uk/Statement (if applicable, please use this space to address any of the bulleted points below)

1.3 Primary contact

Full name (and title) Miss Joanne McPeake

Job title and role on this project Clinical Research Fellow/Senior Staff Nurse Office / contact address Rom 2.73, Level Two. New Lister Building,

Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER.

Email [email protected]

Telephone0141 2018634

PA contact details or alternative contact

Dr Tara Quasim0141 201 8505

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Section 2: About your proposed project

2.1 Please provide an overview of your proposed project (400 words)

Problem

After an Intensive Care Unit (ICU) admission, patients are often left with profound

muscle wasting, recurrent flashbacks and a sense of social isolation. These are just a

few of the persistent physical, psychological and social symptoms commonly referred

to as Post Intensive Care Syndrome (PICS) (1,2). PICS increases healthcare costs

and causes significant burden to individuals, their caregivers and society (3).

Approach

As SHINE 2014 award holders, we successfully prototyped a rehabilitation

intervention for ICU survivors: InS:PIRE (Intensive Care Syndrome: Promoting

Independence and Return to Employment). InS:PIRE is a five week rehabilitation

programme focusing on patient education, peer support and the facilitation of self

management. Each week patients receive one hour of physiotherapy as a group, as

well as individualised sessions with health professionals to help facilitate an

accelerated recovery and return to employment. This unique programme has placed

specific emphasis on recovery for caregivers and has integrated health and social

care.

Setting

We aim to scale up InS:PIRE into five further centres across four Health Boards in

Scotland. The intervention will also continue in its current form at Glasgow Royal

Infirmary. Whilst we will continue to focus on rehabilitation in the general ICU

population, we also hope to include the Golden Jubilee National Hospital’s cardiac

ICU. This centre deals with adults who have congential heart disease, who have their

own specific needs following complex heart surgery. With our evaluators we will

assess how this intervention, successful in one site, scales up to other sites.

Aims and Objectives

We aim to improve patients’ health and how 'in control' they feel about their health

using validated self efficacy questionnaires. We aim to improve psychological

outcome measures for both patients and family members. Patients and healthcare

professionals also set personal goals at the start of the programme which will be used

to assess improvements. We will also explore return to employment following ICU

discharge as an outcome measure. The project team have significant experience in

utilising these measurements.

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Evidence Base

A novel part of our SHINE 2014 award was an intentional learning and reflecting

session at the end of every five week cohort. This allowed us to progressively improve

the programme using feedback from patients.

We have improved patients’ self-efficacy and how 'in control' patients feel about their

health and wellbeing over the five week programme. This programme has reduced

cost per Quality Adjusted Life Year for participants.

Actual word count:397References

1. Quasim, T. Brown, J. Kinsella, J. (2015) Employment, Social Dependency and Return to Work after Intensive Care. Journal of the Intensive Care Society; 16(1):31-36.

2. Mehlhorn, J. Freytag, A. Schmidt, K. Brunkhorst, FM. Graf, J. Troitzsch, U. Schlattman, P. Wensing, M. Gensichen, J. (2014) Rehabilitation Interventions for post intensive care syndrome: a systematic review. Critical Care Medicine; 42(5):1263-127.

3. Griffiths, J. Hatch, RA. Bishop, J. Morgan, K. Jenkinson, C. Cuthbertson, BH. Brett SJ. (2013) An exploration of social and economic outcomes and associated health related quality of life after critical illness in general intensive care survivors: a 12 month follow up study. Critical Care; 17:R100.

2.2 Total amount of funding requested from the Health Foundation

If the funding requested has changed since the outline application, please explain why.

£ 490, 206

Changes: Since the initial application we have been guaranteed further supplementary support

from the Scottish Government (£100,000). This will be used to fund third sector

involvement (Citizens Advice Bureau and other organisations from the voluntary

sector) and backfill the leadership team further.

2.3 Length of project in months:

If the length of project has changed since the outline application, please explain why.

Months: Including Set up Period: 30 months

Changes: No changes

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2.4 When do you expect to start with the implementation of the project? Do you intend to use the recommended set-up period? If the answer is no, please explain why.

We will start the recommended set up phase in April 2016 for 6 months. The main implementation period will start in October 2016.

Section 3: Identifying the problem and solution

3.1 Please describe the nature, significance and severity of the problem your project seeks to address. (300 words)

Research demonstrates that many patients have a poor quality of life following an

intensive care admission (1). Furthermore, it is now well recognised that families

and caregivers of those patients who have been critically unwell, also suffer

psychosocial morbidity in the years and months following intensive care discharge

(2).

There are almost 180,000 admissions to ICU in the UK each year (3, 4). More

patients are now surviving ICU and being discharged from hospital, which will have

a significant impact on healthcare utilisation as well as an increasing societal

burden (5, 6).

There are two randomised trials in this area (RECOVER and PRACTICAL); neither

have shown any quantitative improvement in outcome. Work has focussed on

patient education, the use of rehabilitation assistants within the ward environment

and one off follow up appointments (7, 8). Reasons for the negative outcome

studies may include lack of engagement with service users, poor integration

between health and social care and a lack of focus on the promotion of self-efficacy

for patients and their family members. Evidence also demonstrates that providing

patient education in isolation is unlikely to improve outcomes or motivate lasting

changes (9).

There is also a small body of evidence emerging which demonstrates that patients

and family members who have been through ICU appreciate meeting others with

similar experiences (10).

None of the aforementioned interventions have utilised peer support within their

approaches to rehabilitation and none of the approaches have included support for

family members. Our SHINE 2014 InS:PIRE programme gave ICU survivors and

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caregivers the opportunity to engage with others on the same recovery journey.

This was achieved through a five week, peer supported programme, promoting self

efficacy and the utilisation of existing community services.

Actual word count:284

References:

1. Needham, DM. Davidson, J. Cohen, H. Hopkins, RO. Weinert, C. Wunsch, H. Zawistowski, C. Bemis- Dougherty, A. Berney, SC. Bienvenu, OJ. Brady, SL. Brodsky, MB. Denehy, L. Elliott, D. Flatley, C. Harabin, AL. Jones, C. Louis, D. Meltzer, W. Muldoon, SR. Palmer, JB. Perme, C. Robinson, M. Schmidt, DM. Scruth, E. Spill, GR. Storey, CP. Render, M. Votto, J. Harvey, MA. (2012) Improving Long term outcomes after discharge from intensive care: a report from a stakeholders conference. Critical Care Medicine; 40(2):502-9.

2. Haines, K. Denehy, L. Skinner, EH. Warrillow, S. Berney, SB. (2015) Psychosocial outcomes in informal caregivers of the critically ill: a systematic review. Critical Care Medicine; 43(5):1112-1120.

3. Intensive Care National Audit and Research Centre (2014) Key Statistics from the Case Mix Programme 2012/2013. Accessed 10th of May 2015. https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports/Summary-Statistics.

4. Scottish Intensive Care Society Audit Group (2014) Audit of Critical Care in Scotland 2014 (Reporting on 2013). Accessed 10th of May 2015. http://www.sicsag.scot.nhs.uk/docs/2014-08-12-SICSAG-Summary.pdf?1

5. Lone, NI. Marta, S. Wild, S. Rowan, K. Murray, G. Walsh, TS. (2013) Surviving intensive care: a systematic review of healthcare resource use after hospital discharge. Critical Care Medicine; 41(8):1832-1843.

6. Griffiths, J. Hatch, RA. Bishop, J. Morgan, K. Jenkinson, C. Cuthbertson, BH. Brett SJ. (2013) An exploration of social and economic outcomes and associated health related quality of life after critical illness in general intensive care survivors: a 12 month follow up study. Critical Care; 17:R100.

7. Cuthbertson, BH. Rattray, J. Campbell, MK. Gager, M. Roughton, S. Smith, A. Hull, A. Breeman, S. Norrie, J. Jenkinson, D. Johnston, M. (2009) The PRACTICAL study of nurse led, intensive care follow up programmes for improving long term outcomes for critical illness: a pragmatic randomised controlled trial. British Medical Journal; 339:b3723.

