Transcript Slide 1

How to write an award-winning storyboard
Sian Bolton
Karen Field
Kelly King
Alan Willson
Purpose of NHS Wales Awards
• Recognise achievement
• Provide learning material to
support the training and
development of NHS staff
• Stimulate and encourage an
evaluative approach to
implementing better ideas
in service delivery
Timescale & Submission Process
• Submit storyboard entries from
1st November 2011 - 20th January 2012
• Visit our webpage:
http://www.wales.nhs.uk/sitesplus/829/page/56313
• Enter your text into MS Word storyboard
template
• Ensure your Chief Executive has agreed
and signed off your storyboard
• Register with conference management
system and upload storyboard
submission(s)
Model for Improvement
Judging Criteria
1. Storyboard Title
2. Brief Outline of Context (Where this improvement
work was done; what sort of unit/department;
what staff/client groups were involved)
3. Brief Outline of Problem (Statement of problem;
how they set out to tackle it; how it affected
patient/client care)
4. Assessment of Problem and Analysis of its Causes
(Quantified problem; staff involvement; assessment
of the cause of problem; solutions/changes needed
to make improvements)
5. Strategy for Change (How the proposed change was
implemented; clear client or staff group described;
explain how they disseminated the results of the
analysis and plans for change to the groups involved
with/affected by the planned change; include a
timetable for change)
Judging Criteria
6. Measurement of Improvement (Details of
how the effects of the planned changes were
measured)
7. Effects of Changes (Statement of the effects
of the change; how far these changes resolve
the problem that triggered the work; how
this improved patient/client care; the
problems encountered with the process of
changes or with the changes)
8. Lessons Learnt (Statement of lessons learnt
from the work; what would be done
differently next time)
9. Message for Others (Statement of the main
message they would like to convey to others,
based on the experience described)
continued
Example of a completed storyboard template
Enhanced recovery orthopaedics – Betsi Cadwaladr UHB
Winner of the ‘Improving quality through better use of resources’ category
Example of a completed storyboard template
Examples of winning storyboards
Example – sections 1-5
Colorectal cancer pathway: an interactive journey to
de-mystify the process for patients, families and friends
1. Storyboard Title
Colorectal cancer pathway: an interactive journey to de-mystify the process for patients, families and friends
2. Brief Outline of Context (where this improvement work was done; what sort of unit/department; what
staff/client groups were involved)
Prince Charles Hospital is a District General Hospital in Merthyr Tydfil in the South Wales Valleys and is a part
of the Cwm Taf Local Health Board, providing elective and emergency services for a population of 160,000
living in one of the areas with the highest social and financial deprivation indices in the UK. Care for patients
with bowel cancer is provided by a specialist multi-disciplinary colorectal team led by Professor P. N. Haray,
Consultant Surgeon.
3. Brief Outline of Problem (statement of problem; how they set out to tackle it; how it affected
patient/client care)
Colorectal Cancer (bowel cancer) affects roughly 1 in every 25 people in the UK with over 30,000 new cases
each year. Early diagnosis and expert multi-modality treatment are required to achieve successful results.
There is a plethora of information available for patients with particular diseases, especially cancer. The
internet as a source of information can be invaluable but the veracity of the information can be difficult to
discern. Worldwide, there is no single reliable source of information designed specifically for patients, to help
guide them through the pathway of the diagnosis and treatment of colorectal cancer.
4. Assessment of Problem and Analysis of its Causes (quantified problem; staff involvement;
assessment of the cause of problem; solutions/changes needed to make improvements)
Being diagnosed with any cancer is a very stressful time for the patient and their family. Most
clinicians who deal with such patients explain the various tests, treatments, etc., in detail.
However, once the word ‘cancer’ has been mentioned, patients often lose the ability to retain
detailed information. This is especially true in colorectal cancer, where the majority of patients
are elderly (mean incidence at 70 years) and are not always accompanied by younger members of
their family during consultations. Written material often tends to be quite impersonal and lacking
in the reassurance that direct interactions provide.
