Using Rapid Evidence Synthesis to mobilise innovation in a rapidly changing NHS landscape
Dr Paula Bennett provided early clinical leadership during the implementation of Virtual Wards across Greater Manchester within her role as a Chief Nurse/CNIO at Health Innovation Manchester. When NIHR ARC Greater Manchester began the Rapid Evidence Synthesis (RES) to inform the implementation process, Paula was involved from the start to ensure the RES was asking the right questions. In this blog, Paula shares her thoughts on the benefits of using RES at the start of a transformation programme of this nature.
Follow the evidence
Colleagues at Health Innovation Manchester and I were involved in the Virtual Wards programme from the very beginning as an innovation organisation acting on behalf NHS GM. Having previous experience in clinical informatics research and service improvement, understanding the evidence base for any new innovation is always a critical starting point.
In the case of Virtual Wards as we were designing new models of care for Greater Manchester, it was imperative we learned from existing evidence. One of our early priorities was to understand the existing research about the types of ‘hospital at home’ models for technologically enabled care.
The RES approach wasn’t new to me as I’ve had experience of other RES projects. We had to have a clear foundation in terms of what was the literature is telling us, where the evidence gaps were, and how that could inform how we were going to shape and design services.
We were starting with a blank sheet of paper for something that's relatively innovative and new in the NHS in England. Our professional hunch was that it was the right thing to do - to keep people out of hospital and to provide a level of expert care in people's own homes if it was safe and appropriate. We can’t design new services on “hunches” they must have a strong evidenced-based foundation.
Shaping thinking across the system
Some of the outcomes of the RES supported our assumptions that it was the right thing to do. One of the questions we wanted to understand was the impact on relatives and carers. For example, do carers experience any additional burden as their relative was at home acutely unwell as opposed to being in hospital? Understanding what the evidence tells you about how families in this situation feel was very important to focus people's minds on what those issues were, and it helped to shape our thinking as to what we needed to do as a system.
We spent a lot of time thinking about benefits and impacts, as well as the disadvantages of care at home. This was incredibly useful in terms of informing the subsequent design of the programme and it also helped support clinical conversations and challenges that might arise from switching from traditional hospital models of care to delivering care in someone's home. Rightly, the key question is ‘how do we know that virtual care is as good and as safe as the care you might have in hospital?’. This was a specific element of the RES - are patient outcomes equivalent, better or worse than what we're currently doing? And does this differ depending on the acute medical problem the patient has? From that perspective, it's absolutely critical that we did a RES and I wouldn't start a piece of work like this without one.
When you've got to quickly mobilise a new programme, you can't wait for the results of primary research or a systematic review. So, the RES approach absolutely fits with the way that the NHS is having to rapidly change and adapt. During the pandemic people had mobilised new models of care that were using technology and so we were able to capitalise on that by looking at the research that had already been done.
Reflections
As with any large-scale transformation programme, there have been challenges. The RES served a particular function and helped ensure that we built the design on sound evidence, and we could clearly communicate benefits based on that evidence. The RES also increased our understanding of the elements of successful programmes of this nature as it identified research that evaluated the ingredients for successful transformation. We used this to insight to ensure we built those elements into our programme.
Dr Paula Bennett, RN (Adult) RN (Child) Chief Nurse Health Innovation Manchester
The next blog in our RES Virtual Wards series comes from Professor Emma Vardy, NIHR ARC-GM’s Deputy Lead for Healthy Ageing.
Download the Virtual Wards RES at: https://arc-gm.nihr.ac.uk/rapid-evidence-synthesis