8. Walsh, TS. Salisbury, LG. Merriweather, J. Boyd, JA. Griffith, DM. Huby, G. Kean, S. MacKenzie, SJ. Krishan, A. Lewis, SC. Murray, G. Forbes, JF. Smith, J. Rattray, JE. Hull, AM. Ramsay, P. (2015) Increased hospital based physical rehabilitation and information provision after intensive care unit discharge. The RECOVER Randomized clinical trial. JAMA; 175(6):901-910.

9. Health Foundation (2011). Evidence: Helping people help themselves. health.org.uk. Accessed 10th May 2015.

10. Walker, W. Wright, J. Danjoux, G. Howell, SJ. Martin, D. Bonner, S. (2015) Project Post Intensive Care exercise (PIX): A qualitative exploration of intensive care unit survivors perceptions of quality of life post discharge and experience of exercise rehabilitation. Journal of the Intensive Care Society; 16(1):37-44.

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3.2 What is the intervention/solution you are proposing and how will it address the identified problem? Please describe your chosen intervention including location and scale. (600 words)

The intervention is a five week, self management, peer supported, person centred

recovery programme for ICU survivors and their caregivers. The intervention is

presently run in a single centre. The aim of this application is to scale the

intervention up to five other centres across four Health Boards in Scotland. This will

allow the project team to study the scale up of the intervention across different

Health Boards and local contexts in a manageable way.

For each centre there will be a pre-determined number of cohorts per year. Each

cohort will include 10-12 patients and their caregivers. Appointments to attend

InS:PIRE are sent out six to 12 weeks following hospital discharge. Patients not

wishing to attend at this point are given the option to attend at a later date. We

have seen many patients benefit from attending later.

InS:PIRE is run in area close to, but separate from the ICU. We have a cafe area

which is managed by patient and caregiver volunteers who are further along their

recovery trajectory. This peer support encourages individuals to speak to others

who have been through a similar experience.

Each week, patients and caregivers receive one hour of physiotherapy as a group.

Within this 'class', discussion takes place about different aspects of physical and

psychological recovery including information on, for example, diet and sleep. The

patients and caregivers also have individual appointments with the physiotherapist,

a nurse and doctor from intensive care and the ICU pharmacist.

The pharmacy appointment educates patients to understand their medications. We

have successfully integrated the National Patient Safety Foundation's ‘Ask Me

Three’ education tool to empower patients to become active members of the

healthcare team.

The individual physiotherapy appointment focuses on physical issues, especially

those related to chronic pain. The appointment with the nurse and doctor explores

what happened during the ICU stay and creates, with the patient and caregiver,

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personal goals aimed at improving health and well-being.

On the fourth and fifth week of the programme we have group sessions to

encourage discussion between participants, with the aim of creating peer support.

Week four is the psychology week where we separate patients and caregivers.

Each group receives two sessions, one related to sleep and one related to common

reactions to recovery from critical care and coping skills. The final week of the

programme is the 'social prescription' week. We also have the Citizens Advice

Bureau, the Carers Centre, the Glasgow Council for the Voluntary Sector and the

Local Council Activity Programme visit. Many of these services are mandatory in

Scotland and will be available at every centre.

Patients are followed up at three months and one year. Our follow up rate is over

90% in our SHINE 2014 cohorts which is substantially higher than many other

studies in the area.

InS:PIRE was co-produced with service users as drivers for change. The driver

diagram below explains how our multi-faceted intervention is effective and will lead

to improvement at scale. This is the first ICU rehabilitation model encompassing

and integrating health and social support; this is key for optimal recovery. By

utilising a personal outcomes approach to establish individualised patient goals,

patients are empowered to take control of their health and make meaningful

changes with the support of professionals.

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Finally, this is the first rehabilitation programme which has included caregivers.

During our pilot work, we established that caregivers of ICU survivors face

significant issues following exposure to critical care discharge, including high rates

of depression and anxiety (See Section 8.4 for further details).


3.3 What evidence do you have that your intervention has already been successfully tested and ready to be implemented at scale? (300 words)

1. Patient stories: Using video clips and in depth interviews, we demonstrate the

benefits that patients and caregivers derive from speaking to patient volunteers, the

peer support, access to services such as Citizens Advice and the use of personal

goals to facilitate self management. The following link shows patients and family

members discussing their experience: https://vimeo.com/110552052 (password:

InS:PIRE).

2. Self efficacy: We used self efficacy scores at the start and the end of the InS:PIRE

programme to understand how 'in control' patients feel about their future. The scale

ranges from 10-40 (10 lowest possible self efficacy and 40 being top score). At the

start of the clinic, the average self efficacy score was 26 but within five weeks it

increased to 28 (p=0.04) indicating that patients feel more able to cope with the future

after attending the clinic. We have also seen this improvement sustained at six

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https://vimeo.com/110552052

months.

3. Qualitative Analysis: Interviews with 10 participants demonstrated the positive

impact of the InS:PIRE programme. The data demonstrated the positive benefits of

the health and social support given as well as positive changes to both psychological

and physical health.

The CEO and Medical Director of our NHS Board are impressed by InS:PIRE’s impact

and have committed to support our work beyond SHINE 2014 for the rest of the

financial year (2015-2016). Further, the Scottish Government's Healthcare and Quality

Strategy department have provided a further £100,000 of funding over the course of

the next two years, to help fund development on the programme. We will work closely

with Quality Unit and the Scottish Government over the duration of the award to ensure

future spread.


Section 4: Making improvements and measuring impact

4.1 Tell us about the improvement approaches / change methodology you propose to use to implement the project. (600 words)

We are going to use two improvement approaches to implement this project. The

Model for Improvement (1) will be used to test changes at a local level. The

Breakthrough Series College model (2) will be used to share learning between

participating centres.

We chose to use the Model for Improvement because staff members have

familiarity with it. All ICUs in Scotland participated in the Scottish Patient Safety

Programme (SPSP). The ICUs started using this methodology in 2008; it is the one

improvement methodology they are familiar with.

The Model for Improvement is a simple yet powerful model, used for accelerating

improvement that has two main components. The first asks three fundamental

questions that can be answered in any order:

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?

The second component of the model are Plan-Do-Study-Act (PDSA) cycles to test

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changes on a small scale. These enable rapid learning on how the changes work,

leading to successful implementation of change.

From experience running our SHINE 2014 InS:PIRE project, repeated testing of

changes has allowed us to efficiently prototype our intervention. A key component

in the design of InS:PIRE is that on the sixth week a learning and reflecting session

was built onto the programme. This enabled us to develop and test changes for the

next cycle, based on the learning gained from all the testing done in that five-week

cycle. This step kept team members focussed on working out how to progressively

improve what we were doing. It also enabled team members, who may have

attended on different weeks, to share their experiences and to mutually contribute

ideas to the work.

In the scaling up work, despite our success prototyping in one centre, the use of

improvement methodology and the sixth week learning and reflection session will be

repeated in each centre. In the SHINE 2014 InS:PIRE project, the learning and

reflecting session was facilitated by someone who had been a Scottish Quality and

Safety (previously SPSP) Fellow.

NHSScotland developed the Scottish Quality and Safety (previously SPSP)

Fellowship to build improvement capability in clinical leaders (3). There have been

seven fellowship cohorts with a total of 104 fellows so far. Each acute hospital in

NHSScotland has at least one fellow. We will work with fellows in each hospital to

provide facilitation of each learning and reflection session.

The Breakthrough Series College model will also be used. There will be national

learning sessions for all teams through this project, interspersed with action periods.

The initial learning session will focus on the project, team building, and what the

team will have to do to set up and improve a rehabilitation clinic. An introduction to

the Model for Improvement will be provided for staff who have not previously used

it, for example third-sector partners. This will also provide a refresher for those staff

who have previously used it.