This project was designed to produce an interactive DVD for colorectal cancer patients providing
accurate information in a reassuring manner and which could be reviewed in the comfort of the
patient’s home along with family or friends. Areas were included to show the possibility of
Oncology input post-operatively as well as the protocol for long-term follow up in outpatient clinics
thereby ensuring a continuity of care following surgery.
The DVD takes the viewer through the journey of diagnosis and treatment of colorectal cancer in a
supportive environment with an opportunity to ‘virtually meet’ many of the staff. There is an option
to view a continuous film depicting the patient pathway through all the steps from consultation,
various tests, the multi-disciplinary meetings, operative and postoperative care, etc.
It is interactive with a flow chart with options to select specific areas for more detailed information
on many sections. Each section of the DVD, both in the continuous programme and in the interactive
areas has been filmed in the relevant part of the hospital with the very staff with whom the patient
is likely to come in to contact.
There are also extra sections with invaluable information on patient experiences, stoma care,
chemo/ radiotherapy, an interactive glossary of definitions, contact details, etc.
5. Strategy for Change (how the proposed change was implemented; clear client or staff group described;
explain how they disseminated the results of the analysis and plans for change to the groups involved
with/affected by the planned change; include a timetable for change)
A project plan was prepared and costed. Funding was obtained from an educational grant from Johnson &
Johnson and Digimed, a firm specialising in Medical Videography was commissioned. A project advisory
group (PAG) was set up:
Trust Chairman (a lay person) – Chair the group
Patient representation from CASS (Colorectal And Stoma care Support, a group previously set up by this
colorectal department to support patients with voluntary help from previous patients/ carers)
Patient Care and Safety Directorate
Surgical Directorate management
Clinical Governance
Clinical Experts – colorectal surgery, specialist colorectal nursing
Technical Experts – specialist videography, IT
The PAG remit was to oversee all aspects including the design, contents, quality control, approval of scripts
and the draft versions of the DVD, etc.
After final approval from the PAG, detailed filming schedules were drawn up for each department.
Employees involved at every stage of the patient pathway as well as current and previous patients were
recruited. Informed consent for filming was obtained from all participating staff, patients and bystanders
using specially designed forms. The project was conceived by Professor Haray in 1999, funding resourced in
2008 and the completed DVD launched in April 2009.
Example – sections 4 & 5
Epilepsy nurse led assessment for patients with suspected
first seizures attending the emergency unit
4. Assessment of Problem and Analysis of its Causes (quantified problem; staff involvement;
assessment of the cause of the problem; solutions/changes needed to make improvements)
The Epilepsy team used Results Based Accountability to determine the performance measures that
should be investigated, understand the reasons behind this performance and develop and implement
options for
improvement.
• Reasons identified for the performance level included:
• Delays in the referral process for out-patient clinics
• Limited clinic capacity with unpredictable demand
• Small team – unable to cover absence to prevent clinic cancellation
• Low frequency of clinics causing delay if appointment not suitable for the patient
• Clinic booked by Epilepsy Unit admin staff – if admin staff on leave the clinic slots are not filled
• Consultant triage’s fax referrals – delay if unavailable
One of the options for improvement identified was to develop an Epilepsy Specialist Nurse (ESN) led
Emergency Unit Service for people with a suspected first seizure.
5. Strategy for Change (how the proposed change was implemented; clear client or staff group described;
explain how they disseminated the results of the analysis and plans for change to the groups involved
with/affected by the planned change; include a timetable for change)
The team developed protocols in line with the College of Emergency Medicine Document “Guideline for
the Management of First Seizure in the Emergency Department” (Turner & Benger, 2009); to enable the
Epilepsy Specialist Nurses to provide an Emergency Unit assessment service within the four hour target.
A comprehensive communication strategy was developed within the Emergency Unit. This included the use
of posters advertising the new service and training sessions for staff. Following this the new service started
on the 12th January 2010. A description of the new pathway in comparison to the old pathway is available
in Figure 1.
