An Apple A Day

An Apple A Day

Key contacts

Megan Harrison – Medical Student, Brighton and Sussex Medical School

Joe Tan – Medical Student, Brighton and Sussex Medical School

Harriet Sharp – Medical Student, Brighton and Sussex Medical School

Keziah Kemp – Brighton and Sussex Medical School

Katie Clark – Brighton and Sussex Medical School

James Willans – Brighton and Sussex Medical School

Amaran Cumarasamy – Brighton and Sussex Medical School

Elaine Macaninch – Nutrition Medical Educator and Dietitian, Brighton & Sussex Medical School and Brighton & Sussex University Hospitals NHS Trust

Dr Kathy Martin – Principle Lecturer, University of Brighton School of Health Sciences

Introduction

Adolescents in the UK face numerous health challenges at a crucial time in their development. Evolving consumer technologies and changing contemporary norms have a significant impact on physical, mental and social development. Evidence suggests that development is particularly precarious for adolescents from lower socio-economic backgrounds. This creates inequalities in their educational attainment, employability, financial security, quality of life and increases their vulnerability to serious health conditions such as heart disease, obesity and mental illness. As an example, in the UK, children in the most deprived areas are twice as likely to be obese than children in least deprived areas [1].

This set of inequalities challenge how we envisage a just and fair society. With health professionals at the forefront of the patient and community interface, they can play an important role in the prevention of this asymmetric disease burden, working in solidarity with communities to bring about meaningful change, and fostering the evolution of an NHS fit for the health challenges of today and tomorrow.

‘An Apple A Day’ is an interactive, discussion-based, community initiative led by student health professionals to enhance knowledge and health behaviours among adolescents in deprived areas of Brighton. It provides opportunities to improve understanding of nutrition, health and wellbeing whilst developing practical skills, as well as opportunities for mentors to develop their leadership and communication skills.

The programme takes the form of 6 weekly, one-hour sessions, delivered to Year 7 students at Brighton Aldridge Community Academy (BACA) across one school term. The focus is placed on interactive learning, small-group discussion and translating knowledge into practical skills and positive health behaviours. [2] It has been developed in partnership with the University of Brighton Active Student volunteering platform, members of faculty at Brighton and Sussex Medical School, Brighton and Aldridge Community Academy (BACA), with support from Brighton & Hove City Council, Public Health Team. The sessions cover; what it can mean to be ‘healthy’, the basics of nutrition and a balanced diet, eating smart and positive health behaviours. The final session takes place in the kitchen, consolidating foundation knowledge and developing practical skills in cooking and food preparation. [2]

So far, the programme has received positive feedback from participants, teachers and mentors alike, and overall the project shows much promise. However, there is a need to review and understand its impact on both the participants and student mentors, and we now plan to carry out a formal programme evaluation in 2019-2020. This would allow us to understand how the programme affects the knowledge, attitudes and practices of the pupils – essentially if it has an impact, and in what way, highlighting areas for improvement and new opportunities for further development.

SMART objectives

Specific:

Measuring the knowledge, practices and attitudes (KAPs) of secondary school children before and after the medical student-led nutrition and health teaching programme ‘An Apple A Day’ as a measure of its implications and efficacy. There are two components to this enquiry:

  1. a) To assess its efficacy
  2. b) To explore ways of improving and expanding the programme, and apply this to nutrition teaching in schools.

Measurable:

We will use one of these cycles to do a KAP (knowledge, attitudes and practice) survey on the pupils’ knowledge, attitudes and practice based around the learning objectives of An Apple A Day to measure what kind of effect, if any, the programme has had on the pupils. The surveys will be administered before and after one cycle of the lessons, and will be adapted for the age group. It will be based on a questionnaire, however may take the form of a quiz to keep the children engaged and more likely to fill it out truthfully. A pilot of the questionnaire is likely to be used on the cycle prior to the research.

Achievable:

This service evaluation will be undertaken as part of a student research project, supervised by the AAAD faculty advisors, with support from key contacts including teaching staff at the secondary school. 

Realistic:

This evaluation is designed to be minimally resource intensive. The 9-month window for completion will allow ample time for data collection and analysis. We have secured the support of students and faculty at Brighton and Sussex Medical School, the University of Brighton and staff at Brighton Aldridge Community Academy to ensure a robust evaluation within the time available.

With the ‘An Apple A Day’ infrastructure already in place for 2 years, the set up of this evaluation has been straight forward. The organising team have prior experience in conducting focus groups with young people as part of the setting up of AAAD. Resources are in place and we await the approval of the project proposal for commencement of the evaluation in August 2019.

Timely:

This evaluation will take place between August 2019 to May 2020. Resources have been put in place to ensure progress in line with the project milestones, including data collection and analysis.

Progress made: What have you learned from doing this?

From the delivery of two iterations of project so far, participants have benefitted from tailored and youth-specific small-group discussion and skills development on health and health behaviours. Feedback shows improved awareness and understanding of basic nutrition and health issues and greater enthusiasm for engagement in the issues discussed. Participants have reported greater self-efficacy for more positive health behaviours in the community and at home, including greater input on food shopping and meal preparation.