While the first national learning session will be weighted toward teaching, the

second and subsequent learning sessions will focus on mutual learning. Local

teams will present what has worked well in their local context, learning from tests

they have run, together with what problems remain. We aim to use mutual learning

to promote problem solving. The final learning session will build on previous

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sessions, and help teams make plans for sustaining their new service and how to

spread and share the results.


References:

1. Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. Using the Model for Improvement. The Improvement Guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco, CA: Jossey-Bass; 2009. p. 89 - 108

2. Breakthrough Series College. Institute for Healthcare Improvement. 2003 Cambridge, MA. Available at http://www.ihi.org/education/inpersontraining/BreakthroughSeriesCollege/Pages/default.aspx (Accessed 6th September 2015)

3. Scottish Quality and Safety Fellowship. NHSScotland Quality Improvement Hub. 2015 Edinburgh, Scotland. Available at: http://www.qihub.scot.nhs.uk/education-and-learning/scottish-quality-and-safety-fellowship.aspx (Accessed 6th September 2015)

4.2 What is the expected impact on patients/carers/service users and what are the anticipated outputs and outcomes of your proposed intervention? (300 words)

Previous research from Glasgow Royal Infirmary has baseline data describing return to

employment; GP visitation and quality of life at one year post intensive care discharge.

During the set up period, similar data will be collected for all implementation sites. These will

act as historical control data. We will also collect this data from one site not participating in

the study. The project manager will be responsible for collecting this data with the support of

the clinical lead for InS:PIRE at each site.

The reality of hospital discharge after an ICU admission is very different to what patients are

caregivers envisage. Poor mobility, dependence on family members and continuing health

issues can lead to depression, anxiety and low self-esteem. Patients feel guilty for

burdening their family. As healthcare professionals we have learned from this revelation and

dealt with the consequences directly. For carers, there is exhaustion and disbelief that life is

worse now their loved one is home. Patients and caregivers feel unable to communicate

their fears to each other which can impede the recovery process.

InS:PIRE allows ICU survivors and their family members to ‘normalise’ their feelings and

that in itself is often a huge relief. They feel less isolated after speaking to other patients

and relatives. Patient volunteers provide hope for the future by offering advice on how to

improve the journey to recovery.

This asset based approach aims to co-create health and wellbeing in ICU survivors and

their caregivers. InS:PIRE empowers patients to take control of their own health. They are

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http://www.qihub.scot.nhs.uk/education-and-learning/scottish-quality-and-safety-fellowship.aspx

http://www.qihub.scot.nhs.uk/education-and-learning/scottish-quality-and-safety-fellowship.aspx

http://www.ihi.org/education/inpersontraining/BreakthroughSeriesCollege/Pages/default.aspx

http://www.ihi.org/education/inpersontraining/BreakthroughSeriesCollege/Pages/default.aspx

given the tools and information they require to help support their recovery from critical

illness using community resources.

InS:PIRE improves mental well-being and the ability to cope with adversity. Our aim is to

help patients improve their health and participation in society, including return to work.


4.3 Tell us how the improvements in the quality of care you seek to achieve will be measured. Tell us about your measurement framework including key metrics and existing baseline data. (600 words)

Over the last year, a number of tools have been used to measure improvements. This

has now been rationalised with the input of the service users and caregivers. These

tools are completed at the start of the clinic, at three months and at one year following

critical care discharge. The personal goals and the self efficacy tools are also

completed at the end the five week rehabilitation programme.

Personal Goals: The project team have tested a personal goals tool for ICU patients

and their families. This involves asking patients ‘What can’t they do after ICU, that they

could do before and would like to do again?’ They then rank from 0-10 where they

think they are currently with regards to where they would like to be, we then chart their

progress over the follow up period.

This process has helped establish if patients feel the clinic is having a meaningful

impact on their health and well-being. We have received extremely positive feedback

from patients and their relatives about this approach. This tool moves beyond the

traditional goals approach and explores the social needs of patients and their

caregivers. We think this is one of the key differences in our rehabilitation model.

Physiotherapy: The Six Minute Walk Test (6MWT) and grip dynamometry,

measure exercise capacity and upper limb strength respectively. They have been

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widely used with critical care patients (1, 2).

Quality of life: The Hospital Anxiety and Depression Scale contains 14 statements

relating to mood (3). It takes a short time to complete and has been validated in

intensive care patients and their families (4). The Impact of Events Scale (IES), which

screens for symptoms of Post Traumatic Stress (PTSD) will also be utilised (5).

The EQ-5D (© 1990 EuroQuality of life Group. EQ-5D™) is a simple questionnaire

validated for postal surveys, telephone or face to face interviews. It comprises two

parts, a simple five question descriptive component exploring various health domains

and a visual analogue scale regarding quality of life on the day of questionnaire

completion. Health Economists use the ED-5D to understand any gains in Quality of

Life Adjusted Years (QALY's).

We utilised a self-efficacy tool as a measure of ‘how in control’ patients felt. For the

SHINE 2014 award we used the Schwarzer and Jerusalem (1995) tool, however,

feedback from patients was not favourable (6). The found it to be repetitive and

irritating. As such we will be piloting a new tool for the cohorts funded by the Health

Board. Finally, we also use the Insomnia Severity Index (7) to explore sleep patterns

in this patient and caregiver cohort.

Family members: We will utilise similar quality of life measures for family members

(HADS and the ISI). We will also utilise a Carer Strain Index to understand the impact

of caring for a critically ill patient on relatives.

Pharmacy: The process of Medication Reconciliation will be used to quantify

prescribing appropriateness post discharge from ICU and identify pharmaceutical care

issues. These issues will then be classified and scored according to severity (8). A

letter detailing any pharmaceutical care issues is sent to the patient's GP. Patients are

encouraged to discuss the issues highlighted during the session with their GP using

the National Patient Safety Foundation Framework -"Ask Me 3". The pharmacist also

evaluates any educational needs that the patients have in respect to their medication

and appropriate educational input is provided.

Further, at 12 months we will aim to reduce GP visitations by 20% and increase return

to employment by 20% in this population. We have baseline data to determine if there

are any improvements in these domains.

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Actual word count:600References:1. Alison, JA. Kenny, P. King, MT. McKinley, S. Aitken, LM. Leslie, GD. Elliott, D.(2012) Repeatability of the Six Minute Walk Test and Relation to Physical Function in Survivors of a Critical Illness, Physical Therapy;92(12):1556-1563.

2. Corner, E.J. Wood, H. Englebretsen, C. Thomas, A. Grant, R.L. Nikoletou, D. Soni, N. (2013) The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy; 99:33-41.

3. Zigmond, AS. Snaith, RP. (1983) The Hospital and Anxiety Depression Scale. Acta Psychiatrica Scandinavica; 67:361-70.

4. Cuthbertson, BH. Rattray, J. Johnston, M. Wildsmith, A. Wilson, E. Hernendez, R. Ramsey, C. Hull, AM. Norrie, J. Campbell, M. (2007) A pragmatic randomised, controlled trial of intensive care follow up programmes in improving longer term outcomes from critical illness. The PRACTICAL study. BMC Health Services Research; 7(116).

5. Weiss, DS. (2007) The Impact of Events Scale-Revised. In J.P Wilson & C.S Tang (Eds.) Cross- Cultural Assessment of Psychological Trauma and PTSD (pp. 219-238). New York: Springer.

6. Schwarzer, R. and Jerusalem, M. (1995) Generalised Self Efficacy Scale. In Weinman, J. Wright, S. Johnston, M. Measures in Health Psychology: A users portfolio Casual and Control beliefs.

7. Bastien, CH. Vallieres, A. Morin, M. (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine; 2:297-307.

8. Cipolle, RG. Strand, LM. Morley. PC. (2004) Pharmaceutical Care Practice: The Clinician's Guide, Second Edition.

4.4 Explain the potential contextual challenges and barriers to the successful delivery of the improvement. How do you plan to address them? (300 words)

In any novel project, the initial team have a sense of ownership that makes it work.

