Dr Susan Howard blogs about the benefits of aligning our acute kidney injury applied health research with regional or national schemes.
Ever feel like you’re swimming upstream? You can see what you’re doing is important, but no one else seems to have time to get on board? Well, one of the biggest lessons from my time at CLAHRC Greater Manchester is the benefit from aligning with regional or national schemes. That way it feels like you’re jumping onto a toboggan at the top of a slope; it’s exciting, you know it’s going to go somewhere, and you’re definitely heading in the same direction as the others. That’s why I feel fortunate that our kidney health programme is closely aligned with a variety of other initiatives.
They say the proof of the pudding is in the eating, right? Well the proverbial pudding for me is chronic kidney disease (CKD). We, as a CLAHRC, have been successfully delivering CKD projects across Greater Manchester for several years, supporting GP practices to improve the accuracy of their CKD patient registers and manage this patient population to [alignment alert!] NICE guidance. However, since CKD ‘dropped out’ of QOF (3 of 4 indicators were retired in April 2015), the change in engagement has been profound. Demonstrating that, without other drivers, asking for additional activity from an already stretched workforce is like trying to make it down the luge track without a sled – you might make it to some extent, but you’re going to come out a bit bruised and battered.
‘It’s all to do with £££!’ I hear you cry (as QOF is financially incentivised) – but if you take another example… we’ve been working with NHS Salford Clinical Commissioning Group (CCG) to help support delivery of their sick day guidance project, which is attempting to prevent cases of acute kidney injury (AKI). Sure, it’s a bit of a hot topic at the moment, and there’s great local support, but the clinical evidence is, let’s say, ‘a bit thin’ at present. The bonus is this project is a ‘3-man bobsleigh’, as the work aligns with both NHS England’s Think Kidneys programme and the CCG’s locally commissioned service (which incentivises GPs to participate – and most have).
What’s surprised me, though, is the positive engagement with community pharmacists, many of whom (despite entire lack of financial incentive) have got on board with gusto. We’re hoping our evaluation can shed some light on what the drivers were for each professional group involved, but clearly money isn’t everything – it’s far more complex than that (incidentally, we’re working on a top 10 tips for implementation in primary care at the moment – more on that in a future blog, no doubt).
As well as trying to prevent AKI in primary care, we’re also working with the quality improvement team at Salford Royal NHS Foundation Trust to help support and evaluate a quality improvement project aiming to improve AKI care in hospital. This initiative relies upon Trust employees signing up to a ‘collaborative’, and grafting away at a ward level to make local improvements week on week – not a trifling commitment. One of the key external drivers here is the related CQUIN, plus it’s aligned with work going on in Central Manchester University Hospitals NHS Foundation Trust and Think Kidneys. I think the toboggan needs an extension!
Hot off the press is our next project with NHS Bury CCG, still in the design phase, but which promises to focus on post-AKI patients. This one not only aligns with national activity, but also a forthcoming locally commissioned service.
As these aligned initiatives hurtle down the icy tracks towards the finish line, the bob-teams continue to swap notes all the way down, making adjustments to their trajectory to ensure they hit the bends just right. And then, even once each sled has come to a stop, the teams continue to share learning with the next cool runners to help guide their way – when alignment morphs into collaboration?
Follow Dr Susan Howard on Twitter – @DrSusanHoward.