CLAHRC for South Yorkshire

Implementation Summer 2010 Newsletter

Welcome to the NIHR CLAHRC for South Yorkshire newsletter Welcome to CLAHRC SY’s second newsletter, which focuses on implementation activities within our programme. Whilst much of our work is dedicated to providing evidence of the effective management and delivery of health and social care services for people with

Policy makers, managers and practitioners do not always make use of the research evidence available to inform healthcare. CLAHRCs can help close this gap between research, policy and practice by developing innovative approaches to translate research findings into improved outcomes for patients. CLAHRC SY has four implementation themes focussing on knowledge translation. Each is working in different ways with commissioners, managers, healthcare professionals, patients and the public. The Reducing Health Inequalities theme is collaborating with primary care partners to improve outcomes for communities and populations at large. Intelligent Commissioning is working with teams across the region to develop evidence-based commissioning specifications for the

long-term conditions, the CLAHRCs are also vehicles for the implementation of evidence that will result in changing practices and behaviours. In July 2010 the government released the White Paper Equity and Excellence: Liberating the NHS outlining the extensive changes planned for the NHS. These changes will undoubtedly affect our collaboration, although we are pleased to note that the paper

specifically pledges the government’s ongoing support for the valuable work of CLAHRCs. Our autumn issue will focus on innovative technologies being developed and trialled by CLAHRC. For further information about specific projects or events please visit our website. Professor Sue Mawson Director, NIHR CLAHRC SY

NHS Sheffield was quick to recognise the opportunities CLAHRC offered.

future provision of services for people with certain long-term conditions. Translating Knowledge into Action (TK2A) promotes more clinicallyeffective care by influencing practice. NHS partners have identified priorities and implementation projects trial and evaluate innovative ways of facilitating evidence-based practice. User-Centred Healthcare Design (UCHD) brings together patients, healthcare staff and families to understand the real-life experiences of care provision, using that knowledge to drive innovation and improvement in service design and delivery. Whereas implementation themes focus primarily on knowledge translation, several research themes are also undertaking implementation activity. We are optimistic that through implementing changes in healthcare practice CLAHRC will make a significant contribution to improving healthcare and enhancing the wellbeing of people in South Yorkshire. Professor Kate Gerrish

Through Primary Care Trust engagement across the CLAHRC themes, in particular those which support our strategies in Intelligent Commissioning, Stroke, Diabetes, Health Inequalities and Obesity, we are developing new and strengthening existing research partnerships to help us meet our strategic priorities while placing evidence at the heart of our business. As just one example, we are now leading a social marketing campaign for Black and Minority Ethnic (BME) and deprived communities in stroke awareness, which will benefit not only the Sheffield population but also other communities wider afield. Jan Sobieraj Chief Executive, NHS Sheffield

Implementation Lead, CLAHRC SY

Collaboration for Leadership in Applied Health Research and Care for South Yorkshire

News from CLAHRC for South Yorkshire

Translating Knowledge into Action (TK2A)

Reducing Health Inequalities

Championing nutrition on the wards

Heart failure, housing and deprivation

Malnutrition, or risk of it, among hospitalised patients with longterm conditions is widespread and can lead to serious or adverse health outcomes. Evidence suggests that under-nutrition delays recovery, lowers resistance to medical complications and can be linked to lengthened hospital stay, morbidity and mortality.

Just as some research themes are undertaking implementation activity, so there are examples of clinical or other research within our implementation themes. An example of this is the work on heart failure, housing and deprivation that has taken place within the Reducing Health Inequalities theme.

The project Enhancing the Quality of Oral Nutrition Support (EQONS) focuses on this problem.

Nutrition champions tasting the supplements 1

Developed in partnership with Sheffield Teaching Hospitals’ Nutrition Steering Group, it uses MUST+, an adapted version of the Malnutrition Universal Screening Tool (MUST), and nutrition care guidelines to promote the use of best evidence in healthcare practice. Frontline clinical staff are being enabled to translate knowledge into their day-to-day actions, and act as ‘champions’ with responsibility for developing practice. Facilitation is recognised as a key element in knowledge translation1 and the TK2A team uses a number of approaches to help nutrition champions fulfil their role. This includes frequent support visits to the champions on their ward, drop-in sessions, posters, newsletters, quick-reference handbooks, and study days. At a recent study day staff had the opportunity to expand their knowledge, work together, build relations with the Catering Department and develop action plans to improve nutrition support in their

own clinical areas. Staff commented that they felt encouraged about changes and understood MUST+ and issues around nutrition more clearly as a result of the study day. The team will now support, monitor and evaluate the action plans and audit current documentation to achieve sustainable change, and gain a patient perspective on nutritional care. For further information please visit

