Stroke Event 13 Sep - Afternoon presentations

CLAHRC Impact-Influencing change in practice.

Chair: Prof Avril Drummond

A partnership between

Nottinghamshire Healthcare NHS Trust

and the University of Nottingham

Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire

CLAHRC NDL

Dawkins’ Law

Dawkins’ Law of the Conservation of Difficulty states that obscurantism in an academic subject expands to fill the vacuum of its intrinsic simplicity.

Influencing change in practice


CLAHRC NDL

• My name is Fred Higton• Age 65 - Retired (more or less)• Over 35 years developing medicines and as a

pharmaceutical consultant• Cartoonist and caricaturist for 40 + yrs

FRED’S STORY


CLAHRC NDL

Hobbies:• Gardening especially vegetables• Music. Classical and folk• Played: Banjo, mandoline, mandola,

clarinet, crumhorn, dulcimer• Art

FRED’S STORY


CLAHRC NDL

THE STROKE• 11th Jan 2011 ca 4:00pm• Lost all feeling and movement, right side• Bleed• Seacole ward City Hospital 7 weeks• Moderate to Severe

FRED’S STORY


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• Private physio once a week• Use SAEBO brace every day

• Carer am to help me wash and dress

FRED’S STORY


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Involvement in the Wii STAR project• Initially involved in hospital• Further work in Rehab Unit• Work at Home• Two television appearances

FRED’S STORY


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PROGRESS:• I can walk a little• I have learned to draw left handed• I drive a modified car• I cook• I now sing unaccompanied folk• I volunteer

FRED’S STORY


CLAHRC NDL

LIVING WITH A DISABILITY IS A LOT BETTER THAN THE ALTERNATIVE

FRED’S STORY


CLAHRC NDL

The Diffusion Fellow and the Service Manager

Jane Terry - Occupational Therapist and CLAHRC Diffusion FellowKate Hooban - Team Manager

Community Stroke Discharge and Rehabilitation ServiceNottingham CityCare Partnership

Background to Diffusion Fellow Role

• 2009 new DF role identified within CLAHRC which was highlighted as an opportunity by Pip Logan (Research Lead for Nottingham CityCare) and staff encouraged to apply

• Sought approval from Team Manager and organisation to apply• Informal interview then began in post May 2009.• Backfill for post secured (I day per week of Band 5 OT)• Allocated to individual Stroke theme project (Return to Work) • Project Lead (Kate Radford) identified from Nottingham University• Initial training and development opportunities together with other

Diffusion Fellows took place• Organisation mentor identified to guide role.

Intention of Diffusion Fellow role• Crucial mediator between research and practice with dedicated time,

knowledge, motivation and support to get research findings into practice

• Fully integrated member of RTW research team within stroke rehabilitation theme.

• Help inform design and execution of the Return to Work (RTW) after stroke project

• Identify relevant stakeholders and disseminate CLAHRC information to healthcare partners and commissioners

• Translate information into appropriate language for all stakeholders

Diffusion Fellow Role- Return to Work 1 • Clinical knowledge and experience of working with stroke survivors helped

inform and shape the early development of the study e.g. questionnaire

• Using extensive clinical contact network as reference points

• Mapping key stakeholders in NDL for Phase I

• Commissioner focus group early in study

• Qualitative interviews with trial participants /employers /commissioners /stakeholders

Diffusion Fellow Role-Return to Work 2

• Assisting with thematic analysis of qualitative interviews

• Contribution to publications and presentations

• Acting as member of Expert Panel and Steering Group

• Ongoing involvement in shaping the role of the CLAHRC Diffusion Fellow

• Assisting other stroke theme projects with recruitment

• Assisting with development of ideas for future research projects.

Benefits to Nottingham CityCare Organisation

• Development of body of research aware staff (already championed by Pip Logan in CityCare).

• Established body of clinicians and patients to inform and shape the development of future research bids.

