Coloplast S6E2 Intro - Welcome to Stoma and Continence Conversations from Coloplast Professional. I'm Hannah, Ostomy Care Associate Education Manager at Coloplast. Working in specialist care, I know that stoma, bowel and bladder issues impact the lives of those you care for. This podcast is here to support your educational needs and help you in supporting your patients. You'll hear from fellow healthcare professionals and experts by experience, discuss the latest hot topics in the world of stoma, continence care and specialist practice. Hannah: Hello and welcome back to the podcast. This time we're bringing you a chat that myself and Paul had with Scott Mackenzie back in May as part of our Webinar Wednesday series. The topic is how innovation can improve patient pathways. To start the conversation, I ask Scott how ready he thinks the NHS is for innovative and in particular digital solutions and what it is doing to upscale and support its frontline workforce. Scott: I think that's a pretty straightforward answer to that, on one level, and that is that in reality it varies from place to place and customer to customer. I've got some who are, what I would describe as early adopters, really willing to take most opportunities and try and run with them. They're keen to explore, happy to push the boundary and see where we can get to. Equally, I know probably as many, if not more, who will resist and will continue to resist until whatever the innovation is, whatever we're offering, has been proven without any question that it works and it delivers. So for me, it's really all about knowing the customers. And then I think my additional observation is, that I am currently seeing people who would've been resistant two or three years ago now, starting to adopt innovation much more quickly. And I think it all links back to something we talked about previously around the fact that the NHS in reality is drowning in workload. It has a lack of workforce to meet that demand and therefore it has to innovate to try and work in new and different ways. And you know what I mean, if I think of my most recent encounters with innovation and technology based digital technology. It was in spirometry with a tablet based, approach that enables the patients to be tested at home as well as it does to be tested in practice. And that was with an NHS client, I wasn't actually involved in the project, it was something that was happening alongside work that I was doing, but I had an awareness of it. And I wouldn’t have said they would've ordinarily have been rapid adopters. Yet here they were prepared to try something new out. And when I look across the last two years, I've worked with many different projects, a lot of them with a digital element to it in terms of data extraction, audits or physical pieces of equipment as well. And I think what it really comes down to from our perspective in terms of pharmaceutical medical technology, device companies, app companies, kit and equipment companies, is the problem for the NHS. What is your solution and what would it mean to them in terms of that workload, the patient outcome, if they were to work with you? And I think if you can frame that, you stand a great chance. And then in terms of what the NHS is doing to support its teams… there's huge work going on right now around adoption of digital solution, primarily to meet that workforce agenda that we just don't have enough people and their now looking at where equipment and digital solution, with a human touch to it, it's not, we just give you the equipment and that's it, you're always gonna have a human on the end of whatever's being done. But I think that is now a real drive to upscale people and get them engaged with it in a way that we possibly haven't seen before. Paul: One of the things I'm always really passionate about when I'm talking to you, Scott, is… Yes, we know that, you know, the NHS, when I said it before, it isn't a black hole, we can't just constantly throw money at it. And when we talk, we always talk about putting the, you know, the individual at the end of the path. You know, whether we're talking about a pathway, whether we're talking about anything at all, whether we're talking about the introduction of, you know, new innovation or reviewing old processes. It's always, you start with the kind of, you start with the patient and you work backwards. Scott: Totally! Paul: So that kind of leads me though, if we are talking about innovation and we're talking about this, you know, these places, these hospitals, these ICSs, wherever, you know, where wherever we are kind of focusing on as being early adapters. You know, those ones that are able to see, do you know what actually. I'm looking at the big picture. I'm not just looking at the bottom corner or I'm not just looking at my little section. I'm looking at it. And you also mentioned something there about problem-solving. Scott: Yeah. Paul: So that kind of leads me to, to one of the questions that I wanted to pose to you, Scott, which is… When we innovate within the NHS, are there driving, fa are there.. well, there are, there has to be driving factors, but is it always about solving problems that we know? But obviously, we are now talking a lot more about the patient's self-care agenda, et cetera. You