The challenge is that the project outcome may be person dependent and not a

consequence of the intervention delivered. The evaluation team will explore this.

In scaling up this project, individuals have expressed an interest to get involved. This

favours those who are interested and enthusiastic; however, the project in each local

centre depends on a team. To be sustainable the project requires to be shared in the

wider clinical team. An executive sponsor will be established at each site.

Sustaining this work beyond the lifetime of the project will require us to demonstrate

long-term benefits. We believe the two year duration of this work will enable us to

demonstrate this. Partnership with the Scottish Government will also help sustain and

spread this work.

Our patient and family council led to co-production of a programme that was relevant

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to patients in our SHINE 2014 work. We have experience setting up these councils.

We will coach each unit on how to do this; the grant for this program includes funding

to address this.

We have developed a learning prototype. Maintaining this learning approach will be

necessary on each site. We will need local teams to test their own changes for their

local context and not simply copy the existing InS:PIRE model. Involving the Scottish

Quality and Safety Fellows at each site will support this.

Another challenge to the successful delivery of the project will be ensuring that the

third sector partnerships, which have successfully been created in the pilot, can

continue on a national scale. To overcome this, we are partnering with the Scottish

Government's Health and Social Care Unit. Their role will be to support the health and

social integration component of this project.


4.5 Describe how you will capture learning on making improvements in health care. (300 words)

Each participating centre will contribute to this. The learning and reflecting session is

built onto the end of each five-week cycle. We found this very helpful in our SHINE

2014 work. A person who had been a SPSP Fellow facilitated the session. His role

was to get feedback from each member of the team. This was done by going round the

team and asking in turn in their experience of the most recent cohort: “what worked

well?” and “even better if?”

This method provided a simple relaxed way to engage team members and get them to

reflect on what had happened over the previous five weeks. The latter question

provided the basis for designing what changes to test in the set up and running of the

project for the next cohort.

Malcolm Daniel will jointly facilitate the first learning and reflecting session with the

SPSP fellow linked to each local team. The formal outputs from each team will be a

listing of “what worked well?” and “even better if?”; together with details of and learning

from, the changes the local team decides to test.

We will ask for hard copies of these to be submitted as part of data collection at the

conclusion of each five-week cycle. This will also provide a framework for the local

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teams to share their individual learning with the other teams at the national learning

sessions.

Malcolm Daniel has coached the last three cohorts of SPSP fellows on how to run such

a session and to generate ideas for testing. For sites with a SPSP fellow from an earlier

cohort, he will provide additional coaching.

The project and the evaluation team will track the data being submitted by the local

teams at the end of each learning cycle.


Section 5: About the evaluation

This section of the application should be completed by your evaluation partner, in discussion with you.

5.1 How do you propose to evaluate the project? (1,800 words)

Overview of the EvaluationThe major objective of the second phase of InS:PIRE, which successfully

demonstrated feasibility and effectiveness in the single Glasgow site SHINE 2014

pilot, is scaling up to five other centres in four Scottish Health Boards (including a

specialist cardiac centre). The scaling up objective is to robustly demonstrate this

improvement can be successfully implemented across the UK NHS.

The independent Evaluation Team will work closely with the research team on an

Evaluability Assessment (EA), a formative/rapid cycle evaluation to feedback

changes to the improvement project during implementation and finally a summative

evaluation at project finish.

Rigorous and evolving evaluation is essential to ensure the improvement project is

implemented successfully (avoiding predictable mistakes and reducing latencies)

and to show the final findings are robust and credible. The main evaluation

purposes are therefore to: (a) conduct an initial EA; (b) continue to evaluate all

aspects of the improvement implementation using a formative approach; and (c)

deliver a final independent evaluation (summative approach), with appropriate focus

on what didn’t go according to plan and what the remaining challenges are for a

16

nationwide roll out.

The ICU setting is challenging and this improvement project involves many

disparate stakeholders including multidisciplinary ICU staff, as well patients and

carers, and several institutions (the Scottish Government's Health and Social Care

Unit [HSCU], Healthcare Improvement Scotland [HIS], Patient and Family Councils

[PFC], and the Scottish Intensive Care Society [SICS]), as well as the five sites in

four Health Boards and the media (TV, press and social media). The evaluation will

ensure that all the stakeholders are properly consulted and informed.

The patients and carers are central to this improvement exercise. Although the

SHINE 2014 pilot successfully engaged them, it will be a significant challenge

porting that to other sites and making any necessary adaptations. For example,

finding a workable space for delivering the intervention (e.g. the café space that

facilitated patient shared interaction) might be challenging. A further challenge will

be the acceptability of the improvement programme to the patients and carers and

that the proposed outcomes assessments are not too onerous in either time or

complexity. The pilot indicated for example, negativity towards some aspects of the

patient outcome questionnaires, which is currently being addressed.

Sometimes a pilot/feasibility conducted on ‘home turf’ can underestimate the

difficulties in scaling up to different sites. For example, buy-in of the various

stakeholder institutions may be automatic in the Chief Investigators site because it

capitalises on existing relationships and/or the project is seen as a priority. The

evaluation will scrutinise the plans for ensuring institutional stakeholder engagement

(e.g. NHS Health Boards, ICU sites, national co-ordinating bodies such as HIS),

through reviewing the written materials (the project ‘branding’), the proposed

engagement meetings (face-to-face or video or teleconference) and ensuring

adequate opportunity for stakeholder feedback.

The addition of comparator or control groups is a substantial development from the

single site pilot design. We will carefully review the plans for control data. This is a

combination of baseline data from all study sites (so acting as their own control,

using a before and after design, but potentially confounded by time) and a separate

control site not included in the improvement intervention. We will evaluate the

statistical plans to ensure that the control data is of an appropriate quality

(completeness and accuracy) and fit for purpose as comparator data. The

evaluation team will also assess the statistical analysis plans to make use of these

17

data in the full report. In particular the evaluation of the ‘before/after’ control data will

try to quantify the risk of this temporal confounding.

Phase One – The Evaluability Assessment (EA)

The purpose of the EA is to carefully scrutinise all aspects of the proposal and how

this will translate into a workable project with achievable goals, set to realistic

timelines. There will be face-to-face meetings to assess initial feasibility of the

objectives and implementation plans and also to agree an Evaluation Charter (the

expectations between the evaluators and the research team and their mutual roles

and responsibilities), as well as a detailed Evaluation Plan.

The EA will explore every dimension – the setting, the improvement intervention,

the proposed controls, the suggested outcomes, the stakeholders and their

expectations, what activities are necessary for the project to succeed, the

scheduling of these activities and matching all these to available resources. The

evaluation will require a clear project communication plan and will demand a risk

assessment, identifying the conditionalities in the proposed activity schedule, with

evidence of appropriate and feasible contingency plans built in.

We will review proposed plans and timelines for gaining ethical approvals and

financial authorisations, including all necessary consents for patient record access

and ensuring appropriate consent for any record linkage into national datasets.

The Evaluation Team will also assess project methodologies to ensure that they are

fit for purpose and sufficiently near best practice. We will review who is doing what

and ensure they are suitably trained and experienced for the roles. Any training

gaps will be identified and a plan to rectify any gaps sought.

We will assess the improvement project timelines for feasibility and try to identify

any latencies or bottlenecks that can be removed. Having identified the activities

that will deliver the improvement projects objectives, we will assess whether there

are any redundancies or missing links.

The EA will take place throughout the first six months of the initiation stage. There

will be an initial meeting between the Evaluation Research Fellow (ERF) based in

HSRU, Aberdeen (along with Professors Norrie and Campbell, the Evaluation

Supervisors) and the study team (including Professor Kinsella, Joanne McPeake,

18

Helen Devine, Pamela MacTavish, Malcolm Daniel and Tara Quasim) in Glasgow

(month one, face-to-face, full day). We will review all documentation and draft an

Evaluation Plan, describing what will be evaluated and when. This will also include:

an agreed specification of roles and responsibilities for the Study Team and the

Evaluation Team (The Evaluation Charter), ways of working and what expectations

the teams have of each other. The Evaluation Plan will include a schedule of key

improvement intervention activities, including interviews of project staff by the ERF,

interviews with site staff (of all disciplines, including clinicians, nursing staff,

pharmacists and psychologists) and likewise with patients/carers.