• Delivery of evidence based clinical interventions and best practice which improves patient experience and more importantly OUTCOMES.

• Cost savings through working more effectively and moving away from non proven traditional practices.

• Enhanced reputation of the organisation through DF contribution to posters/presentations at national conferences and publications.

Opportunities for CityCare Stroke Service

• Stronger links with researchers and Nottingham University

• Opportunities to engage with other CLAHRC Stroke theme projects (Wii Star and ESDT consensus

• Raised profile of research which benefits patients

• Development of research culture within the service leading to new research projects (RCAS)

• Commissioned Return to Work OT pilot service with I year funding and evaluation by Nottingham University

Benefits for Nottingham CityCare Staff

• DF role developed communication channels between researchers and clinicians and provided a conduit for information and innovation.

• Greater opportunities for clinicians to be involved in research projects by contributing to recruitment to stroke projects. Formal and informal links were fostered.

• Personal development for diffusion fellow through contribution to posters, presentations and publications

Challenges • Managing time within 2 roles and clinical caseload pressures. Difficult to

limit to one day a week.• Working within two very different work cultures and environments.• Demands of new training requirements in role.• Pressure of achieving 2 sets of objectives.• Practicalities of organising and managing backfill- extra supervision,

training • Loss of Band 7 clinical knowledge, skills and expertise in team• Organisational changes throughout period (TCS, new manager, new

mentor, several staff changes on RTW project, new commissioning structures and commissioners)

• Uncertainty of time length of role (Extended towards end of period)

Going Forwards Negatives:• Lack of continuation of DF role due to end of CLAHRC• No current opportunity to build on skills learnt and carry forward

experience and knowledge• Time limited push of CLAHRC not continued . Research and practice links

could be lost.Positives:• Nottingham CityCare presentations were completed at strategic level to

raise profile of CLAHRC project and potential benefits to CityCare patients.• Business case for pilot RTW service was developed in partnership with

Nottingham City commissioners and has been shared with Derbyshire to support bid in that area.

• New Return to Work service commissioned as a one year pilot. OT transferred skills and knowledge into this project.

• What is diffusion?– In the CLAHRC context it is spreading research knowledge to aid take up of

evidence in practice

• How did CLAHRC try to do it?– Diffusion Fellows

• Almost 30 people seconded by CLAHRC’s partner organisations to be attached to a CLAHRC study for 0.5 – 1 day a week for five years

• Included nurses, physiotherapists, managers, consultant psychiatrists, psychologists, occupational therapists, City Council employees

Diffusion


CLAHRC NDL

• No

– Some diffusion fellows left early on– Some study teams did not gel with their diffusion fellows– Some studies didn’t produce results to be diffused– Some organisations didn’t give enough support (e.g. backfill or showing

interest)

• Yes

– Success in developing networks– Studies that made a difference to practice, e.g. Return to Work and

key role of diffusion fellow

Did it work as originally conceived?


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• From ‘yes’ and ‘no’ we learned– It helps to have a fit between diffusion fellow and study– Getting to know each other is important and varied between themes– Personal characteristics of diffusion fellows – no template but there are some

characteristics that help– There are characteristics of study teams, managers and organisations that help

the process– Support and development is important– Diffusion happens both ways, into research as well as into practice– It is a brilliant way to develop research receptiveness in organisations – capacity,

capability, knowledge, understanding, ensuring feedback loops, engaging teams on the ground

Huge benefits beyond original idea


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…… they are one part of a big system and other things need to be in place:

• Timeliness• Politics• Mutual respect • Relevant, quality evidence• Support and interest from all parts of the system

Diffusion fellows are not the only answer


CLAHRC NDL

Thank you for listening

[email protected]

www.clahrc-ndl.nihr.ac.uk

Twitter: @CLAHRC_NDL


CLAHRC NDL

Influencing cultural change; becoming a clinical academic

Phillip WhiteheadNIHR Doctoral Research Fellow

[email protected]

Background

• Occupational Therapist

• Social Care - Nottingham City Council

• Researcher - Psychiatry, Business School

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How do you combine a clinical and research career?

