Innovation Insights with King’s College Hospital NHS Foundation Trust

Jonny: Do you see innovation in the context of your role, of what you do? Is it a singular part or is it something across those different barriers? Is it something that is generally talked about? Do you see it as a part of your function?

Sonia: I think I experience innovation daily through different elements. A big challenge for the NHS is its resources of course at the moment, be that money, time or staff resources. So you are forced to think outside the box and innovation is automatically there. If you are looking at clinicians, take that area as an example, you have both the clinical burden and the admin burden that you are facing. In terms of clinical burden, it is being innovative at how we work. You may not need to see a GP and we may train nurses up more instead and introduce new associates to support and take some time off of consultants. Same thing with the admin burden – looking at how non-clinical members of staff can go in and be trained, to have that level of confidence as well. 

For example in the workflow, how can they code something so that a clinician is not sitting there typing 100 letters, but at the same time making sure that patients’ safety is of the utmost importance and constantly being reviewed. So having support and safety mechanisms in place. Having clinical supervision and escalation systems in place so that people know who to contact if they need. Having audits in place to make sure there are no errors in reporting and how to compare and improve. So having innovation in those kinds of places. Also just having the right training and being innovative around that, how you support your team through that training…

Jonny: …It sounds like a lot is already happening and it is just an aspect of your day-to-day job to an extent.

Sonia: I think it’s a mindset as well, and a bit of a culture, it’s about adopting this culture and being open to it, it does become second nature to how you think especially when there are limited resources and the pressure and the challenges you face change. I mean no one day in the NHS is ever the same. It’s about meeting the demand and understanding our utilisation as well

Jonny: I think your role still sounds more like where innovation generally sits. If we try and look at trusts collectively, do you see any barriers to innovation? Normally we see time, money, resources . In innovation you often know you need to do things, but to understand how you need to step back, look at it and that that creates change, and change creates time and resources, and I can appreciate that time and resources have never been more critical. How do you manage that?

Sonia: I think time is money and money then buys resources. So the prioritisation of that time set aside, we go and do prioritisation process sessions, we can have innovative conversations with people. It’s quite easy on paper to say let’s have a meeting, but in reality it’s a lot harder to pin everyone down. But I think it’s possible to create the awareness that this is the main goal, that trajectory is understood and you’ve got that engagement, the initial person buy-in as well from everyone. Engagement from stakeholders across the board is the only way we can push forward, so communication’s important. You can do things in terms of freeing up time as well, if someone needs to dial in, we have different resources that we are lucky to have access too. I think it’s also knowing the people you know who you need to go to for the right information and getting them in for that moment in time. So having a bottom-up approach and making sure everyone feels valued and that is how we can have these leaders and champions in place. It is also about linking innovation and change management as well

Jonny: Yeah it’s a huge part cause innovation does create change as well. I liked your comment on the bottom-up approach, cause that is something that we often talk about and challenge organisations with, cause that’s probably the hardest thing to do. Do you at the NHS trust use any kind of technology, I don’t know like email boxes, or suggestion schemes. Do you see any way that these ideas are being captured that the organisation can benefit from later?

Sonia: Of course you have your general practise meetings where people can have those conversations. I think at Kings’ we are lucky that that thought is embedded in you from the induction. They’ve got the opportunity to go through a series of change management courses if they need to, also communication and personal development and that kind of stuff. I think it’s about exploring what there is that you can use and best fits your project or best fits the business needs. We are lucky in the sense also of having technology to create survey or patient participation groups where you get different stakeholders involved at different parts of the journey. However you would need something to capture all of that in one place as well, rather than having someone to do that, that would be something quite useful as well. 

We have something called ECCO – Extended Community of Care Outcome, which allows consultants or different practitioners to link in together, and evaluate cases and take it from there. That’s just one tool, but there are a lot of other that we can use Initial engagement is important so having these process mapping session and taking them back and looking at the data, they do impact analysis as well – there’s a lot out there, it’s just exploring what fits the bill.

Jonny: Yeah, often part of the problem, isn’t it, there’s so much and it’s coming from so many different places, so many data points and it’s the analysis of them that adds the time and the complexity. But ECCO sounds like a great project, something that aligns different coalitions of practitioners and they discuss different scenarios, and new ways of doing things – is that how it works?

Sonia: So initially it was trialed out in Mexico – it helps to provide help in rural areas. But now we are lucky to be using this tool to educate practitioners as well. With their feeding in and we can take and evaluate the data and we can take that forward and we can see how to better improve the model. Initially starting off with a scalable solution and working with a certain res and seeing how we can work with many areas as well such as transplants or cirrhosis, and really seeking how we can seduce and de-stigmatise people with those problems and take it from there in terms of how they can be treated. Like hepatitis got from something that needed chemotherapy as part of its treatment to a 8-week process that has less side effects than paracetamol. So you can see innovation is part of all of these processes, from the clinical side of it to treatment to how we de-stigmatise our patients after it.