Fig. 1. The old and new
first seizure pathway:
The service is initiated when the Emergency Unit staff bleep the ESN. One of the two ESN’s will assess the
patient in the Emergency Unit within the 4 hour EU timeline. A detailed history is taken from the individual
and, where possible, an eyewitness to the attack, to determine whether or not an epileptic seizure is likely
to have occurred. Once the patient has been assessed the ESN’s are able to triage the patient and offer an
out-patient appointment based on presentation. They also provide specialist advice and refer patients for
further investigations where appropriate.
Example – sections 4 - 8
Carmarthenshire multi-disciplinary
weight management clinic
4. Assessment of Problem and Analysis of its Causes (quantified problem; staff involvement;
assessment of the cause of problem; solutions/changes needed to make improvements)
Evidence suggests successful weight management interventions consist of frequent appointments
(fortnightly) with intensive support over six months to one year (Knowler et al, 2002). The NICE
Obesity guidelines (2006) suggest that different intensities of treatment should be available
depending on differing levels of obesity. Obesity is also associated with increased psychological
problems (WHO, 1998).
It was agreed that pressures to manage new referrals in the dietetic service often led to reduced
capacity to offer routine reviews potentially impacting on outcomes for this patient group. In
addition, patients were offered the same dietetic service regardless of their level of obesity or
whether they had patterns of disordered or binge eating.
Patient involvement was sought via a questionnaire sent to patients with obesity who had accessed
the dietetic service over the previous year. Patients requested more frequent follow-up and
support.
Evaluating the review of services it was agreed that offering an intensive, multi-disciplinary service
to patients with morbid or complex obesity with possible related physiological and psychological
health needs should be provided.
5. Strategy for Change (how the proposed change was implemented; clear client or staff group
described; explain how they disseminated the results of the analysis and plans for change to the
groups involved with/affected by the planned change; include a timetable for change)
A multi-disciplinary weight management clinic was established utilising the skills of a Medical
Consultant and a Specialist Obesity Dietitian within existing resource. In view of the WHO evidence,
existing resource was also sought to fund the input of a Consultant Clinical Psychologist.
Based on the evidence and feedback from patients, patients undergo an initial assessment
individually with the Consultant, Psychologist and Dietitian at their first clinic appointment and then
individual patient-centred treatment plans are agreed, with fortnightly follow-up appointments.
The change to the service provided to obese patients was communicated to local GPs via a written
report detailing the initial audit results and outlining proposals for the weight management service.
As this patient group were already being referred to the dietetic service, information regarding
inclusion criteria and details of the service were provided to the wider dietetic service to enable
them to refer into the specialist clinic.
6. Measurement of Improvement (details of how the effects of the planned changes were
measured)
Interim audit data was gathered after 6 months of clinic delivery to measure changes in weight and
psychometric outcomes.
Qualitative data was gathered via patient interviews in order to explore patients satisfaction with
the service.
7. Effects of Changes (statement of the effects of the change; how far these changes resolve the problem that
triggered the work; how this improved patient/client care; the problems encountered with the process of
changes or with the changes)
Six months after commencement, thirteen participants had attended the clinic with no participants dropping
out, as compared to a drop out rate of 50% with usual care. Outcomes demonstrated improved weight loss with
10 of the 13 (77%) having lost weight. 6 participants (46%) lost >4% of initial body weight, comparing favourably
to the previous weight management service audit results showing 12% of patients achieved clinically significant
weight loss. A re-evaluation is currently underway to measure the clinic outcomes at one year post
commencement. Further weight loss together with a reduction in risk factors, such as lipid levels, is predicted.
62% (8) of patients required intensive support from the Clinical Psychologist. Outcomes demonstrated
• Improvements in participant’s cognitive restraint,
• Improvements in the control of their eating patterns,
• Reductions in their emotional eating patterns,
• Improved scores on a Patient Health Questionnaire,
• Reduction in levels of perceived emotional stress, an
• Improvements in self-efficacy
• Improved self perception of physical shape and size
Through qualitative interviews, patients highlighted the regular support, the multi-disciplinary nature of the
clinic and the insight provided by in particular the Clinical Psychologist as the most successful aspects of the
clinic.