The Evaluation Plan will also formulate a Dissemination and Publication Plan for the

Evaluation (DPP-E), as well as critiquing the wider DPP for the improvement project

in general. Approximately one month later after a written correspondence on this

draft by e-mail, there will be a teleconference to adopt the Evaluation Plan.

The ERF would then meet in person / over Skype or telecall at least weekly with the

project team for this first phase. This would be a smaller constituency, with the main

collaborators being the ERF in Aberdeen and the Project Lead (Joanne McPeake)

in Glasgow. In month three there would be the second face-to-face all day meeting,

which would now be the formal start of the Evaluability Assessment. At the end of

that day we will have discussed all aspects of the project and the Evaluation Team

(ERF and Norrie/Campbell) will draft the EA Report (one month). In month four

there would be the third face-to-face meeting to discuss the EA Report and assess

any required changes and/or contingency plans. In the final two months there would

be regular teleconferences to sustain progress in the EA phase.

Phase Two – The Evaluation of the Implementation of the Improvement ProgrammeThis will be the most substantial part of the evaluation, adopting a mix of formative

and rapid cycle evaluation which will be characterised by detailed and purposive

interaction between the Evaluation and Study teams. This will ensure refinement of

the intervention and strengthen its potential for successful implementation. It is not

a developmental evaluation per se – we feel the scope of the objectives of the

improvement project are well defined and have been demonstrated as feasible and

fit for purpose, from the pilot phase in Glasgow Royal Infirmary. The main

uncertainties now concern the scaling up to five more diverse sites and hence

demonstrating this improvement project can be rolled out nationally. Consequently,

the main focus of the formative evaluation is to ensure coherent feedback on

problems or barriers to the scaling up phase.

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The refining of the improvement intervention will be informed by two main sources

of “feedback”: insights from the end of cohort intentional learning and reflecting

sessions (which are built into the intervention roll-out) and in-depth semi-structured

interviews with key stakeholders at each site (interviews will be conducted with at

least one member of all key stakeholder groups at each site including lead ICU

clinician, local NHS manager, patients, caregivers and rehabilitation clinic

personnel). There will be approximately five-seven interviews per site. Core to

these interviews will be identifying what worked/did not work, for whom and why.

In summary, the objective will be to confirm the proposals carried forward from the

EA, re-visiting and refining these as appropriate and to address developing and

emerging issues in the implementation stage of the improvement project. We will

cover important dimensions such as communication, time commitment required,

practical and resource issues or constraints and patient, clinician, and managerial

acceptability. Frequent meetings between ERF (and their supervisors) and the

study team (face-to-face or by videoconferencing) will continue throughout this

phase. This process will facilitate rapid and tailored refinement of the intervention,

as required, over the implementation phase.

Phase Three – The Summative Final EvaluationThis will take place in the last three months of the project and will use a summative

approach. Success of the scaling up will be through two primary dimensions:

Overall acceptability of the intervention to the different stakeholders groups

assessed through end of study semi-structured interviews with stakeholders at

each site and

Quantitative evaluation of the patient-based quality of life measures collected

as part of the project (from both intervention and the control sites).

Key learning points will focus on both successes and the failures (what worked/did

not work for whom and why),what lessons have still to be learned, what barriers are

still to be overcome and what uncertainties still addressed.

The Final Evaluation will also consider issues around the sustainability of the

improvement. It will be drafted by the Evaluation Team and shared with the study

team in advance of a final one-day face to face meeting when the draft will be

discussed in detail. The Final Draft will then be issued within a fortnight and

20

disseminated to interested stakeholders (which could include the patients & carers,

or their representatives, the ICUs both in and outside the study group, the

professional societies, Health Boards, the Scottish Government and other

institutional stakeholders).


5.2 Tell us about the experience and expertise of the evaluation team. (400 words)

The evaluation team will comprise the appointed Grade 7 Research Fellow, based

in the Health Services Research Unit (HSRU) at the University of Aberdeen,

supervised by Professors John Norrie (Director of the Centre for Healthcare

Randomised Trials (CHaRT), an NIHR registered Clinical Trials Unit) and Professor

Marion Campbell (Director of HSRU). Additional expertise within HSRU will be

available from Professor Craig Ramsay (Director of Health Care Assessment and

expert in improvement science methodology) and Professor Lorna McKee (Director

of Delivery of Care and expert in the evaluation of organisational change).

This team is vastly experienced in health services research, specifically in clinical

evaluation studies. We intend to employ a Grade 7 mixed methods researcher to be

the Evaluation Research Fellow. The main supervisors – Professors John Norrie

and Marion Campbell, are very experienced health services researchers and

statisticians by background.

John Norrie was involved in both the two prominent randomised control trials in the

area of ICU Follow up – PRACTICAL as grant holder and RECOVER as an expert

member of the Data Monitoring Committee (DMC) charged with independent

oversight of the study (1, 2). He has over 25 years experience of major medical

projects, including landmark randomised trials of both drugs and complex

interventions. He has sat on numerous funding panels, involving extensive

evaluation of a huge variety of research proposals and is also as an independent

member of a large number of Trial Steering Committees and Data Monitoring

Committees. John is co-author on over 200 peer reviewed publications in the

medical and statistical literatures. Finally, he has extensive experience at

communicating complex research ideas and methodologies to lay audiences.

Marion Campbell is Director of the Scottish Government funded Health Services

Research Unit. She specialises in the evaluation of complex interventions including

evaluations of large scale system changes. She has significant experience in

21

leading mixed methods evaluations and in the synthesis of findings from

quantitative and qualitative approaches. She was a grant holder on the

PRACTICAL trial and has extensive domain expertise in ICU trials, highly relevant

to this evaluation. Until recently she was Deputy Chair of the NIHR Health Services

& Delivery Research Board, which specialises in (qualitative and quantitative)

service and delivery evaluations.

Actual word count:364References:Cuthbertson, BH. Rattray, J. Campbell, MK. Gager, M. Roughton, S. Smith, A. Hull, A. Breeman, S. Norrie, J. Jenkinson, D. Johnston, M. (2009) The PRACTICAL study of nurse led, intensive care follow up programmes for improving long term outcomes for critical illness: a pragmatic randomised controlled trial. British Medical Journal; 339:b3723.

Walsh, TS. Salisbury, LG. Merriweather, J. Boyd, JA. Griffith, DM. Huby, G. Kean, S. MacKenzie, SJ. Krishan, A. Lewis, SC. Murray, G. Forbes, JF. Smith, J. Rattray, JE. Hull, AM. Ramsay, P. (2015) Increased hospital based physical rehabilitation and information provision after intensive care unit discharge. The RECOVER Randomized clinical trial. JAMA; 175(6):901-910.

22

Section 6: Managing the project

6.1 Provide a brief description of each of the organisations involved in the application. (50 words per organisation per column)

Please note that if any changes to partner organisations have been made since your outline application, you must explain the reasons for this and demonstrate how it will strengthen your application.

Organisation name and type of organisation

Rationale for involvement in the project (areas of expertise relevant to the project)

Role within the project and engagement with the proposal to date and in the future

Lead organisationNHS Greater Glasgow and Clyde Host of the original pilot site

Three out of four of the clinical leads are based in NHS Greater Glasgow and ClydeThe Change Management expert involved in the programme is based in NHS Greater Glasgow and Clyde.

This Health Board have run and continue to support the pilot work of InS:PIRE. All senior managers within our sector (Chief Executive, Chief Nurse and Clinical Director) have visited the clinic and are fully supportive of the proposed scaling up bid.

