29 June 2021

Leighton Buzzard Restarts its Triple Aim Work to Improve the Health of the Older Population

By Daisy Maradzika, Improvement Advisor

In September 2020, East London NHS Foundation Trust (ELFT) staff, service users and carers came together to improve the health of their local population in Leighton Buzzard. Together, they represented Mental Health, Community and Primary Care Services as well as local partners (Local authority, non-profit organisations, elderly care facilities, Central Bedfordshire Clinical Commissioning Group and Cambridge Community Services), with support from the Institute of Healthcare Improvement.

They decided to use the Triple Aim approach to simultaneously improve the health outcomes of the chosen population, their experience of care and ensure value around the use of resources.
Based on local knowledge and preliminary data, the project team identified the following population for the Triple Aim initiative as:

‘The local elderly population aged under 65 with moderate or severe frailty or Mild Cognitive Impairment (MCI) or diagnosed dementia with two or more underlying physical health long term conditions.’

From November to December 2020, the project team met virtually each week. They established the Project Board and the team co-produced and developed a purpose statement:“In Leighton Buzzard, we will work together to provide people-centred integrated care and support, so that our population can live well.”

The project team then started a three-part data review, which analysed existing data and surveyed services users, carers and staff. This helped stakeholders understand the needs of the specified population. Interviews for staff were easy to conduct and were completed using existing structures and forums within services. The staff used a root cause and effect analysis tool to explore the reasons they thought prevented this population from living well (figure 1).


Figure 1: Cause and Effect Diagram for staff to explore “What is preventing people from this group living well?”

Results showed that a lack of timely interventions, social interactions, digital exclusion and poverty and a lack of insight into health were the main reasons staff mentioned as preventing the population from living well (figure 2).

Figure 2: Pareto chart displaying what staff perceive is contributing to this population not living well

Due to the impact of the Covid-19 pandemic, the team had to find innovative ways of conducting interviews remotely with service users and carers via telephone or using an online survey with support from People Participation and the Quality Improvement team. Data collection from service users and carers is ongoing, to enable a comprehensive understanding of their perspectives.
Another important activity was the mapping of actors and assets, an informative exercise that generated:

• An understanding and appreciation of the assets for the identified population in Leighton Buzzard
• Benefits and values of all stakeholders to enable collaborative efforts to co-produce the triple aim of the work.

Impact of the Covid-19 pandemic
As the second wave of Covid-19 pandemic hit in January 2021, the project came to an abrupt halt as resources were diverted to support services. However, during this time the project board managed to identify projects for this work (Figure 3).

Figure 3: A driver diagram displaying the Prioritised Projects for Triple Aim Leighton Buzzard 

Despite the challenges, the energy for this work has been maintained and in June 2021, the team began to rebuild the project by planning regular meetings and workshops with the Institute for Healthcare Improvement. Service user and carer interviews have restarted and the team are developing a measurement plan.

On 25th June 2021 the IHI supported the fourth workshop to help the teams think through their measurement plans and provided guidance towards capturing baseline data. We’ll be continuing to update on this work as it progresses.

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