Designing better processes and services

Mortality from sepsis reduced across Scotland from a baseline by 21% since 2011

The ihub assists in the design of processes, care models and systems which will improve outcomes.

  • We offer an easily accessible store of knowledge, tools and guidance to support the work of redesigning models and pathways of care. As part of this, we help link evidence and standards to the work of redesign.
  • We provide advice and support on co-designing services with all relevant partners, including individuals who use them, their families and wider communities.
  • We enable easy and wide access to work with national and international experts to support redesign.
  • We support work to design and test innovative solutions to common improvement challenges across Scotland.

Examples of our work

New Strategic Commissioning Support Unit

In the later part of 2016–2017, we developed a new Strategic Commissioning Support Unit to provide expert assistance to Integration Authorities on their work to redesign services. This unit will provide advice and support on the:

  • application of design methodologies to the work of redesigning services
  • use of strategic planning tools and methodologies that support data and evidence driven decisions when redesigning care
  • development of outcome-based commissioning, and
  • effective engagement with third and independent sectors to optimise their contribution to health and wellbeing for people in Scotland.

The unit aims to work alongside strategic planners, health and social care professionals, and the public to maximise the potential of health and social care organisations and community assets in supporting their local populations to achieve better health and wellbeing outcomes.

Working in partnership with the Improvement Service

During the early part of 2017, the Strategic Commissioning Support Unit was invited, as part of the Improvement Service’s Change Managers Network, to deliver three webinars to explore approaches that support Integration Authorities to understand their strategic commissioning requirements.

  • The first of these focused on understanding what strategic commissioning is and provided an overview, with reference to published studies and practical experience, of commissioning processes, tools, and approaches.
  • The second webinar discussed the use of data to inform decision-making, addressing the tools and techniques to support data analysis.
  • The third webinar explored the concept of co-production and how services might be designed, commissioned and operated differently.

These joint promoted webinars were attended by individuals working across the system and in a range of sectors, including health, local government and the third sector from across Scotland and the UK.

Rapid reviews of evidence

Drawing on the skills from Healthcare Improvement Scotland’s Evidence Directorate, we completed rapid reviews of evidence to inform:

  • the redesign of diabetic foot care services
  • work to refocus community hospitals
  • the design of improved approaches to communication with individuals with advanced dementia
  • an assessment of the value of participation in health and social care services, and
  • the development of economic indicators/proxy measures for the House of Care Wellbeing Service.

A new model of integrated care – the 8 Pillars Model

In August 2016, we concluded work with five sites to test a new model of integrated care. Called the 8 Pillars Model , the model was tested in the community for people with moderate to severe dementia. This model was developed by Alzheimer’s Scotland in recognition that current models used by services often end up with people experiencing fragmented care and key gaps in support. This model was based on what people with dementia themselves said was important to them.

We published an evaluation of the effectiveness of the 8 Pillars Model of homebased support. Key findings included the value placed on having a single point of contact for people with dementia and carers and a personalised approach to support. One of the Dementia Practice Co-ordinators commented that:

“The 8 Pillars Model was beneficial as it examines all aspects of a person’s life, not just the aspect most directly concerned with their own professional practice.”

Our findings have also informed the new Dementia Strategy for Scotland. We are now working with the Scottish Government and key partners to develop an approach to supporting local implementation and spread of this work.

Supporting the redesign of overnight support

In recognition of the significant financial impact of a legal decision that care staff providing overnight support (sleepovers) are entitled to the minimum wage, we initiated work aimed at finding alternative and equally effective ways of providing overnight support. In December 2016, we worked with COSLA establishing an event focusing on the redesign of overnight support provision. Representatives from the Scottish Government, trade unions, Integration Authorities and service providers worked together to develop a national picture of the improvement and redesign opportunities.

The ihub, in partnership with the Scottish Government’s Technology Enabled Care Programme, the Scottish Centre for Telehealth and Telecare and NHS 24 are running a series of Action Learning Sets to help providers and partnerships to continue to share learning, form stronger cross-sectorial links and develop their local plans for the redesign of overnight support services.

At the end of the Action Learning Sets, each partnership will have developed a plan to achieve their local aim for overnight support. Their local aim and their associated plan to deliver it will have been aided by national support, but developed by partnership and providers to reflect their area’s needs.

The first Action Learning Set has taken place and was a huge success with 13 partnerships and a range of providers in attendance. Feedback was very positive with one provider stating:

“The openness and fresh thinking that the ihub brought to the day was positive. The structure of the day allowed participants to get together in an environment that engendered openness and sharing - allowing us to learn from each other. It wasn't just about high level messages; the day allowed us to share how we actually put this into practice.” – Social care provider