SHAREHD - a quality improvement collaborative to scale up Shared Haemodialysis Care for patients on hospital based haemodialysis

Renal failure has a major impact on quality of life and survival. Most patients who are treated using haemodialysis, spend at least 12 hours every week in hospital, but the current dialysis environment encourages them to be passive recipients of care. 

SHAREHD is a Health Foundation funded programme, supported by Kidney Research UK. It is scaling up a previous regional quality 
improvement intervention led by Sheffield Teaching Hospitals NHS Foundation Trust, to extend the benefits of shared haemodialysis care to all haemodialysis users at 12 centres across England who are partnering with the programme.

This 30 month programme aims to improve experience for people who have their treatment at dialysis centres, by giving them the choice and the support needed to learn about and participate in aspects of their own dialysis care. As they become more independent and confident some people may choose to dialyse independently at centres or to dialyse at home. By the end of the programme, an estimated 30% of patients will be participating in tasks relating to their own dialysis care.

Method: A cohort questionnaire based study of 600 patients across the 12 NHS Trusts is gathering data throughout the programme to determine the impact of the Trusts participating in the Quality Improvement Collaborative.
Two phases of Learning Events for participating teams held in Sheffield will focus on the best ways of implementing shared haemodialysis care at each site and sharing learning. Teams from the first 6 randomly selected Trusts have met to plan and implement ‘tests of change’ that are actioned locally to increase patient participation in sharing their care. After 6 months the second wave of teams joined the collaborative and further events will be held to share learning and continue implementation using quality improvement methodologies.

Findings: As shared haemodialysis care is person centred, implementation requires to be individualised both to take account of the characteristics of each participating centre and each patient. This is achieved locally by testing approaches in each environment and by sharing the learning as a collaborative. The patient advisory group is central to guide the direction of travel. Local teams working together with patient partners is key to ensure ownership of changes. Mutual support from other teams across the country, who are all working to the same vision, is vital particularly when issues arise or where validation of an idea is needed.

A communications and social media strategy has been developed to share the vision and support the collaborative network across both health professionals and patient partners.

Next steps: Data from cohort questionnaires are being collected from 600 patients every 3 months through to mid 2018. Learning events for the first wave continue throughout 2017, the remaining 6 Trusts coming on board from Autumn 2017. Learning achieved by the first wave will be passed onto the second wave. The findings from the evaluation will be published early 2019.