Rycroft-Malone J (2004) The PARIHS framework: a framework for guiding the implementation of evidence-based practice. Journal of Nursing Care and Quality 19: 297-304

Better Outpatient Services for Older People

The patient and staff participants were encouraged to use stories of their visits to or work in outpatients to illustrate areas of good practice and areas for improvement. Stories proved a powerful means to move beyond the ‘mustn’t grumble’ response and provided a far richer source of information than traditional survey methods. 1


Heart failure can be extremely debilitating, and around 40% of people die within a year of diagnosis. Hospital readmission is common. Depression and social isolation are common complications, and increase the risk of death. Our aim was to investigate the factors that predict mortality and hospitalisation in heart failure. With CHD both the prevalence of the disease and the rate of emergency

User-Centred Healthcare Design This project used design thinking to achieve service improvements, based on the engagement of patients and staff in a creative process of learning, improvement and innovation. The team used different methods to achieve this including experience based design1, ‘secret shoppers’ and training delivered by a local applied theatre group.

Heart failure is caused by the inability of the heart to function efficiently. Its causes include high blood pressure, heart valve disease and coronary heart disease (CHD), especially following a heart attack. Although relatively rare in younger adults it becomes increasingly common with age, affecting around one in ten people over 65.

Several issues arose from the patient and staff stories, and the project team and participants worked together to propose solutions to these problems.

the technical issues but was firmly based in the patient experience. This proposal is under consideration by the Estates Department.

Patients described how anxiety often started with the receipt of the appointment letter. Together staff and patients designed a new letter including a picture of the correct clinic door and key information printed in bold. This letter is now being sent to all new older patients within the Medical Outpatients department, and may be used elsewhere in the Trust.

‘Customer care’ was a recurrent theme throughout the stories, representing a particular challenge in terms of implementing change in healthcare. The project team chose to commission Dead Earnest, an applied theatre company, to deliver a training session to highlight the issue for the staff of the outpatients department in an innovative and original way.

The road outside the outpatient’s department was noted as being confusing and potentially dangerous. The project team and participants worked with Sheffield City Council to develop a proposal that addressed

For more information on these and other changes that were implemented please see our website at: or contact [email protected]

hospitalisation rise in line with social and economic deprivation. However, because the causes of heart failure differ from those of CHD, it was uncertain whether this would also apply to heart failure. While heart failure emergency admissions were related to deprivation, we found no association between deprivation and mortality or between hospitalisation and mortality. This implied that the prevalence of heart failure might not be related to deprivation. However, we did find that mortality was related to ‘housing churn’: the proportion of households moving in a 12 month period. This suggests that, unlike CHD, outright deprivation is not a predictor of heart failure mortality, although it does predict hospitalisation. However, housing turnover does suggest a link between the risk of heart failure death and community cohesion and stability, which may be related to the known association with social isolation. For further information please contact Dr John Soady john.soady@

Stroke Aspects of implementation within stroke research A number of implementation projects are taking place within the Stroke research theme. Our work on stroke unit quality and the impact of the government’s FAST campaign (Face, Arm, Speech, Time see below) both use an implementation approach to enable them to have a direct impact upon the nature of stroke services in South Yorkshire. Stroke unit quality The National Stroke Strategy and related guidance has placed an emphasis on the need for stroke patients to access a range of acute services during and following diagnosis. Important developments to these key services placed in the hyperacute and acute part of the pathway have occurred across the region in recent years. Our project seeks to build on this important work by facilitating further service improvements. In addition to considering evidence and guidance, we will also be taking account of patient, carer and staff priorities. Following a period of exploration with key stakeholders the work will use knowledge transfer methods to facilitate the desired changes. For more information please contact Madeleine Harrison madeleine.harrison@ Impact of FAST Last year, the Department of Health launched its FAST campaign to raise public awareness of the signs and symptoms of stroke. During this period Yorkshire Ambulance Service NHS Trust recorded a 30% increase in stroke related calls. We are undertaking a project to analyse a sample of those patients admitted to hospital trusts with suspected stroke to explore the appropriateness of these admissions. We anticipate that the work will contribute to improved procedures, training and local evaluations of the use of social marketing campaigns in this context. For more information please contact Dr Tony Ryan [email protected]

NHS Institute for Innovation and Improvement. (2009). The ebd approach: Guide and Tools. Coventry: NHS Institute for Innovation and Improvement.

