A Methodology for Spread and Adoption

What our stakeholders told us

Wessex AHSN is above average or leading the field

• 78% recommend working with us• 83% report a ‘good working relationship

– 11% higher than the AHSN average • 66% say we have helped them achieve their objectives

– 10 % higher than the AHSN average• 70% feel ‘involved in the AHSN’

What our stakeholders told us

Doing the right things, and doing them well• ‘Priorities aligned to local priorities’ - 74%• Effective at ‘focusing on the needs of patients and local populations’ - 71%

- 10% higher than AHSN average• ‘Identification, adoption and spread of innovation’ - 65%• ‘Confidence in the AHSN to deliver its plans and priorities’ - 66%

Working well together• ‘Facilitating collaboration’ - 67% • ‘Good accessibility’ - 75%

Building partnerships• 42% have a good understanding of our role

- 70% feel clarity has increased in the last 12 months

• 35% have a good understanding of our plans and priorities- only 1% have no understanding at all!

Where are we now?

The given• The five licence requirements• Patient Safety Collaboration• Medicines optimisation (national

role); respiratory & nutrition (national offer, our BRU and BRC)

• Vanguard support; Test Bed (if we get accepted)

• Some aspects of our wealth programme – Life Science Cluster, genomics

Our choice

Fewer things with greater impact

Catalysing system change

No more ‘seeds’, lots more spread

Leapfrogging – moving much more

quickly from spot to spread

Why it’s important

• The stakes are high. The NHS needs to transform the way it delivers care if it is to meet the demographic and financial challenges it faces.

• There is a good supply of innovations that can help meet this challenge.

• But they aren’t spreading through the NHS at anywhere near the rate that need to.

Aims of the methodology

• Use the evidence base on when and how good ideas spread in healthcare.

• To develop a systematic approach to assessing an innovations potential to spread and be adopted.

• So that a decision can me made on whether and how to support it to spread.

• And a consistent approach is used to develop Spread Plans.

Overview of the methodology

Assessment Decision ImplementDevelop spread plan

Steps 1 and 2

Step 1: Potential to spread

There are 7 attributes known to determine the likelihood that an innovation will spread.1. It has a clear advantage. 2. The benefits are observable.3. It is compatible with the needs of adopters.4. How complex it is to adopt.5. Adopters can trial it before committing.6. Potential adopters can adapt it to their needs.7. The strength and quality of the evidence.

Step 2: Will it be adopted?

Adopters are the individuals and organisations that we want to implement the innovation. It is important to be able to describe the adopters as precisely as possible and to understand the process of decision making and adoption from their perspective.

Who are the potential adopters?

How would they benefit?

What could constrain them?

Step 3

Step 3: AHSN decision

• What is the evidence that this innovation will spread and be adopted?

• Build this in to our business planning process.• A spread panel will take in-year decisions.• New roles – Clinical Lead for Spread and

Spread Manager.

Step 3: Diffuse or disseminate?

Innovations can spread in 2 ways:• Diffusion – communication through

horizontal/ peer social networks. Largely unplanned and organic.

• Dissemination – a planned and active process intended to increase the rate and level of adoption. Use vertical/ formal networks.

Step 3: AHSN Support

A plan to diffuse

Step 4

Step 4: Diffusion

Innovations diffuse through horizontal networks. They are were professionals meet, share experiences, ideas and best practice – where ‘word of mouth’ happens.Examples:• Clinical forums, such as Wessex Stroke Forum and

Wessex AHP Forum• Training events – e.g for primary care or speciality

training for junior drs.• Internet hubs

Step 4

Step 4: Dissemination

Innovations disseminate through vertical networks. They are the formal networks that bring together decision makers, set policies and priorities and allocate resources.Examples:• The AHSN• Local Medical Committees and Local Pharmaceutical

Committees• The Strategic Clinical Networks• The Hampshire Commissioning Network• Wessex HEE and Research Networks

Step 4: Key roles in networks

Opinion leaders: Highly respected people who influence others. Their opinions are sought and valued. Champions: Key individuals who are willing to back an innovation and push for its adoption.Networkers: Provide an important role supporting the flow of information about innovations across organisations.

Step 4: Network plan

• Identify the networks that can support the spread of the innovation to the adopters identified at step 2.

• Research how they work and how they can be used to communicate and influence adopters.

• Identify the opinion leaders, champions and networkers that can play a role in supporting spread and adoption.

Step 5

Step 5: Communications plan

Brings together the advantages of the innovation, our understanding of the needs of potential adopters and our intelligence on the key networks and key people.

Priority audiences Key messages Communication actions and channels

Specific organisations, departments, roles and people. Provider and Commissioner.

Messages that are specific to each audience.Responding to the benefits and constraints at step 2.

Using the intelligence on key networks and key people at step 4.

Step 6

Step 6:Implementation and sustainability plan

Organisation commitmentExecutive support, time and cost, other departments, reporting arrangements …

✔System commitmentCommissioner support, networks interested, communications, reporting …

✔Implementation teamExecutive sponsor, clinical lead, project manager… with sufficient time. ✔Support for implementationAHSN, the innovator, champions, other adopters, specific skills such as commissioning/ informatics

✔SustainabilityAdopters continue to network with other adopters and receive and share information on its impact

✔

A checklist covering the main factors that determine the success of the implementation of an innovation and its sustainability:

Groupwork

Groupwork

4 innovation stations:1. OPEN (Older People’s Essential Nutrition)2. MISSION Severe Asthma3. Mental Health (psychosis) Quality Improvement4. Dementia Friendly PracticesRoad test the templatesCapture your learning, feedback and improvements on the methodology on the flipchart

Groupwork

Two tasks:

1. Road test the methodology and templates2. Capture your learning, feedback and ideas for

improvement on the methodology on the flipchart.

Identify your top 2 points to feedback in plenary.