know, so innovation in healthcare, and it's more of a discussion for you is, is it about problem-solving, or is it more about enabling people to self-manage themselves? Which in my opinion, is putting the horse before the car and going, surely if we can reduce the amount of pressure and make people self-manage, it surely clears the funnel up at the start of the process? Scott: Yeah, yeah, yeah. I mean, the reality to your question, the short answer is it's about both. But let me explain that. Let me clarify that because I want to go back to that point you make about problem-solving, because it's a phrase I use all the time. In terms of when we're approaching the NHS, we must be able to clearly articulate this is the problem that I will solve if you work with me. And often, in my work I'm trying to discuss with people, particularly, again, the industries, you know, medical technology, the devices, pharma and so on. Can we demonstrate that we can significantly improve the patient outcomes? A reduction in unnecessary appointments or referrals? And of course, admissions is the big one. Can we demonstrate that we're working to tackle health inequalities and closing the inequalities gap? Is it just part of a complete pathway redesign approach that we would take? Are we supporting the delivery of the primary care network? A direct enhanced service or the investment and impact fund or quof. You know, all of those things are absolutely aligned with the problem that we would help the NHS solve, which is fundamentally to try and improve the patient outcome. Back to your point about, start with the patient and work backwards. Totally agree with that, if we improve the patient outcome, pretty much everything else that I've just described there then follows. And again, if I go back to the operational planning guidance published on the 23rd of December, Christmas just passed, it highlights that the prevention agenda from the NHS long-term plan. It really now has a desire. NHS has a desire to see that now being embedded in the way we work. And that includes the effective management of long-term conditions, of course, which is key to improving patient outcomes and population health. And that actually goes back to your point. That's how you start to curb this ever-increase in demand. So, when you look at that prevention agenda from the long-term plan, and the reason I highlight this is cause I'm gonna come back to your point on self-care. So yes, it does the standard prevention messages around obesity, smoking, alcohol, sexual health, antimicrobial resistance, et cetera. All of that is absolutely part of it. But, and there is a big but… What the long-term plan highlights is, it's no longer a focus on just stopping people becoming unwell. It now has a focus on reducing avoidable appointments, referrals, and admissions. The next step is, it requires a focus on supporting patients to improve self-care. That's absolutely part of the long-term plan of the prevention agenda. And then when people do come forward looking for care, it's how do we direct them to the right NHS services when they're required. And people, we've noticed that recently we had the announcement about an increase in what community pharmacy can do, that was over the Coronation Bank holiday weekend. There was an announcement there about increasing prescribing in community pharmacy, and increasing testing and community pharmacy for things like hypertension and, and such like, all designed to try and take workload away from general practice and improve capacity. But again, there was a big stress point in there about patients improving their own self-care and looking after themselves. Beyond that, we start to get into the message I gave you earlier about tackling health inequalities and stopping the unwarranted variation between the different providers so that we can see its system level, that we are genuinely tackling our inequalities. And then the last bit, and I think this is where industry plays a huge part... In supporting that long-term plan, embedding and that's in learning, upskilling and education because when we upskill the teams to better manage the patients and improve the outcomes, what's the knock on effect? We reduce our unnecessary appointments, referrals, and admissions through those better patient outcomes. So it's a case of does your project fit all of those, or some of those meaning that you have a route to a conversation that is prevention led. And is based around very much the problem that you will solve in working with them. Paul: Yeah. Phenomenal! And I know that Hannah is, Hannah's jumping at the bit to go again, I've worked with her long enough now I know that! Really, it's just to kind of wrap that up and thank you, you know, that insight that you can provide again and know, knowing your history and that sort of thing is, you know, your insight from there. And I think almost to kind of tie for me personally to tie that up. I always think about, and it's slightly off topic, but I will bring it back, is I did a podcast and I think I mentioned it last time, I did a podcast with the mighty and lovely, now retired Maddy White, previous chair at the ASCN. Scott: Yeah. Paul: And I did a podcast with her about the journey of a stoma nurse and one of the things that she