8. Lessons Learnt (statement of lessons learnt from the work; what would be done differently next time)
This innovative clinic is unique in Wales, offering not only medical and dietetic support for obese patients but
also intensive psychological treatment. The interim outcomes demonstrate it’s potential value - it is recognised
that although losing weight is physical, psychological barriers can be a determinant of successful weight
management. Although the outcomes demonstrated to date highlight the potential success of this model of
treating obesity, these results need to be replicated with a larger cohort of patients, with longer term outcomes
monitored. It is hoped that with ongoing audit results and increasing patient numbers the evidence will be
strengthened for this model of obesity treatment.
Example – sections 6 & 7
Improving the management of anticoagulants in
primary care
6. Measurement of Improvement (details of how the effects of the planned changes were measured)
A control chart was used to analyse the percentage of INRs >8. It shows an improvement from May
2009, when the audit results were fed back to GPs and Pharmacists. The mean reduced from 0.4 to
0.2% of all INR test results being >8. The overall improvement in the % of INR tests >8 is from 0.53% in
April 2008 to 0.23% in November 2010.
7. Effects of Changes (statement of the effects of the changes; how far these changes resolve the
problem that triggered the work; how this improved patient/client care; the problems
encountered with the process of changes or with the changes)
In GP surgeries, there was an improvement in documentation across all patient types in 2009-10 cf.
2008-9.
There was no significant increase in % of patients with 3 INR’s > 5 or INR’s >8 indicating consistent
level of control but in patients with additional safety indicators there was a 7% decrease in
patients with INR>8, which is shown in the run chart above. This shows an encouraging fall in INR
tests >8 (April 2008 to April 2010). (INR>8 is a marker for hospital admission).
There was improvement in the processes associated with the dispensing of anticoagulants including
29% increase in checking if patients had received appropriate information regarding their
treatment
39% increase in checking whether INR is safe prior to dispensing
Each INR test >8 is regarded as an adverse event. The number of these adverse events reduced
from 12 in April 2008 to 7 in November 2010.
Example – sections 6 & 7
Offering mothers-to-be 'virtual tours'
of maternity options
6. Measurement of Improvement (details of how the effects of the planned changes were measured
Use of videos, as per number of views; and also user feedback.
7. Effects of Changes (statement of the effects of the changes; how far these changes resolve the problem
that triggered the work; how this improved patient/client care; the problems encountered with the
process of changes or with the changes)
Within eight months of going live, the maternity videos have received 6,418 views:
Viewing figures (source: Youtube audit data) show a spike at
the time of the launch, and a steady rate of views since then,
(approximately 150-200 per week). Additionally, in 30% of
cases, more than one video is viewed in succession, suggesting
that some women are using the videos for comparative
purposes during an online session.
Feedback coments posted on the YouTube site include:
“I hope my wife will be able to access these fantastic
facilities.” (Comment about Neath Port Talbot Birth Centre.)
“Well done to Penny and Sian for a helpful and informative
video.” (Comment on Community midwives)
Example – sections 8 & 9
Enhanced recovery orthopaedics
8. Lessons Learnt (statement of lessons learnt from the work; what would be done differently
next time)
Initial attempts to ‘cherry-pick’ patients into the programme proved futile and early on we learnt
that every joint replacement will benefit from the Enhanced Recovery Programme, regardless of
age, clinical condition etc.
9. Message for Others (statement of the main message they would like to convey to others, based
on the experience described)
Large-scale transformational change in Orthopaedics can occur without significant financial
investment. The quality and efficiency gains prevalent within our Enhanced Recovery Programme
are by in large, the by-product of changing culture and ‘the way we think’ clinically. Fundamental
to this was strong clinical leadership and a cohesive and engaged musculo-skeletal team.
Common Problems
• Not ready to submit
• Section creep
Judging Process
• Shortlisting of storyboards by judges during
February 2012
• Site visits by judging panel during March/April
2012
• Awards ceremony – July 2012
How to write an award-winning storyboard
Sian Bolton
Karen Field
Kelly King
Alan Willson
Any Questions?