Case study: strategies for healthcare service improvement

This post was written by Adiba Enwonwu, a member of the Covid 19 Taskforce for the UK Cabinet Office.

What was the problem?

We like to talk about wrap-around services – and designing the service around the service user – but how often is this genuinely done? The Pacesetters Programme was a transformational change programme in which the department worked in partnership with local communities and the NHS to reduce health inequalities. In this case, a project in the West Midlands of the UK looked at increasing access to breast screening for women with learning disabilities who had lower uptake rates for breast screening. This was caused by a range of reasons including:

• Not knowing the real cause of the problem;
• A lack of joined-up working amongst clinical staff;
• Apprehension and fear amongst the women;
• Poor communication;
• The extent to which patients themselves had input into the design of their care process.

What was done to solve the problem?

The collaboration and involvement of the women whose service was being looked at was key. They were asked what they needed and wanted: patient experience and engagement was used to help drive the change. The women were empowered patients – helped to be more accountable and proactive regarding their care, using open and constructive dialogue between themselves and those responsible for their health. The women played a pivotal role in:

• Improving their role so that they were not passive recipients of care, but actively participated in co-designing/co-producing a model of care that was relevant for them. For example, to overcome fears around screening, they had pre-familiarisation visits – accompanied by nursing support.
• Driving the clinical change in the care that they needed.
• Open and constructive dialogue between themselves and those responsible for their health.
• Developing their easy read information and visual aids,
• Working in health promotion groups for other women with learning disabilities, collaboratively designing easy read information and visual aids.

What was learned?

• Put the needs of patients before organisational boundaries.
• A lack of joined-up working – possibly due to cultural working amongst clinical staff and patient preconceptions, is detrimental to developing relevant, personalised patient care and services.
• The extent to which patients themselves have had input into the design of their specific care process has a direct impact on the take-up of the service.
• The extent to which health professionals actually appreciate the input of patients helps shape their knowledge of their patients and their needs.
• Joining up parts of the care system in the patient’s care pathway delivers better outcomes for the patient.
• How to commission effectively and make a real and positive difference in the lives of people.
• How to get clinical practice, service improvements and innovation to work together.
• Question established ways of doing things and encourage innovation.
• How to show people – especially people who do not have a voice, that they matter. That their services matter.

Developing more integrated people-centred care systems has the potential to generate significant benefits. For patients, this includes improved health and clinical outcomes, better health literacy and self-care and increased satisfaction with care. For health workers, it includes improved job satisfaction, improved relationships with patients and improved efficiency of services.

Evaluation of the programme showed a significant increase in uptake by patients who were able and wanted to be screened. In addition, the methodology was subsequently been transferred to bowel and cervical screening services for people with learning disabilities.

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(Image Credit: Unsplash)