highlighted was no matter what stage you're at within your stoma career, and again, I'm talking stoma here, but it goes for any kind of clinical nurse specialist, is whether you like it or not, you've got to be aware of things like the NHS long-term plan. Scott: Yep. Paul: Gotta be aware, because when we talk about innovation, when we talk about these early adapters, The people that, and the individuals that are at the coalface are those CNSs, are the specialist, healthcares are the clinical nurse specialists, which see it every single day. And I think, dunno about you, but it's there's, I dunno, I almost think sometimes there's a fear of this activation. There's a fear of this moving into the unknown. But, so the best way to remove fear is to increase knowledge, and whether that's from a healthcare frontline worker or whether that's from a patient. And I know that, you know, this kind of leads on to what Hannah wants to ask. So I'm gonna stop talking now and I'm gonna hand it over to Hannah, cause I can see that she wants to, she wants to jump in. Hannah... Hannah: So, I know we've already almost alluded to it a little bit with a couple of things that we've already mentioned, but what, in your opinion, Scott, are those biggest barriers to launching that innovation or to process within the NHS? Scott: Yeah, I mean, all the points that you're making guys are absolutely spot on. And what you've gotta keep in mind is there is often a fear and a reluctance. It's what's we call comfort zone is the reality and there's a great quote. It's a quote I used to use a lot that you can't steal second base while keeping your foot on first. Clearly an American baseball coach, but the analogy's brilliant. If you're stuck on first base, some point you gotta let go and make the dash for second base. And unfortunately, I would say the biggest barrier is often they don't want to be the first one to make that dash for second base. They don't want to be the first to do anything. Most of my experience with the NHS and new innovations, is that they require someone else to try it first and, and show that it works. And sometimes it's not just one person, you know, they like to know that there's been, you know, a hundred or more other people have already done this and it's worked before they feel safe and secure in doing it. But this is where, and also why Scott is also happy to start a new project with just one practice or one department or one individual and grow out from there. And I've got some great examples, working with my NHS client base clearly, and then with, you know, the pharma, the medical technology, the appliance companies, and growing out their projects. And if I think of one example right now, it comes from, Coventry and Warwickshire ICB, where we started a project with one practice and then scaled it from there up to the PCN and then from there across 24 practices within the whole place footprint. What they did was right from day one started to gather some evidence. So they had enough information at the end of it to be able to write one side of A4 that basically said, this is what the project was designed to do. This is how it was designed to deliver. This is who was responsible and for what each step of our project. Here's the outcomes we expected to deliver. This is how we measured and evaluated, and here are the outcomes that we achieved. Now, the other thing that we had done in the build-up is, we had a contingency plan that said, if anything doesn't work, this is how we'll get the team back together and we'll work out what we do to fix it. But when it came to the write-up, we didn't have to include that, but I would just include that in your project plan. The key here is that the delivery was exactly what they had agreed and what had been envisaged, meaning the pilot practice loved it and were then prepared to speak up about their experience. And that is how often, I will get innovation adopted in the NHS to start with one practice or one individual and get them to agree that they will write it up so that we can then share the outcome, share the good news with other people, so you don't have to get a whole ICB to adopt something to make it work. Actually, just start with that one motivated and wants to make it happen, and then grow out from there. And I've done that many, many times over my 18 years working inside the NHS. Hannah: Kind of moving in the same line, and I'm going to come back to something Paul mentioned earlier, the black hole, which is the NHS and money, which we know is always a bit of a… Scott: Always a factor! Hannah: Yeah. So where would you say is that tipping point between innovation and cost? Scott: The one observation I would make is, you know, that's a topic that comes up in my work, literally, constantly. We have to remember that there's a finite resource, that it isn't a bottomless pit. But, again against that, we've got to remember, the NHS is literally drowning in workload right now, and it just does not have the workforce to meet the demand. And that's what's driving it to look for those innovative solutions to support them to work in new and different ways. Particularly if you can relieve pressure on our GPs and our nurses in general practice or our hospital consultants and nurses, by moving the work