24 April 2019

Triple Aim work in Newham

The team in Newham have been busy getting underway with their Triple Aim work looking at improving the lives of those who live in Newham. Here are some thoughts from Ed Lander, Newham Crisis Pathway Project Lead . 


Where are we focusing our efforts?

Newham’s Triple Aim work is focusing upon a population who have more than five referrals to assessment and crisis pathway services within a 12-month period. This is around 300 people. This population has complex needs, presents frequently in crisis to a variety of emergency services and is not currently thriving. Our Triple Aim work links in with our wide service redesign work within Newham’s crisis and assessment pathways.


How have we gone about it so far?

To get the work going one of the first things we did was form a Triple Aim project group, which has a broad range of staff and service users with interest in helping the population. We meet fortnightly and since mid-February the group have been working to understand the needs and assets of the population by undertaking the three part data review.

First off we went out and had a look at what data was available from the Trust. What did we know about this population already? This was things like how often people present to A & E, if they are known to the trust and what type of condition they live with.

The next step was to hear about the lived experience of citizens within the population by undertaking some phone interviews. This was a powerful experience for us and we were able to hear stories from people within the population, including views on unmet needs, assets and interventions. Though each interview was unique, the people we interviewed suggested things that make it difficult to thrive include social isolation, deprivation, long waiting times for services, difficulty accessing secondary care services and there being poor communication between services.

As part of the interview we were also interested to learn about where people go when they do need support. What we learnt was that whilst ELFT and partner services do play a role, people also told us that they seek help from family and friends, religious centres, social media and by feeling active in their local community through volunteering. To help make things better, people suggested improving communication interfaces between services and partner agencies, service provision to tackle social isolation and alternative service provision to A & E for people in mental health crisis.

For the partner interviews, a range of staff from the assessment and crisis pathway services have been interviewed. We are due to explore as a team and identify themes that emerge from the narratives.


What was our experience of undertaking the three part data review?

There were challenges to the three part data review. At first, it felt like quite a bit of work and given the nature of our population, getting in touch with service users who were able and happy to talk to us was sometimes difficult. Our hope was to do the three part data review in about six weeks, so we could quickly get to testing some changes that were meaningful to service users.  Learning from other teams in the Trust, we decided to share the work amongst members of the working group. This really helped and by taking a few calls each we were able to get the views of about 20 services users in three weeks.


What’s next for us?

We recently sat down as a team and went through a group exercise to pull out themes from the service user interviews. This was really insightful for us and we have been able to identify what’s not working well in system, where service users go to get support and what changes we might be able to make to improve things.

We’ve still got to sit down and look through the interviews we’ve done with our partners and people that provide care within the system, but once we’ve done that, we hope to be able to develop a purpose statement for the work and create a theory of change. Ultimately we hope that by working to understand our population, we will be able to develop change ideas that can have a highly positive impact upon this marginalised population.


Ed’s Top Tip for learning quickly from the three part data review

  • Share the work amongst people in your working group and invite other people you think might be interested to help you. We had junior doctors, admin staff and nursing all help do some interviews;
  • Don’t aim to collect hundreds of interviews; think about just enough data to give you insight into your population so you can begin to test;
  • Come together as a group and review the data, so you draw out themes.

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