NETWORKS IN DIABETES Peter Hindmarsh Children and Young Peoples Diabetes Service University College London Hospitals and Great Ormond Street Hospital for Children THINGS HAPPENING IN PAEDIATRIC DIABETES Peer Review Best Practice Tariff Networks, National and Regional National Paediatric Diabetes Audit Patient Related Experience Measures Patient Related Outcome Measures VALUE OF THE NETWORK "Networks are a powerful way of sharing learning and ideas, building a sense of community and purpose, shaping new solutions to entrenched problems, tapping into hidden talent and knowledge, and providing space to innovate and embed change. HOW DID THIS NETWORK ARISE? National Network originally driven by NHS Diabetes - Service delivery plan 2010 National Network drove the Regional Networks (regional networks reported to NPDN- and the progress to agreed objectives was monitored by the NPDN Now the Regional Networks are almost independent of the National Network Forum for review of case load, outcome measures, and overall performance of commissioned local services. Support for services such as:- -intensive insulin therapy -pump therapy -psychology supervision -therapy for complications Educational forum for sharing of good clinical practice, crisis limitation, and managed clinical care. Ongoing audit and performance management with interaction with National Bodies defining Standards and direction in Paediatric Diabetes REGIONS AND QUALITY IMPROVEMENT Data Sharing for Performance Management Engaging Users Improving Health Care Delivery Aligning Benefits and Finances NHS England Monito r CQC Networks HEE National statutory bodies Commission ers ACDC BSPED RCPCH National Parents network National Parents network NHS IQ RCN BDA Psycho l Academic health sciences networks SCNs Maternity and Childrens services Gen Paeds SCNs Maternity and Childrens services Gen Paeds NHS CB National Paediatric Diabetes Network Providers Region al PDNs Professional Bodies Charitable groups JDRF DUK ABCD NICE Primar y Care RCPGP ISPAD National Paediatric Diabetes Network Board National Network Board Steering Group National Network ChairNational Network Vice-Chair National Network Coordinator ? ???????? ?Wales Nursing (RCN) Dietetics Rep (BDA) Education and training rep ACDC repBSPED RepRCPCH Rep ??CCG and NHSE commissioning Rep/DOH/ Monitor link Task and Finish Project Groups National Parent group rep x2 Chair PnCO Paren t rep Chair PnCO Paren t rep Chiar PnCO Paren t rep Chair PnCO Paren t rep Chair PnCO Paren t rep Chair PnCO Paren t rep Chair PnCO Paren t rep Chair PnCO Paren t rep Chair PnCO Paren t rep Chair PnCO Parent reps Wale s DUK JDR F Diabetes Research network rep NETWORKS FAIL BECAUSE fail to reach common understanding across members of purpose and direction institutionalisation over-management cementing relationships and structures that need to be dynamic and evolving over expectation of network members willingness or ability to collaborate which damages creativity of the parts predicating network some members over others constraining network members independence not recognising when leadership needs to change/rotate ACTUALLY THEY FAIL BECAUSE THERE IS NO VISION OR MISSION AND THERE IS NO ACCOUNTABILITY BUT IS THAT ALL? EXCHANGE INFORMATION (Network) HARMONISE ACTIVITIES (Coordinate) SHARE RESOURCES (Cooperate) ENHANCE PARTNERS CAPACITY (Collaborate) + + + WE ARE NOT JOHN LEWIS CURRENT STATE OF PLAY National Diabetes Audit HbA1c under 7.5%15.9% HbA1c under 9.5%72.4% Care Processes Blood Pressure44% Urinary Albumin11% Eye Exam17% How does this fit with other Quality Control Systems Diabetes 841,000 Baggage Handling 6,210 Deaths due to Anaestheisa 30 Motorola 10 Anaesthesia Post Intervention 5 NEED FOR CHANGE Feeling of frustration expressed by professionals and patients over how care is delivered. Capitalise on new knowledge and technologies. Limited resources and increasing demand. Waste in the system. Lack of progress towards restructuring to address quality and cost concerns or towards applying IT to improve the process. Services have been developed on an acute care model which is inappropriate for chronic care. To allow children and young people with diabetes to discover and develop their own capacity to be responsible for their own life The choices made every day in the self management of diabetes produce consequences that accrue first and foremost to the person making those decisions and they matter Glucose is merely an imperfect reflection/measure of those choices and as they accrue (HbA1c) produce consequences for that person The patient is his own nurse, doctors assistant and chemist E. Joslin, 1924 COMPONENTS OF CHRONIC CARE QUALITY SERVICES Safe for patients and staff Effective in providing services based on scientific knowledge to all who can benefit and refraining from providing services to those that will not benefit. Patient Centred which respects and responds to patient preferences, needs and values. Timely reducing waits and delays to patients and staff. Efficient in avoiding waste of equipment, supplies, ideas and energy. Equitable. AreaSafetyEffectiveEfficientPatient Centred TimelyEquitable General DKA CareEvidence-based Monitoring for complications Care across multiple sites Self monitoring Access to results, information, clinics All populations IT On line information on risks and ease of access to records Real time home monitoring Shared health care record Continuous single patient record Secured messaging system Available in multiple languages COMPONENTS OF CHRONIC CARE ORGANISATION OF HEALTH CARE Delivery System Design Care management roles Team practice Care delivery/coordination Proactive follow up Planned visit Visit system change Self-Management Support Patient Education Patient activation/psychological support Self-management assessment Self-management resources and tools Collaborative decision making Guidelines available to patients Decision Support Embed in system Guidelines/prompts Provider education (training) Expert consultation support Access to information Consistency of information Clinical Information Systems Electronic Patient Record Information for care management Feedback of performance data to patient and provider Access to all that need to know Community Resources Schools Youth facilities Exercise facilities Environments to meet Communication channels Health Care Organisation Leadership support from NHS Provider and patient participation Roll out improvement and prune as necessary More effective cost analysis and performance measures REGIONAL AND LOCAL QUALITY IMPROVEMENT Strategic Health Authority Population (m) Paediatric Population (m) Paediatric Population with Diabetes Number of LSD Number of Regional Centres North East North West Yorkshire/Humber West Midlands East of England South West London - North ESSENTIAL FEATURES OF REGIONAL INITIATIVES Components: Purchaser involvement Patients as user groups, advocacy services Provider groups in terms of local service providers Education Authorities and Social Services DATA SHARING FOR PERFORMANCE MANAGEMENT Performance = f (Value). Access. Satisfaction Where Value = Quality/Cost Lewin, 1938 and Festinger, 1957) WHAT TO MEASURE FOR PERFORMANCE MANAGEMENT? Process Improvement Outcome Improvement How is practice designed and organised to meet patient needs Quality of patient involvement and experience Efficiency and waste measures TARGET PROCESSES THAT WILL IMPROVE PATIENT OUTCOME SCREENING FOR COMPLICATIONS SURVEILLANCE OF ACTUAL COMPLICATIONS V Everyone should have annual retinal examination If timing of photocoagulation is suboptimal BUT No amount of concentrating on frequent screening as opposed to timely treatment will improve quality ARE YOU READY? EXCHANGE INFORMATION (Network) HARMONISE ACTIVITIES (Coordinate) SHARE RESOURCES (Cooperate) ENHANCE PARTNERS CAPACITY (Collaborate) + + +