Jonny: So it’s not just about the medical advancements or drugs or treatments. You mentioned the stigma as well – do you guys manage the message back out to the public as well cause people outside this issue don’t often even know about what is new? Is that part of the process when you talk about innovation? Does this message get pushed out or is it just when it happens the more people just become aware of it?

Sonia: So if I initially start with Hepatitis C, the stereotype remains that if people were using the same needles for example or there was actual substance misuse, that is how people actually get it. That’s not actually the case. You’ve probably just stayed at uni at the same home, shared blades – happens – that can be also the case. That initial thought has made us understand that we’ve got our easy-to-treat patients which is all the substance misuse or sharing needles population, not we need to go and understand who else there is. That would be testing that we’ve started in prisons, our team goes out and it could be for events through outreach in the community, homeless shelters, again, substance misuse providers, religious communities as well. 

But at the same time I think it’s not enough, there needs to be something more on a public scale though PEHE. We’re quite lucky to have a lot of support and direction through charities such as the HepC Trust as well, and we have also got engagement from the group called the London Joint Working Group. – that’s an innovation in itself, as it allows all key stakeholders to come together around this strategy specifically and to be able to have those conversations and share best practices as well. We are quite lucky with public workshops to engage and share best practice. 

Different areas have different population needs and different health inequalities, so we need to be addressing those as well, so one tool may not fit a certain area. One tool to educate and de-stigmatise patients may not work in Southwark but if we take the same tool to Lambeth it might work. There is still a lot of work we have to do around that too, I hope we work more with GP’s and practitioners as it makes it more conspicuous and gets the opportunity to get tested. It’s no a big banner saying come and get tested, it’s you coming to your practitioner, and now it’s literally a finger prick test and not something long and mundane, and after 15 minutes we will now if you have the antibodies or not and then we can do some further testing. Again, that’s where innovation comes in with testing, again with COVID-19 it’s a similar conversation.

Jonny: So one of the key things that we see as challenges to innovation is about how those innovations are shared. I can give you an example, you have talked about all of the amazing work that you are doing with Hepatitis C around treatment and stigmatisation, but how do you make sure that this knowledge can then be absorbed by NHS England for example and then disseminated? Do you think that there’s a mechanism or is it something that’s difficult to do at the minute?

Sonia: I think I am lucky to have worked on both sides – primary and secondary care – i think the commissioning across both areas makes it quite different because trusts operate very differently and so integrating both together to make sure they can transfer information to one another. And at the same time it’s quite difficult and that’s the conversation that needs to be had between commissioners. In terms of how we can share knowledge and share innovation, we’ve got a few systems in place for example NHS forums and workshops that they promote where you can share best practices. Also coming up with a strategy, taking it to NHSE and saying this is what we want to do as the pilot, let’s see how it goes, and then evaluate and share the results, which they can localise to their population needs. You also have your usual tool, futures and having the conversation with commissioners so that they promote this new model of care, especially with primary care and disintegrate systems care coming in at the moment as well. 

As a trust we want to be able to go out to the community and provide services and support, and primary care wants to have these services out in the community, plus it shortens the referral pathways. So that allows the population to have access to the expertise in the primary care setting where they are more comfortable and it now with the pressure on resource that is when it’s crucial to explore that more

Jonny: The key thing is that the frameworks are there, it’s just about trying to use them. Obviously you have worked between a few trusts and moved roles, do you think there is a lot of difference between trusts? Do you see a high level of standardisation or are they all run independently and very different in their nature?

Sonia: I think it depends on the field, at most if anything it’s the demand that’s coming through, what are patients’ priorities, what are priorities for the trust? At the same time the trusts are quite different in clinical expertise and have different cases that they see as an opportunity to build on, build the support network around. We have a great liver department, so that is something we are utilising at the moment. Other trusts may have a great trauma unit, like Birmingham. So it’s about understanding capacities and available resources. The same is with primary care – certain areas might have certain specialists, and then becoming hubs in those areas among trusts and in the community as well. Having that expertise lead on that change and then indulge in it and take what they can from it for their patient population

Jonny: So the final question is, what you see as the future of innovation in NHS Trusts?

Sonia: I think there is going to be a change in services now delivered and access that patients get to these services, so specialists expertise being more readily available for the patients. A lot of care comes out of hospitals and is provided in community settings. A lot of transformation, a lot of change, a lot of positive change. A lot more emphasis on the data that we gather, and not just a broad picture but getting into the fine details of things too. New models of care, a lot more communication and integration. A lot more jobs that didn’t exist before, because there is a lot more capacity to do stuff. Flexing the system, effectively, changing how we work at the moment and reevaluating the lines we drew between clinical and non-clinical staff and their impact.