to some of the less senior roles where we can recruit people. I'm not saying there's anything wrong with those, I'm not for a minute being derogatory about those less senior roles. What I'm saying is they’re easier to recruit. If you think about it, it takes seven, eight years to train a GP. You know when we can recruit Healthcare Assistants and Healthcare Co-ordinators and social prescribers and train them much more quickly, if they can take workload away that absolutely helps. But going back to your point, price is always gonna be a consideration, but I would observe that I'm now working with clients who will push the boundaries when we can demonstrate the outcomes in terms of our reduction in workload or the ability to shift work to other people. You can absolutely get your projects landed. Then in essence, you know I've got some right now. Working with the industries, with pharma, with medical technology, particularly with appliance companies, who will invest to reduce workload or to be able to shift work to others in the team using technology absolutely as part of that solution, the key comes back to the point we've made a couple of times, demonstrate the outcomes. And I've got a brilliant example of that at play right now where the project has freed a full-time nurse each week! And this came about through real innovation in wound care and they had an industry partner working alongside them, who supported with the very point that Paul made about education and upskilling of the practice team, with a bit of hands-on support. And it's another project, this is another one that started with one practice, a practice of 16,000 patients and it's now scaled to a whole place footprint because that's been so successful. They're now looking at how they scale it to whole system level. So the tipping point over price, where that really comes in is all linked to an outcome and whether or not we can free that workload capacity and then potentially invest the limited budget that we've got in slightly different ways to achieve that outcome. What's really hard, and I will observe this right now, is to get them to double run. It's to say, continue to run your normal service over here and invest in a new service here that is now really, I would say nigh on impossible to achieve. So that's where scaling it down, reigning it in, having one practice, one department where it's a small amount of money required to really test the proof of concept. That's why I work like that now much more often, um, than I maybe would four or five years ago. Paul: And it's all about, from what you said there, it's the adapting to the current environment. Scott: Yes. Paul: You know, it's, we cannot always rely on the tried and tested, you know, we've been doing this for years. And again, it's one of those almost, I used to hear it in nursing, I still hear, we still hear it in nursing, is that's how I was taught, that's how it's always been done. It's not, you know, yes. It's obviously it's worked because it's been the tried and tested… Scott: It’s a risky way though because, it's a bit like if I use a football analogy, okay. Forgive me viewers for, for using a football analogy. Mrs MacKenzie doesn't understand the football, she just knows that we all shout at the telly and she can tell the results as I get out the car when I come home on a Saturday without actually having to look at what the results are. She knows by my body language. But if you think about it from the point of view, whether you're managing a football team or rugby team, a cricket team, even an individual, a tennis player, you know, Andy Murray's coaching teams… What they're always doing is looking at what kind of change in the game if the result is not what I want, if I'm not getting the outcome I envisage, what changes am I gonna make substitutes in? In team sports tend to be think, take some days off, introduce someone else to try and change the game. That's really what we are doing here, unless we're 100% happy with the outcome we're currently achieving. So that's where I've got a manageable workload. I've got a full compliment to staff, my pathways work, my formulary works. Everything that I work with is absolutely 100% brilliant, and there is no need to change if you're just gonna give it the same input, you've gotta expect the same outcome. So yes, you can do it more quickly. Yes, you can do it with more people and less people and all of that. But, we just keep doing what we're doing. Same outcome as what's coming. So that's where always my encouragement is take a step back and think, you know, I'm not really happy with this, and what are we going to change to try and drive that better outcome? So I often ask that question, so, Paul, what are you telling me that you're a hundred percent happy with your current outcomes? Because people look at you and go, of course, I'm not saying that. Okay. So if we're not saying that, what changes are we going to make? To try and improve the outcome because more of the same input is guaranteeing us more of the same outcome, so it's dangerous to do that. Paul: It is. And I completely, and I love that analogy, to be honest. It's making that change. It, it's putting your hands up and saying, and having that in almost looking at it from an independent point of