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CLAHRC – The HOVIS Study

• Excellence in Occupational Therapy Research

• Methods: RCT, Qualitative Interviews, Survey

• Ethics, Research Governance, Research Procedures

• Publications and Conference Presentations

• MPhil

• BESTS – Travel Scholarship

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NIHR Fellowship Scheme

• Personal Awards

• Health Research - Clinical and Generic

• Person, Project, Place, (Training) Plan

• Highly competitive application and interview process

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04/10/2023 30

Project – Occupational Therapy in Homecare Re-ablement - OTHERS

• Homecare Re-ablement Services “in-vogue”

• Social Care Institute for Excellence

• Systematic Review

• Qualitative Interviews

• RCT

Training• Building research skills

• University of Nottingham Modules/Courses

• National Courses (e.g. Oxford University, DLF)

• Conferences

• Collaborations/Networks

• International Travel

Place• Reputation of Institution

• Mentorship

• Departmental Links

• Networking Opportunities

• Developing New Links

•PhD

•Develop clinical and research skills

•Practitioners involvement in research

•More collaborations with Social Care

•Challenges

What have we achieved in stroke rehabilitation

through CLAHRC NDL?

A partnership between

Nottinghamshire Healthcare NHS Trust

and the University of Nottingham


CLAHRC NDL

Four successful projects


CLAHRC NDL

What are our learnings?


CLAHRC NDL

Doing things differently


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• Existing expertise in stroke rehabilitation research

• Consultation with patient partnership group

• Consultation with NHS and social care service providers and commissioners

How were stroke projects decided?


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• Innovation– Addressing issues that are key in the NHS– Exploring feasibility/acceptability of specific stroke rehab interventions

• Homevisits• Return to work• Upper limb

• Implementation– Moving what we know into what we do

• Early Supported Discharge

Innovation and implementation


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Direct input into service specifications e.g ESD service specification

Meaningful contribution to reviews of service provision

Trust and respect......stronger synergy

Inter dependency absolutely crucial!

Output


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Key ingredients for success


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• Publications– 25 publications

• Conference/meeting

Presentations– >60

Traditional research output


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International collaboration (Int J Stroke)


CLAHRC NDL

• Phillip Whitehead – MPhil• Karen Fellows – Mphil• Matt Horrocks – MSc • Louise Bramley – PhD • Kate Hooban – MPhil• Andy Richardson – MPhil• Phillip Whitehead – NIHR Fellowship award• Kate Threapleton – Senior Stroke Association Fellowship Award• Christine Cobley – Clinical Psychology Training• Clare Edwards – Clinical Psychology Training• Emma Ford – Clinical Psychology Training • Hazel Sayers – PRINCE2 Foundation and Practitioner (Project Management) & City and Guilds Senior (Level

4) award in Professional Practice (HE Administration• Karen Fellows – CLAHRC RIPPLE award• Rachel Tomasevic – CLAHRC RIPPLE award

Increasing capacity


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• Research Into Practice people• Fully funded places to:

– Conduct original research– Evaluate practice– Service Review

• 13 days over 6 month period• Mentored by lead researchers• Additional £500 to work with patients and public

RIPple


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First cohort of RIPples


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• Local Health Trusts and Social Care partnerships also providing funding

• Funded secondments

• Examples of current stroke projects– Implementing a return to work intervention– Cognition and TIA– Homevisits

• Rehab staff embarking on research degree’s

Success is catching


CLAHRC NDL

BITES - Engagement


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Diffusion Fellows


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• What is expected of me?• What skills do I have to offer the CLAHRC?• I don’t understand the language used• How much time will it take?• Who will I be working with? • Will I have a desk within CLAHRC?• Where is the CLAHRC stroke theme based?• What happens when the research project ends?• What’s in it for me?

