Bryn Kentish

In 2019, Paul Twose, a consultant therapist at Cardiff and Vale University Health Board (UHB), was awarded a small amount of funding from the Welsh Critical Care Network to develop a tracheostomy care team within the Health Board.

The objective of this team was to improve the quality and safety of the care given to patients with tracheostomies across the system, but especially those receiving critical care, by improving the skills and confidence of staff, thereby improving patient outcomes.

They quickly became involved in a UK-wide project, the Improving Tracheostomy Care Collaborative, in which they were representing one of 20 sites in the UK. The team learnt a lot being part of this network and felt as though that the knowledge they had gained, even at this early stage of their journey, would be beneficial to other Health Boards in Wales.

Many patients who require tracheostomies from across Wales are seen in tertiary services in Cardiff and Vale UHB. Then, they would go back to their local hospital for rehabilitation following their treatment.

Therefore, the idea was to train and support clinicians across the whole of Wales with their treatment of patients with tracheostomies in order to reduce variation in the health and care system.

Paul said, “We thought we had the idea, one that could just be essentially copied and pasted into other organisations. Of course, it wasn’t that easy. So, we thought, ‘how do you take an idea that’s working well in one area and spread it as far as you can?’”

In September 2019, just a few months after they had initially formed, the tracheostomy team attended the inaugural Spread and Scale Academy hosted by Cardiff and Vale UHB in partnership with the Billions Institute, a Los Angeles-based organisation which specialises in supporting innovators to unleash their potential and make large-scale meaningful change.

Unleashing their potential is precisely what attending the Spread and Scale Academy allowed Paul and his team to do. He said, “The Academy made us refine our idea, and create enough flexibility within it to allow other organisations the freedom to do what they needed to achieve the common goal of great tracheostomy care. We were a newly formed team comprising me, a physiotherapist, Gemma Jones, a speech and language therapist and Jennifer Lowes, a specialist tracheostomy nurse. We were also supported by Dr Paul Morgan, a consultant intensivist and the tracheostomy lead for Cardiff and vale UHB. Although he did not attend Spread and Scale, he has always been an integral part of this multidisciplinary team.

“Before Spread and Scale we had not yet worked out our internal dynamic or aligned our individual ideas of where we wanted to get to into one common goal. It sounds like basic stuff, but it was fundamental.”

The team left the Spread and Scale Academy with a clear 90-day plan of action and a solid understanding of what each member of the team should be doing to achieve it. This allowed them to prioritise their actions effectively, recognising what was most urgent and who were the key people in the system they needed to bring on board.

They quickly built strong links with the Respiratory Health Improvement Group and the Institute of Clinical Science and technology, using their networks to establish the best ways of spreading the team’s learning across Wales.

Working with them, the team were able to create online education and training packages that anyone in NHS Wales can access; these include 20 videos, case studies and questions for staff to answer. There are now “superusers” of this system in each Health Board who can gather analytics about who is accessing the training.

The team established links into other Health Boards in Wales by working through the Welsh Intensive Care Society to create a network of interested people. They found that clinicians across Wales were all trying to achieve the exact same thing of improving the care of their tracheostomy patients; it was clear that this was not just a Cardiff and Vale UHB project.

Paul said, “Had we contacted these organisations without having attending Spread and Scale Academy first, it would have been so much more difficult to explain what our goals were. I don’t think we had clearly defined them in a measureable, communicable way before the skills we received at Spread and Scale allowed us to really re-evaluate them.”

However, before the team were able to progress their project any further, COVID-19 struck. The pandemic presented a huge barrier by effectively ending all face-to-face training, especially across different organisations.

Paul said, “We needed to come up with a different way of looking at the problem and how we were going to solve it. We had heard about the Capital City Region (CCR) deal and because a large part of our success to this point had been through partnership working with other organisations, we thought that a CCR Innovation Challenge Fund might help us build new relationships to solve new problems.”

The team were successful in their application for a Challenge Fun worth £400,000. This funding is available to competitive bids from any enterprise capable of delivering innovative, impactful tracheostomy training for Cardiff and Vale University Health Board.

Paul said, “We never imagined that we would receive the amount of interest that we did, and that we would be the first ever CCR Innovation Challenge Fund. It’s very exciting, as a successful outcome for this challenge will change the way we deliver tracheostomy training forever. More than that, it could be applied to other areas of healthcare and modernise training across the NHS.”

Reflecting on this journey, Paul acknowledges that what he and his teammates learnt at the Spread and Scale has always been a cornerstone for any step they have taken since. Paul has since began to facilitate other Spread and Scale Academies, helping other teams begin to think differently about what they want to achieve and how they can use their individual talents to do so.

Paul said, “You can see yourself in the people who are attending now, and recognise the headspace that my team and I used to be in. For me to help them get past those barriers is incredible; six days a year to facilitate is nothing in terms of my diary but the benefit it can deliver for these teams, their projects and the people they serve is potentially huge. We’re trying make improvements in everything we do and Spread and Scale informs all of it; even just linking in with the Health Board’s Improvement and Implementation team has opened so many doors for us.

“I’m convinced that if we hadn’t attended that 2019 Spread and Scale Academy, it would have taken me my whole career to get where I am now, both in the way I approach challenges and the projects I’m working on. Instead, it has taken only a couple of years.”

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