Evaluation partnerHealth Service Research Unit, University of Aberdeen

Evaluation of the Scaling up Intervention.The Health Service Research Unit has an international reputation in health service research.They have expertise in evaluating mixed methods research and complex interventions such as InS:PIRE. The team in Aberdeen have been involved in previous ICU follow up research.

Independent Evaluation.We have engaged in weekly conference calls in the run up to this proposal being submitted.

Patients’ / Carers’ / Service users’ organisationICU Patient and Family Advisory Council (Glasgow Royal Infirmary). This Council will be replicated in each InS:PIRE scale up site.

This asset based model of care was co-produced with patients and carers. Each caregiver and family member involved has direct experience of the ICU recovery and understands the complex

Different geographical populations may have different requirements with regards rehabilitation. A Council will be created at each site during the set up phase to ensure that the planned

nature of the rehabilitation process. programme is safe, effective and person centred. Volunteer User Group This model of care thrives due to the use of peer

support between patients. This peer support is also facilitated through patient and caregiver volunteers who are further along their recovery trajectory.

We have now established a network of patient and caregiver volunteers within Glasgow. With the support of this group we intend to create a network across all sites. We are currently co-producing a programme of training and induction for our volunteer group with Diabetes Scotland.

Other partnersUniversity of Glasgow Higher Educational Institute

Higher Education Institution. This organisation will be involved in providing staff for both the implementation and design of this project. Staff from University of Glasgow have been involved and have been co-project leads in the pilot of InS:PIRE

NHS Healthcare Improvement Scotland

National healthcare improvement organisation for Scotland and part of NHS Scotland

Support for spread, dissemination and sustainability of the programme across NHS Scotland. Involvement of SPSP fellows across different sites. Vast experience in large scale improvement projects.

Scottish Government Health and Social Care Quality Unit

The Scottish GovernmentResponsible for Health and Social Care Integration across NHS Scotland

Developing the social and healthcare integration component within the project on a national scale. Responsible for funding both: A Local Information Service for Scotland (ALISS) and the Health and Social Care Alliance Scotland.

Scottish Intensive Care Society Registered Charity/Professional Organisation Organisation with representatives from every ICU/HDU in Scotland. Key for scale up and sustainability beyond the grant funding.

6.2 Tell us about the organisations’ experience in designing, implementing and sustaining large scale improvement projects. How successful were they and what lessons were learnt from this experience? (300 words)

7

NHS Greater Glasgow and Clyde, the University of Glasgow, Healthcare Improvement Scotland and the Scottish Intensive Care Society all

have experience in designing, implementing and sustaining large scale improvement projects. One of the main features of the partnership

between the project team and Healthcare Improvement Scotland will be the utilisation of expertise to aid in the implementation of the proposed

work.

Healthcare Improvement Scotland take a lead role in co-ordinating the work of the Scottish Patient Safety Programme (SPSP). The SPSP

was launched in 2008. It was a unique national initiative which aimed to drive improvements across the whole of NHS Scotland. Since its

launch, the Acute Adult work stream of the SPSP (a national collaboration across all acute hospital settings in Scotland), has contributed to a

significant reduction in harm and mortality to acute adults, including a 20% reduction in mortality from sepsis. Other work streams within the

programme, such as the Maternity and Children Quality Improvement collaboration, have seen similar striking results. Through this complex

project delivery, there is already established partnership working between the Scottish Intensive Care Society and all Health boards which will

be involved in the scale up of InS:PIRE.

Many lessons can been learnt from the SPSP which will be utilised within this Scaling up for Improvement Award. Firstly, the use of rigorous,

systematic data to drive improvement is key. Data will be managed locally within the programme and used to drive improvement at both a local

and project wide level. The use of Learning sessions/conferences and the innovative use of WebEx sessions by the SPSP programme, has

also helped implement ambitious improvement work in a reliable manner across sites and wards in Scotland. We will utilise the WebEx system

at local and national learning events throughout the duration of this award.


6.3 Provide details of the core team members working on this project. (50 words per person per column)Name Organisatio Role in the Evidence of specific skills in relation Connections to relevant expert / specialist Time allocated

8

n and job title / role

project to the proposal networks or community of practice to the project (FTE)

TBC Project Manager

Will oversee the smooth running of the project in other sites.

The individual recruited to this post will have the following skills: project management; budget management and financial management.

TBA 0.8

Miss Joanne McPeake

NHS Greater Glasgow and Clyde Clinical Research Fellow

Joint Project Lead. Coordinate nursing involvement in project. Lead for Patient and caregiver involvement in the design of intervention

Project Manger of pilot programme

Project management skills Budget management skills Extensive experience in ICU

follow up Experience of service/user

engagement and creation of Patient Councils

Recent completion of PhD investigating the health and social consequences of ICU recovery.

Member of the Nurse Research Committee, Society of Critical Care Medicine

Member Nursing Group- Scottish Intensive Care Society

Co-Chair, Nursing Research and Practice Committee North Glasgow (NHS Greater Glasgow and Clyde)

Honorary Lecturer, Critical Care- University of Glasgow

Member of the Florence Nightingale Alumni Association

0.05(Joanne will spend a total of two days per week on this project. Backfill for this will be provided from the Chief Scientist Office/ Scottish Government)

Mrs Helen Devine

NHS Greater Glasgow and ClydeSenior Physio-therapist

Coordination of Physiotherapy involvement in project

Extensive experience in ICU follow up

Physiotherapy lead for pilot programme.

Member of Chartered Society of Physiotherapy

Involvement with Scottish Surgical and Critical Care Physiotherapy PD Network

Involved in setting up NHSGGC critical care physiotherapy working party

0.2

Mrs Pamela MacTavish

NHS Greater Glasgow and Clyde Senior Pharmacist

Coordination of Pharmacy involvement in project

Extensive experience in ICU follow up

Pharmacy lead for pilot programme

Experience in Medicine Reconciliation.

Member of the United Kingdom Clinical Pharmacy Association Critical Care Group

Member of the Scottish Adult Critical Care Pharmacist Network

Strathclyde University Undergraduate

0.2

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and Postgraduate tutorProfessor John Kinsella

Professor and Head of Department University of Glasgow

Strategic leadership andmanagement of University partners

Expertise in research methodologies pertinent to the project

Extensive national leadership experience in research management and dissemination

Leadership of pilot programme

Chairman of the Scottish Intercollegiate Guidelines Network

Lead Clinician, Managed Clinical Network, Burns in Scotland

Member- overarching medicine and technologies group, Healthcare Improvement Scotland

Member of Quality Committee, Healthcare Improvement Scotland.

0.1

Dr Malcolm Daniel

Consultant in Anaesthesia and ICU

Lead on improvement methodology. Malcolm willco-ordinate with Healthcare Improvement Scotland and SPSP fellows through the project

SPSP Fellow (Cohort 1) 2008-9

Health Foundation Quality Improvement Fellow (Cohort 7) 2010-11

While at IHI participated in Breakthrough Series College programme

Faculty for SPSP Safety Programme 2009-13; has experience setting up, facilitating and running learning sessions.

Mentor to Scottish Quality and Safety Fellows

Member of NHS Scotland QI Hub Strategic Partners Expert Group

Health Foundation Q Initiative Founding Cohort Fellow

Connected internationally via the IHI Fellows network

Mentors and teaches on Scottish Quality and Safety Fellowship.

0.02

Dr Tara Quasim

Senior Clinical LecturerUniversity of Glasgow

Joint project leadCoordination of medical involvement over the duration of the project.

Co-lead for pilot study Experience in research into

quality of life after ICU Project management skills Experience of multi centre trials

involving ICU patients MPH related to social recovery

for ICU survivors

Registered with GMC and current Fellow of the Royal College of Surgeons (Ed) and Anaesthetists and of the Faculty of Intensive Care Medicine.

Vice-Chair of the Scottish Critical Care Trials Group

0.1

10

6.4 Provide a detailed project plan which includes key deliverables, milestones and timelines. (400 words)

We have created three Gantt charts to demonstrate the project plan, key milestones

and timelines. Gantt chart One sets out the plan for the six month set up period.