Collaboration for Leadership in Applied Health Research and Care for South Yorkshire


News from CLAHRC for South Yorkshire

Intelligent Commissioning


Implementing Commissioning

CLAHRC Conference in association with SDO Network

Commissioning is the process by which health and care services are chosen by the NHS to meet the needs of the population. It is crucial that commissioning decisions are made not on the basis of superficial financial information, but by choosing the best ways of investing in healthcare. The Intelligent Commissioning theme aims to build on PCTs’ existing work, converting the outputs of CLAHRC SY and other research evidence into commissioning for key long-term conditions (LTC) in South Yorkshire. Through this theme we will develop commissioners’ skills in using research evidence and techniques in line with the Department of Health’s intention to make commissioning in the NHS world class. The theme provides a two-year structured programme for five commissioning teams drawn from

6-7th October 2010, The Edge, Sheffield Speakers include: Dr Ian Graham, Canadian Institute of Health Research; Professor John Gabbay, University of Southampton; Professor Kate Gerrish, STH and SHU; Professor Hilary Scholefield, STH; Professor Harry Scarbrough, Warwick Business School and Professor Jo Rycroft-Malone, Bangor University.

the region’s PCTs and a GP practice based commissioning consortia. Each team has taken an existing ‘chronic disease management’ purchasing specification, which it is systematically improving by gradually incorporating researchbased evidence, skills and techniques from other themes into the commissioning cycle. The teams are also targeting key areas within their specific disease pathways to improve quality, innovation, productivity and prevention (the NHS’s QIPP agenda) in their area. Several of the commissioning groups have expressed interest in applying for additional external funding. They are drawing on skills and resources made available to them through CLAHRC to solve challenges within their care pathways. For further information please contact Dr Julian Sorrell j.sorrell@

Up to 2,500 people in Barnsley to be supported with Telehealth A partnership between CLAHRC SY, NHS Barnsley, Barnsley local authority and Robert Bosch Healthcare is working collaboratively to introduce and evaluate telehealth provision in the region; the first of its type at this scale. Working with the Rehabilitation and Assistive Technology Research Group at the University of Sheffield, good practice in the deployment of the Bosch Telehealth Plus system, used in the US with over 100,000 patients over ten years, will be translated to the UK context and evaluated in Barnsley. Phase one will pilot the approach with 150 users in September before being scaled to 500 and then ultimately 2,500 patients being able to benefit from a variety of Telehealth solutions over the next few years.


Knowledge Exchange Seminars 16th September 2010 - Core Team and Depression Theme Seminar 10.00 -12 noon 15th October 2010 - Stroke Seminar 12.30 -2.30pm 10th November 2010 - Genetics Seminar. 12.15 -2.00pm

News in brief Collaborative working with the healthcare industry

Both days are free to attend for all delegates. Registrations are no longer being accepted but if you would like to be added to the waiting list please fill in the online registration form at html

For more information please contact Jenny Powell [email protected] For further information contact Dr Simon Brownsell, s.brownsell@ HIEC The Long Term Conditions theme of Yorkshire and the Humber’s Health Innovation and Education Cluster (HIEC) is making good progress. It is working with the Strategic Health Authority’s education commissioning team to agree priorities for telehealthrelated training provision, developing an introductory telehealth/telecare e-learning module in collaboration with the Virtual College and the Advanced Digital Institute, and working with the Regional Telehealth Programme to define educational needs for region-wide adoption. A plan has also been formulated for the adoption of the regional Telemedicine Project in Stroke (TEMPIS). For more information please contact Dr Dawn Lawson dawn.lawson@

Learning Together Workshops Open to research fellows and assistants, PhD and MMedSci students and other theme members. 13th September 2010 - Applying for funding. This will be run in conjunction with the Yorkshire and Humber Research Design Service, and will be a full afternoon. November 2010 - Getting published and developing writing skills March 2011 - Public and patient involvement in health service research May 2011 - What health services want from research. For more information please contact Dr Christine Smith [email protected] NIHR CLAHRC for South Yorkshire acknowledges funding from the National Institute for Health Research. The views and opinions expressed in this newsletter are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health. CLAHRC SY would also like to acknowledge the participation and resources of our partner organisations. Partner details can be found on our website.

Collaboration for Leadership in Applied Health Research and Care for South Yorkshire © Sheffield Teaching Hospitals NHS Foundation Trust, 2012

Implementation Newsletter [Summer 2010].pdf

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