EBT Projects and workstreams

Our projects are focused around the following workstreams:
  • Behavour change to support service transformation
  • Identifying  and understanding positive deviants for service transformation 
  • Engaging with patients to support service transformation

There is wide variation in performance of NHS trusts on key quality indicators across the Yorkshire and Humber region.
 
For example, the standardised hospital mortality index for patients with a fractured neck of femur ranges from 65 to 145 (65% of expected deaths in one hospital to 145% in others). However, trusts rarely share information about the structural and behavioural circumstances that might produce these differences. 

There is emerging evidence that using an approach called ‘positive deviance’ can guide the spread of excellent practice across the healthcare sector and produce large scale change.
 
To use this approach we must first identify ‘positive deviants’ - organisations, hospital teams or general practices that demonstrate consistently excellent performance in a particular area of care. Once identified, these organisations can then be studied in-depth, to reveal:
  • what it is that they do, including the processes and structures in place that enable such positive practice and that can be transferred to other organisations; and
  • potential mechanisms for spreading this positive practice throughout the service.
This Positive Deviance approach is an innovative quality improvement method, and is being pioneered within the Academic Health Science Network in Yorkshire and Humber. The approach depends upon having good data on important patient outcomes from hospitals, general practices and other community services.  Working with the Yorkshire and Humber Public Health Observatory has enabled us to access routinely collected data to identify  organisations, teams or individuals demonstrating exceptional performance, and to learn from them. We have applied this pragmatic approach within various healthcare settings including elderly care, elective hip and knee surgery, transitions of care and intermediate care services. 
 
In Autumn 2018, we delivered a workshop "The Positive Deviance Approach: Learning from exceptional performers to improve the quality and safety of care".  This was attended by multiple organisations who have access to performance data, such as National Audit teams, AHSNs, Patient Safety Collaboratives, CCGs, other CLAHRCs and NHS Improvement. The aim of the workshop was to help these teams understand how they could use data they routinely collect to identify exceptional performers, learn from them to improve quality and safety in their teams.

In addition, we have recently established a ‘positive practice network’ in collaboration with the Improvement Academy Yorkshire and Humber, to help ward staff make better use of patient experience feedback.  The network consists of coaches who are trained to implement our new tool -  The Yorkshire Patient Experience Toolkit - to help ward staff make better use of patient experience feedback to improve patients' experience of care.