Gantt chart Two details the two year implementation phase. Finally, Gantt chart

Three demonstrates the evaluation timeline which will be undertaken by the

University of Aberdeen.

Activity April 2016

May 2016

June 2016

July 2016

August2016

September 2016

Recruitment of staff/ organisation of locumRelevant Ethics and R&D approvals from hospital boards Creation of Patient and Family Advisory Council at each site*Involvement of Patient and Family Advisory Council on design and delivery of programme*Advertising of programmeRecruitment/organisation of social care input across different sitesRecruitment/training of volunteers (including disclosure checks, creation of job descriptions and support of applications)Educations sessions and joint working sessions for all site staffStaff education in all units involved Baseline data of patients discharged from ICU 12-18 months previously.

Gantt chart One: Plan for six month set up period (April-September 2016)

* We will support teams to engage with their local patient populations to ensure that

the interventions being delivered and the interface between health and social care is

safe, effective and person centred. We envisage this being through the use of

Patient and Family Advisory Councils. The core project team had significant

experience both in creating and developing these councils to ensure a model of co-

production is achieved between healthcare providers and patients.

13

Activity Oct-Dec 2016

Jan-Apr2017

May-Aug 2017

Sept -Dec 2017

Jan- April 2018

May-Aug 2018

Involvement of Patient and Family Advisory Councils at each siteLearning sessions at each site with the support of Healthcare Improvement ScotlandStaged implementation at each siteNational collaborative learning sessions Learning and feedback sessions from the evaluation team with the core project team

Gantt chart Two: Plan for two year implementation phase(October 2016- September 2018)

Activity April 2016 May 2016- September

2016

Oct 2016- May 2018

May - Aug 2018

Recruitment of Grade Seven Research Fellow Evaluability Assessment

Formative Assessment

Summative Assessment

Start of Dissemination

process

Gantt chart Three: Plan for the evaluation component of the programme


6.5 How will the project be managed on a day to day basis? (200 words)

A project manager will be recruited during the set up phase and will work four days a

week on the project. A lead nurse, medic, pharmacist and physiotherapist will also be

employed to lead and support the multidisciplinary nature of the project. These

individuals will support recruitment and implementation at all sites.

During the set up phase, any issues which arise will be managed by the project leads.

They will work closely with the project manager during this phase. During the

implementation phase, the project manager will deal with the day to day running of the

programme. They will network with local sites and partnership organisations as

appropriate.

Each site will have a clinical lead for the programme who will be supported by the

15

project leads. SPSP fellows will be supported by Dr Malcolm Daniel.

Project teams will meet twice yearly to share learning and experiences. These

meetings will also include the evaluation partners. The evaluation team will also meet

as detailed in the evaluation plan with the project leads and a member of the Scottish

Health Department, Person Centred Care Team. We expect this overarching advisory

group to include the Health Foundation Research Manager.


Section 7: Embedding and spread

7.1 Tell us how you will sustain the improvements you achieve in this project beyond the life of this award. (300 words)

The project team will utilise the Health Foundation's Communication in Healthcare

Improvement Toolkit as a framework to plan, sustain and spread project InS:PIRE over

the duration of the project.

To ensure sustainability we will:

Plan regular communications with audiences we have already engaged. We

are already planning a national showcase event. We will also continue to

present the learning and ongoing results at national and international

conferences.

We will continue to present novel and transferrable learning from the project at

a national and international level. For example, our work in peer support and

the input of patient volunteers has been presented at the Scottish Parliament.

Indeed, one of our patient volunteers has been shortlisted for the Scottish

Government's 2015 Self Management Inspirational Person of the year award.

This improvement can only be sustained if it is fully embedded within the NHS

and timetabled into job plans. It is for that reason we have been campaigning

the plight of ICU survivors and highlighting the improvements in well-being and

return to employment. Our partnership organisations have been chosen to help

with the sustainability of this programme as the evidence to support the

economic, physical, social and psychological problems for the patient group is

a compelling driver for change.

This project is about improving patient outcomes and has been co-created with

service users. To that end, we have invited senior management from NHS

16

Scotland and senior representatives from Scottish Government to observe the

clinic and speak to the patients directly.

Finally, we have already created and are continuing to create patient stories,

which have been filmed. We are also planning to create an InS:PIRE website.

This will be available for both healthcare professionals and service users.


7.2 Tell us how and when you will disseminate, communicate and spread the improvements you achieve in this project beyond the participating sites. (300 words)

From the outset we will continue to disseminate and communicate information about

this innovation and its outcomes:

Locally Present at local network events.

Use local health boards networks (i.e. staff newsletters) to disseminate the

findings.

Nationally Present the design and outcomes of the project at the Scottish Intensive Care

Society and the Intensive care Society meetings.

We are in the process of organising a 'showcase learning event' for both staff

and caregivers as a result of the learning from our initial SHINE 2014 award.

We will invite members of staff from every ICU and ask individual units to

cascade this to patients and caregivers.

Endorsement from patients to other patient groups if they feel it is of help.

Invite members of key stakeholder groups to observe InS:PIRE.

Our involvement with Scottish Government will give us access to the annual

NHSScotland Event.

Internationally The submission and publication of papers to peer reviewed international

academic journals.

Presentation of conference papers.

Presentation on the design and outcomes at the International Forum on Quality

and Safety in Healthcare.

All publications will highlight the support of Health Foundation.

We will continue to apply for various national and international awards to ensure the

work of InS:PIRE is recognised. At present we have been nominated for three awards

(nominated by Senior Management Staff and by patients).

17


Section 8: Project budget

8.1 How much funding are you requesting from the Health Foundation?

Total cost of project £591,406

Total amount requested from the Health Foundation: £490, 206

8.2 Is there any funding from other sources that has been confirmed (include in-kind and / or cash)?

8.3 Please provide a breakdown of your proposed budget – how will you use the funding on a separate Excel spreadsheet. Please submit it in the same email as the application.

You do not need to write anything here, it is a reminder for you to complete and submit the budget template.

8.4 Please tell us how the costs submitted in the budget represent good value for money. (200 words)

A full economic evaluation of the InS:PIRE programme is currently in progress,

however, initial work is encouraging. InS:PIRE has produced improved Quality of Life

(based on six month follow up results). Assuming no increase in healthcare utilisation,

the cost per Quality Adjusted Life Year (QALY) for the working age population has

fallen from £119,867 at the start of InS:PIRE clinic to £17,235 at six months post

clinic. We have historical data that highlights those receiving the InS:PIRE intervention

have improved quality of life, compared to those who have not.

18

Source Amount In-kind / cash Purpose of fundingScottish Government

£100,000 Cash To support this award and dissemination of InS:PIRE

Patients (Patients who attended the clinic had a fundraising night)

£1200 Cash We will offer all of the volunteers involved training. This funding will paid for the establishment of resources.

It has been calculated that one cohort of InS:PIRE costs £7821 to run (up to 12

participant in each cohort). This equates to approximately £650 per participant.

Our baseline data demonstrated that the caregivers of ICU survivors suffered

significant upheaval also. 53% of caregivers were defined as being strained, 69% had

mild, moderate or severe anxiety, 56% had symptoms of depression and 53% had

symptoms of PTSD. All caregivers receive the same interventions as their relatives

within the InS:PIRE programme.

If we include the cost of 8 family members within each cohort (not all participants bring

a caregiver), this bring the costs of the InS:PIRE intervention to approximately £390

per participant.

Actual word account:200

8.5 Has the budget and distribution of the budget between organisations been approved by the finance teams of all project team organisations?

YES NO

8.6 Please give an example of how the lead organisation has managed a budget of this size while working with multiple partners. (200 words)

This budget will be managed by the Research and Development Department of NHS

Greater Glasgow and Clyde (NHSGGC). NHSGGC researchers submit more than 200

grant applications per annum with budgets varying from £50k to £5million. Many of

these proposals involve working with University and other UK wide and international

partner organisations.