What is my role?


CLAHRC NDL

• Act as crucial mediator between research and practice with the time, knowledge, motivation and support to get research findings into practice.

• Takes time to grow into this role!!!

• Fully integrated into the stroke rehabilitation theme

• Help inform the design and execution of research in the NHS

• Four key roles…………

Diffusion Fellow ……….


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• Passionate about building a research friendly culture

• Sustainability of research beyond life of CLAHRC– Take lessons learnt and experiences gained during

their involvement in CLAHRC to act as champions for future change and innovation

Capacity Builder


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• Lead implementation activities in clinical setting– Facilitate workshops– Chairing and leading sessions– Regular update review meetings

Change Agent


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• Spread the work of the CLAHRC and the project to healthcare partners and commissioners

• Translate it into appropriate language

• Identify and recruit appropriate CLAHRC Associates

• Access point for clinical staff to discuss research and CLAHRC activities

Public Ambassador


CLAHRC NDL

• Become involved in capturing data– E.g. conducting interviews, helping recruit patients, gathering data,

conducting follow –up assessments.

• Helping with analysis

• Writing up for publication

• Presenting research findings

Hands on research


CLAHRC NDL

Academic Health Science Network


CLAHRC NDL

15 AHSN’s throughout EnglandIn set up

Accelerating Adoption and Diffusion ‘Getting evidence into practice’

Older people and stroke rehabilitation

East Midlands budget £3 million per year

Pop 4.8 million

• Two projects determined from strategic clinical network objectives• A checklist for the regular follow-ups for stroke survivors• National Stroke Strategy Quality Marker 14

All stroke survivors should have a regular follow up at 6 weeks, 6

and 12 months. • CCG required to return data on ‘People with stroke who are

reviewed at 6 months.’• Development of post stroke checklist – endorsed by WSO• National Survey• Roll out of 6 month reviews across East Midlands

AHSN Stroke rehabilitation


CLAHRC NDL

• Build on CLAHRC and Health Innovation Education Cluster (HIEC)

• To equip MDT in the community to monitor quality and demonstrate their effectiveness.

• Interactive workshops – focus on data collection, data sharing across organisations and analysis.

• HIEC pilot project

Effectiveness programme for CS services


CLAHRC NDL

• Caring for older people and stroke survivors

• Research to Implement EVidence Based In-Hospital Stroke Rehabilitation (REVIHR)

AIM :

Develop and evaluate a change programme designed to facilitate the delivery of evidence based stroke rehabilitation in hospitals across the East Midlands

East Midlands CLAHRC


CLAHRC NDL

• Robust evidence exists– Early/ High intensity/Task specific/Specialist

• Challenges in implementation– Delivery interventions vague– Benefit in trials found in practice?

• Clinical Guidelines go some way to addressing but…….

• Behavioural change• Organizational context• Structure and resources of the institution• Economic and political context etc

REVIHR


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• Phase 1

What is evidence based rehabilitation in a hospital setting? (SSNAP

2 high achieving hospitals)• Phase 2

How and why is rehabilitation delivered? (Behavioural and

qualitative mapping)• Phase 3

Improving delivery of rehabilitation – Construct theory of change• Phase 4

Pilot and evaluation of change programme.

REVIHR


CLAHRC NDL

• High quality research output that has informed service delivery

• Developed a research active workforce in the NHS

• Developed a culture of joint collaboration addressing key issues in

NHS and social care.

• Focus, Time and Resource to make it happen!!

Summary


CLAHRC NDL

Thank you for listening

[email protected]

www.clahrc-ndl.nihr.ac.uk

Twitter: @CLAHRC_NDL


CLAHRC NDL

This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire and Lincolnshire (NIHR CLAHRC NDL). The views expressed in this presentation are those of the speaker(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Stroke Event 13 Sep - Afternoon presentations

Health & Medicine

Transcript of Stroke Event 13 Sep - Afternoon presentations