view, you know, if I was looking at my service, would I be a 100% happy with my own service? Again, I think from my point of view and taking on board a lot of what you're saying and, you know, and from how Hannah's positioned it as well. Is, and I always used to be quite, almost afraid of making that change. And like you said, you know, it is that thing of, I was always that nurse that wanted to say, right, prove to me that it works, prove to me I want the proof. So if I instigate this for my patient, for the person I'm looking after, I need you to show me that it works. Which is fine. But there has to be somebody at the start willing to say, I'm gonna bite this bullet and let's make this change. Let's initiate it. Let's try it, let's practice it. Let's evaluate it. But, as again, in your opinion, and again it comes and again, because of Covid and all those sorts of things, I know we've almost gone all the way through and we haven't mentioned those five letters yet! I think that, you know, the digital world has, and like I keep saying, the digital world has exploded. And we mentioned it right at the very, very start of this webinar when we spoke about supporting frontline staff to take on innovations and support them with, you know, whether it's, you know, enabling them to utilise digital tools, digital resources, digital innovations. But a lot of it is about fear. And I know that for nurses and a lot of nurses that I speak to, They almost want to know what criteria have we used, what criteria is there in place? If I am gonna be that nurse that is the first one to push the domino to have that domino effect, to get that. Cause back in 2021, NHS Digital, which again has just exploded in the last three or four years, they launched the digital technology assessment criteria or DTAC for people who like using acronyms is DTAC. So it's digital technology assessment criteria. And I know that that's what it does. So its support and it gives a criteria set that the NHS uses when it's selecting patient solutions, whether that is apps like you said, you know like you said, you know that that spirometry at home. NHS apps, we all had the NHS Covid app, you know, we were told you have to do it. But is there a way, or are you aware of how we, you can provide some support and you know, reassurance to people, to nurses out there say, you know, wwhen there is innovation, especially in the digital world, are there, is there set criteria, is there robust criteria? Scott: The reassurances there are, there are very robust criteria. DTAC is the perfect example of it. You know, it's designed to give the patients, the staff, and us as a wider population confidence that any of the digital health solutions. That we access or are used in our care, have met all the agreed standards. And I'm doing this off the top of my head. I'm sure it's clinical safety, data protection will be one, and usability, accessibility standards that they're secure technically. All it's things like that. That's what the DTAC is done it. It brings together legislation. It shows what good practice looks like. And really provides national baseline criteria for any digital health technology. So it's then down to the healthcare organisations to assess the suppliers before they go to procuring them or to using them as part, just part of a due diligence process. So first and foremost, that would be where DTAC fits. But then beyond that, I think there's, this is where it's really incumbent on us to be able to demonstrate those things I talked about earlier that, you know, improve patient outcome, reduction in unnecessary appointments, referrals, admissions. When it's possible, we're tackling inequalities and closing the gap. We're potentially completely overhauling and redesigning a pathway so that people don't need to be seen as frequently or as often, or don't need to be seen face-to-face, be dealt with remotely, just as you mentioned Paul, as we had routinely through Covid particularly through primary care. And actually, when you mention primary care, NHS England is supporting a lot of the digital and online tools so that patients can much more easily than we would've pre-pandemic, access the advice, the support, and of course the treatment by having online and digital conversations. So it's now much more common to have a telephone conversation where it's appropriate to do so, and if you need a face-to-face one, you'll still absolutely get that. So for me, it's about using data because it's appropriate to do so. But then it's about going the extra steps around the outcomes and the reduction in appointments, referrals, admissions, et cetera. And then the last thing I would do is just check locally. Are there any other requirements that we need to be aware of? And then act from there. To the best of your knowledge and ability in terms of how you would help and support them, and the problem that you would solve. As you know what, you're not gonna go far wrong. Hannah: What a fantastic chat that was with Scott. We've put together a handout to go alongside this episode, and it's available in the show notes for you to download right now. Thanks for listening to Stoma and Continence Conversations. We'll be back with another episode next week. 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