Guy Lubitsh and Amy Rylance explain a model aimed at improving diabetic care in the UK.
The Diabetes UK clinical champions programme began with an ambition to make a difference in diabetes healthcare delivery, despite facing a seemingly impossible situation and ‘perfect storm’ conditions.
It is producing major improvements, has addressed highly complex challenges, and has led to the delivery of multiple tangible changes without adding any extra strain on the health system or a single penny to the budget.
For other organisations facing similarly complex challenges or no longer able to rely solely on themselves or their own resources to do everything, the programme offers an adaptable model – a way forward where others have failed.
In this case study we share the principles behind this inventive programme. The context and challenge In the UK, the number of people living with diabetes has doubled in the past 10 years, standing today at 4.5 million.
As a nation, we find ourselves unprepared and under-resourced to meet the increasing associated needs. It is putting immense strain on health and social care services, costing the NHS £10bn annually and is exposing both the lack of patient education as well as dangerously inadequate specialist knowledge among healthcare professionals.
the ability for diabetes specialists to address the problems, to work outside their silo and role or even to build an understanding of the challenges across the diabetes pathway is non-existent given the pressures, hierarchical nature and fragmented organisational structure of the NHS.
Basic errors in medication, mistakes and misdiagnosis are all too common occurrences for people with diabetes, and the latest figures from the Diabetes UK State of the Nation report 2016 are alarming: of all deaths from diabetes, 80% are avoidable; diabetes is now the major cause of blindness in working age people; 80% of limb amputations are 100% preventable.
Completing the picture, healthcare professionals are demoralised and exhausted from the daily frustration of not being able to meet patients’ needs and deliver adequate levels of care while also cutting costs.
Furthermore, the ability for diabetes specialists to address the problems, to work outside their silo and role or even to build an understanding of the challenges across the diabetes pathway is non-existent given the pressures, hierarchical nature and fragmented organisational structure of the NHS.
The programme is a partnership between Diabetes UK and Ashridge Executive Education, in collaboration with the diabetes specialist pharmaceutical company Novo Nordisk who provide support and funding.
Reflecting the reality that change must come from within, the central concept of the programme is the creation of a new role of Diabetes UK clinical champion, into which frontline diabetes healthcare professionals from the NHS are recruited.
The programme is centred around each champion owning the remit of making changes happen, led by a process which incites participants to identify failings in their locality, commit to evidence-based change initiatives, understand and work with underlying systemic challenges, and come together as a community to take on shared obstacles.
Champions, who range from nurses, dieticians, GPs, pharmacists, consultants and podiatrists, are supported in this mission through highly relevant learning and extremely hands-on practical involvement and
The programme itself comprises four 24-hour residential modules (limiting time away from work yet maximising the benefits of being together) plus action learning groups, within a two-year working process. Content priorities include exploring what is really stopping change (rather than ‘change theory’), systemic hierarchy, authority and influencing, and growing the knowledge and confidence to lead change.
The first module begins the work of scoping the failings/problems to be addressed, developing skills/ understanding and building a network. Module two addresses the specific challenges of reaching out to complex communities, using patients and engaging local communities in change.
Module three includes important technical aspects such as communicating business plans effectively and stakeholder mapping, but also draws in ‘big players’ from within the NHS, national government and industry to share insights on leadership and resilience at this crucial stage in leading change.
The last module looks at increasing personal impact and profile-raising, as well as exploring topics such as managing negativity, saying “no” and celebrating successes. However, all involved are driven by the same underlying belief: “what happens outside the programme is why we’re all here”.
As champions begin to address problems, hands-on involvement and support from Diabetes UK, Ashridge and Novo Nordisk is a crucial element and ensures that all involved can “make changes faster”. Their support ranges from practical resources and help to the provision of data, research findings, legislative information and contacts.
This level of involvement is far beyond that usually found in L&D programmes and means champions never have to start from a blank page or work in isolation.
Impact and feedback
In terms of the impact of the programme, this has exceeded all expectations and there are multiple examples of directly correlated change. These include:
- Reducing medication errors in hospital (46.9% to 26.7%),
- Reducing instances of serious hypoglycaemic episodes in hospital (15.5% to 6.9%).
- Implementing new care guidelines.
- Increasing the number of limb screenings (18.2% to 34.4%).
- Securing funding for a new role of Schools Educator in Wales.
- Designing new staff training initiatives.
- Delivering training to schools.
- Reducing call-out numbers.
About the authors
Guy Lubitsh is Client Director at Ashridge Executive Education and Amy Rylance is Head of Healthcare Professional Engagement, Diabetes UK. Organisations wishing to find out more can read an extended case study about this programme at http://bit.ly/2eZ3hkU