Grants are administered in line with funder terms and conditions, and adhere to

NHSGGC Standing Financial Instructions. Specific cost centres are set up to manage

the income and expenditure for each award with model contracts between the lead and

partner sites outlining responsibilities, financial transactions and milestones. A recent

example is an Association of Medical Research Charities five year study, with 30

partners and a budget of approximately £1m.


19

Section 9: Organisational Support

9.1 Tell us about the executive sponsors for this project and how they will support the project.

Name Organisation name & job title/role Statement of Support

Signature

Dr Jennifer Armstrong

NHS Greater Glasgow & Clyde, Board Medical Director

Statement of Support from Dr ArmstrongThe InS:PIRE team have work tirelessly to design a project with the aim of ensuring that patients and their families are provided with a programme to help them reintegrate into their daily lives including employment and social life. The programme is a 5 week cohort which shows that the cost per qualy is good value, not only for the health service, but also for local authority budgets. In addition, and most importantly, it has significant benefits for both patients and their families.

There are a large number of people admitted to ICU each year both across Scotland and the UK, therefore scaling up of this project is vital to realise maximum benefits. The team have been excellent in their communication and commitment to drive forward this programme and have enthused colleagues, patients and NHS managers as well as the board to take this project forward. I wish them well.

Professor Anna Dominiczak

Regius Professor of Medicine, Vice Principal and Head of College

University of Glasgow

Statement of Support from Professor DominiczakThe University of Glasgow fully supports this innovative project scaling up the InS:PIRE Project across several hospitals in Scotland. This represents collaboration between researchers from the University of Glasgow and a wide group of partners including the NHS, third sector organisations and other HEIs. Angolina Foster

Chief ExecutiveNHS Healthcare Improvement Scotland

Statement of Support from Ms FosterHealthcare Improvement Scotland fully supports the scaling up of the InS:PIRE project. This project has the potential to significantly improve the quality of life in survivors of critical care. This project also addresses Health and Social care integration, a key policy driver within NHS Scotland. Health Care Improvement Scotland is also directly involved in health economic evaluation of the project presently and during this scaling up period. Professor Jason Leitch

Clinical DirectorHealth and Social Care Quality UnitScottish Government

Statement of Support from Professor LeitchI fully support and endorse the successful work being undertaken by the InS:PIRE Project. The impressive work undertaken by the team based at Glasgow Royal Infirmary has brought together a broad range of expertise to work in a collaborative and multi-disciplinary way, with particularly positive engagement from the third sector.

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It has been instrumental in giving ICU survivors the skills, confidence, knowledge and understanding to play a more active role in their care and support. This is very well-aligned with the Scottish Government’s policy ambitions around self management, health literacy, and person-centred care.

Several of our staff members have visited the project over its lifecycle; they have been uniformly impressed.

Shaun Maher from the Person Centred and Quality team commented:

“It was powerful to see how the InS:PIRE approach of first and foremost focusing on understanding what really mattered to the person in the context of their life, in their words, led to big changes in the way support was delivered and big impact in the lives of the people they were helping.”

Graham Kramer, Clinical Lead for Self Management and Health Literacy, added:

“I was hugely impressed by the support that survivors and their families received from the InS:PIRE team, helping them to adapt and self manage in the face of such traumatic and life-changing circumstances. I also sensed it had a mutually beneficial effect on their professionals, enriching their determination to care for their patients.”

I’d highly commend the project for further funding to scale-up and spread this approach to other places across Scotland.

Dr Graham Nimmo

PresidentScottish Intensive Care Society

Statement of Support from Dr NimmoOn behalf of the Scottish Intensive Care Society I am pleased to be able to offer our full support to the continuation of the InS:PIRE Project. The work being undertaken, and developed, by the InS:PIRE team based at Glasgow Royal Infirmary is vital to the recovery, in all its aspects, and the well being of survivors of intensive care, their families and carers.

I have had the opportunity of visiting the project and have been extremely impressed by the practical application of the work to the individual people for whom it has been designed. In terms of social capital it is also invigorating and enthusing the staff who are involved, to their benefit, and to that of the patients, relatives and carers.

SICS strongly recommends that further funding is made available in order for the project to be scaled-up and spread to other places across Scotland.

Section 10: Declaration and Signatures

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To comply with the Data Protection Act, we require your consent to the Health Foundation using personal data supplied by you in the processing and review of this application and in any other legitimate activity of the Foundation; this includes transfer to and use by such individuals and organisations as the Foundation deems appropriate. The Health Foundation requires your further assurance that personal data about any other individual is supplied to the Foundation with their consent.

The applicant also accepts the Health Foundation’s requirements relating to the Data Protection Act (see above). The signatory below will provide this consent and assurance. The signatory below also confirms that the information provided in the application form is accurate.

Electronic signatures are required as the application form is to be returned by email.

10.1 Primary contact (named in 1.3)

Applicant name: Miss Joanne McPeake ....................................................................................

Signature ......................................................................................

Date 28th of September 2015.....................................................................................................

10.2 A senior leader (chief executive, senior deputy or senior clinical lead) from the lead organisation (named in 1.2) must fully support this application signing the declaration below:

‘I confirm that I have read and fully support this application. The organisation accepts The Health Foundation’s requirements relating to the Data Protection Act (see above). The signature below provides this consent and assurance.’

Name: Dr Jennifer Armstrong

Job Title: Medical Director

Signature

Organisation: NHS Greater Glasgow and Clyde

Date: 29th of September 2015

10.3 The Head of Finance Department or Director of Finance or equivalent of the organisation financially accountable to the Health Foundation (the lead organisation named in 1.2) if an award is made should sign the declaration below.

‘I confirm I have read and fully support this application and, if an award is made, the Organisation will administer it. The organisation also accepts The Health Foundation’s requirements relating to the Data Protection Act (see above). The signature below provides this consent and assurance.’

Name: Mrs Sandra Quinn

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Job Title: R&D Finance Manager

Signature

Organisation: NHS Greater Glasgow and Clyde


10.4 A senior leader from each partner organisation (chief executive, senior deputy or senior clinical lead) from the lead organisation (named in 1.4) must fully support this application signing the declaration below:

Partner organisation 1:

Name: Professor John Norrie

Job title: Director, Centre for Healthcare Randomised Trials, Health Services Research UnitOrganisation: University of Aberdeen

Signature:



‘I confirm that I have read and fully support this application. The organisation accepts The Health Foundation’s requirements relating to the Data Protection Act (see above). The signature below provides this consent and assurance.’Name: Professor Anna Dominiczak

Job Title: Regius Professor of Medicine, Vice Principal and Head of College

Signature:

Organisation: University of Glasgow



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‘I confirm that I have read and fully support this application. The organisation accepts The Health Foundation’s requirements relating to the Data Protection Act (see above). The signature below provides this consent and assurance.’Name: Angolina Foster Job Title: Chief Executive

Signature:

Organisation: NHS Healthcare Improvement Scotland Date: 29th of September 2015



Name: Professor Jason Leitch Job Title: Clinical Director

Signature

Organisation: Health and Social Care Quality Unit, Scottish Government

Date: 23rd of September



Name: Dr Graham Nimmo Job Title: President, Scottish Intensive Care Society

Signature

Organisation: Scottish Intensive Care Society Date: 24th of September

Section 11: Interviews

11.1 Interview dates

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Interviews with shortlisted applicants will be held in February 2015. You should confirm the lead applicant and key members of the team’s availability to attend (up to 5 team members in total). The interviews will take place in central London.

Please tick at least 3 preferences for interview dates and times.

The earliest time for a morning interview will be 9.30am and the latest slot will run until 5:30pm.

Preferred option Possible for us2 February 2015 Morning

2 February 2015 Afternoon

3 February 2015 Morning


4 February 2015 Morning


We will make every effort to schedule an interview at your preferred time but we cannot guarantee this.

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web viewthe addition of comparator or control groups is a substantial development from the single...

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