We set up NHS innovation labs in October 2018. In January 2019 the labs presented analysis and proposed solutions to the practice and to external guests including Ruth Cadbury MP at the House of commons.
What problem were you addressing and why was it important?
We’re an NHS GP practice with 26 staff at the time. We’re a busy practice open 12 hours a day 7 days a week. We realised that our work was fragmented, with staff working in silos dependent on shift patterns. We weren’t functioning cohesively as a team.
With so many competing targets, we found our staff hadn’t the direction required to drive NHS innovation, change and results. Ultimately, we were running the practice on a ‘keeping heads above water’, maintaining standards but not exceeding them. Individually, staff had ideas on how to improve in clinical areas but no space/forum in which to implement them. The impact was two-fold: low staff morale; and patient care which had room for improvement.
We wanted to introduce a new way of team working and create a more motivated practice. it also gave us a chance to be more proactive and explore ways in which we could be proactive.
What did you do to understand the scale of the problem?
When we started the project we (informally) gathered staff views on the practice and the team. Morale was low, and staff felt isolated and unheard. Subsequently, we surveyed staff to gather views on the practice before and after the innovation labs, finding they didn’t feel involved in the running of the practice, nor did they feel they worked cohesively.
Using baseline data, we identified clinical areas where we could do more. Our practice manager gathered the data from Open Exeter, SystmOne reporting, as well as QoF data from the CCG. We were struggling in: Diabetes Management; Care Planning; Mental Health; Immunisations; and Public Health. They were the perfect areas in which to incubate innovative ideas.
What did you do in your NHS Innovation labs?
Setting the labs up
We created ‘NHS innovation labs’: multidisciplinary teams within the practice comprising a mix of clinical and administrative staff. We engaged staff, together with our Patient Participation Group lead, ascertaining that everyone was enthusiastic to take part. One of our GPs was studying at London Business School and consulted his colleagues and professors, about the best way to implement innovation labs in other industries.
We then asked staff to take a personality test, and created 5 groups, each comprising a range of professional skills (leadership, project management, administrative, technical, clinical) but also different personality types, so that styles of working would complement each other.
Choosing a project
Groups were clinically led, by a GP. Then groups chose which Group Project most interested them, and we allocated it accordingly. Groups each drew up a team contract setting out working terms – communication, meeting times, etc. We gave groups ‘protected’ time – rescheduling clinics where appropriate, allowing teams to work together for 2 hours per week, without impact on day-to-day clinical/administration work. We asked groups to identify problems and look for clinical, managerial and administrative solutions, which the practice could implement.
What impact did NHS Innovation project have?
The NHS innovation labs impact two areas: Staff cohesion and patient care. We quickly saw a marked impact on staff. For the first time every member of staff is coming up with and working on improvements to patient care and enjoying working together. We conducted a survey after groups presented their ideas at our event in January, and the results were excellent. In summary, 95% of those who responded said they thought the practice team as a whole works cohesively now, where only 50% thought so before we created the innovation labs. 95% felt confident to contribute their own ideas to the practice (compared with 45% before).
The impact on patient care is significant. There has been a change in culture and a practice-wide awareness of where we need to improve. At our presentation event on 16 January, we found that common themes emerged across all key areas – indicating that we can use solutions practice-wide to tackle problems in different clinical areas. Interestingly it was often around areas such as communication within and between professionals and patients.
As Group Projects are ongoing, we’ve yet to analyse results of the implemented innovations. However, we expect impact on patient care to be significant. Already we are starting to see results, purely because of a greater and practice-wide awareness of where we need to improve.
We’ve already seen a marked impact on staff. For the first time every member of staff is coming up with and working on improvements to patient care and enjoying working together. We conducted a survey after groups presented their ideas at our event in January, and the results were excellent. We have sent the results in full (‘Innovation Lab Staff Survey’) to the email address specified above. In summary, 95% of those who responded said they thought the practice team as a whole works cohesively now, where only 50% thought so before the innovation labs. 95% felt confident to contribute their own ideas to the practice (compared with 45% before).
The benefits of effective teamwork in a GP practice are huge. We have noticed a productivity boost seen since the innovation labs project started. Staff have more motivation. They feel much more an important part of the direction of the practice – shown by the results of our survey. By creating small teams each with an area of care to focus on, the workload of the practice is being shared more equally, which results in a better ‘oiled machine’.
What lessons have you learnt from NHS Innovation labs?
Staff feedback has been extremely positive. “I feel like my contribution’s important and valued by my group and the practice. I’ve been given a chance to work in areas which I otherwise wouldn’t have been exposed to, giving me a new enthusiasm for my job”
“I feel like my contribution’s important and valued by my group and the practice. I’ve been given a chance to work in areas which I otherwise wouldn’t have been exposed to, giving me a new enthusiasm for my job”
Our biggest challenge was making time without adding significantly to our workloads. Our Manager coordinated clinics, making sure there were enough reception staff at all times, and supported them by providing data and advice on how to tackle problems. She’s thrown herself into the role of facilitator successfully, undertaking the challenge with confidence and efficiency. The improvement we’ve seen in staff motivation is significant and our ‘innovation labs’ model can be implemented in any general practice, anywhere. Working in innovation labs is something we aim to continue to do beyond the conclusion of the Group Projects.
In terms of solutions to Group Projects, all groups created new practice protocols which have now become our new practice standard, and we’d anticipate solutions to be applicable not only across clinical areas but also in general practice as a whole.
“I feel like my contribution’s important and valued by my group and the practice. I’ve been given a chance to work in areas which I otherwise wouldn’t have been exposed to, giving me a new enthusiasm for my job”Manager
Was your project innovative and original?
NHS Innovation labs, using a matrix organisational structure, are increasingly used in large corporations to bring about change in business. However, in NHS General Practice, group work focused on innovation, we think, is an untried concept. We feel the key to implementing innovation in healthcare is to engage all staff at all levels. Innovative ideas are fostered by many different perspectives working together.
Creating groups with a mixture of clinical and non clinical staff of varying levels of experience also creates a flat hierarchy which encourages people to feel comfortable about coming forward with ideas. The benefits this approach brings are multiple. We have already discussed above the positive impact on staff morale and team motivation. When staff feel more involved in the running of the practice, they feel more valued and job satisfaction increases. But aside from staff attitudes improving, the awareness of the issues the practice faces has improved too, and that of course is vital in the journey to better patient service. Before we created the NHS innovation labs, only 19% of staff felt they knew the areas in which the practice is under achieving – compared to 86% after. That knowledge drives staff to make improvements in those areas.
Did you co-produce your project with patients?
We’ve involved our PPG representative in the innovation labs project, and he’s actively engaged in its progress. He was at our presentation event and has always been an invaluable communicator between patients and practice. Patients’ care is at the core of our efforts. In relation to each Group Project, we surveyed our patients for views on the areas of our service we had identified as needing improvement. As for engaging others, groups worked with the CCG, PCPC, SystmOne, health visitors, and in researching child immunisations, the safeguarding team.
We feel privileged to have presented our projects to our local MP, the Head of Strategy at Chelsea and Westminster Trust, and colleagues from NW London CCG and NHS England. A range of perspectives is key, and presenting to them was incredibly helpful. The initial problem was highlighted by staff morale and our results. The outcomes of the individual Group Projects are vital to patients as they form the basic areas of primary care.