It has also provided a wealth of opportunities for our medical students including; teaching on health and lifestyle topics, developing youth-specific communication skills, organising and planning the content of the sessions, taking leadership decisions, contextualising child health alongside the Year 4 paediatric placement, and an opportunity to connect with and understand the needs of the local community.

What’s your take home message?

Widening social and economic inequalities are having profound impacts on the health of our population, disproportionately shifting a growing disease burden onto low income groups, limiting opportunities and prospects for a life in good health. With adolescence being such a formative stage for health behaviours, this presents a powerful opportunity for healthcare professionals to work in solidarity to address the impacts of social, economic inequality in deprived communities.

‘An Apple A Day’ recognises a significant role for student health professionals to promote discussion and learning on nutrition, health and wellbeing with youth from deprived communities, reaping numerous possible benefits for both participants and mentors.

A robust service evaluation will help cast a critical and valuable lens on this community-led approach, providing opportunities to understand the efficacy of the project, areas for improvement and other possible avenues of development. [3]

Resources?

[1] NHS Digital: Statistics on Obesity, Physical Activity and Diet – England, 2016. Available from:

https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statistics-on-obesity-physical-activity-and-diet-england-2016

[2] (Giles, E) Disaggregating Young Adults’ Knowledge of Healthy Lifestyle Practices, Centre for Rural Economy, Discussion Paper, Series No. 30, March 2011. University of Newcastle. Available from:
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.455.5845&rep=rep1&type=pdf

[3] (Linsday, AC) The Role of Parents in Preventing Childhood Obesity. Future Child, 2006, Spring 16(1): 169-86.

Quality of sleep in children and parents admitted to a paediatric inpatient ward

Quality of sleep in children and parents admitted to a paediatric inpatient ward

Key contacts

Dr. Nandita Kaza 

Dr. Lucy Pickard Sullivan 

Dr. Caroline Scott-Lang 

Introduction

The quality of sleep in paediatric inpatients has been shown to be poor and many hospitals have been demonstrated to have night-time environments which are not conducive to patients experiencing adequate sleep and rest during inpatient admissions. 

SMART objectives

The aim of this project was to  use descriptive measures to describe sleep quality in parents and unwell children admitted to a general paediatrics ward in a tertiary London hospital and to identify barriers to adequate sleep amenable to quality improvement interventions. 

Progress made: What have you learned from doing this?

This study used semi-structured interviews with parents who resided in hospital alongside their unwell children admitted to the ward. 20 families admitted to the ward sleeping in both open bays and private cubicles who had been admitted for at least one night in hospital were included. Interviews were conducted by an external member of staff (unaffiliated to the ward) and results were analysed using content analysis.

75% of parents experienced poor to average sleep quality while on the ward a majority felt that their sleep quality overnight affected daytime functioning with regards to emotional lability, difficulties with concentration, exhaustion and physical symptoms of tiredness. Similarly, 70% of children experienced poor sleep in hospital compared to when in their own homes and this manifested as daytime irritability, restlessness and lethargy. Barriers to sleep originated principally from ambient factors (lighting, noise and ventilation) and staff interventions. The interventions which we identified included using a welcome pack explaining ward etiquette, the use of sleep masks and fans across all areas and staff training addressing night-time conduct. Quality of sleep was unrelated to whether the patient and their family were in an open bay or private cubicle. Parents felt that experiencing poor sleep was routine and within their expectations of a hospital admission.

What’s your take home message?

Quality of sleep for parents and children on the St Mary’s inpatient paediatric ward is poor and there are several modifiable contributory factors which can be addressed. Further work on co-producing interventions alongside nursing staff and junior doctors is envisioned with post-intervention data to be collected. 

Resources?

Bevan RGrantham-Hill SBowen R, et al
Sleep quality and noise: comparisons between hospital and home settings
The power of patient stories: sharing the patient experience through art

The power of patient stories: sharing the patient experience through art

Key contacts:

Dr Katherine Malbon

Dr Kate Sullivan

Dr Katja Freund

Paul Doyle

Chris Bound

Introduction

Patient stories are an important tool for organisational improvement, as they help health professionals understand the patient experience and shape health services to better address the health needs of our community. The Adolescent Health Big Room at Imperial was launched in ??2017 with the aim of ??improving young people’s health. To connect its attendees with the needs of the population it serves, the weekly meeting commences with a Patient Story. Since its induction, the Adolescent Big Room has collected 30 Patient Stories. However, once shared, these stories are not revisited or discussed.

We are hoping to use the Patient Stories that we have collected creatively, as a way of engaging young people and staff with our health service, encouraging interaction and discussion around themes within adolescent health.

SMART objectives

We aim to host an art and photographic competition, inviting patients, families and staff to illustrate the themes contained within the Patient Stories that we have collected. We aim to exhibit the best submissions in an art/photographic exhibition in December 2019, and to award a people’s choice prize to the best artwork displayed.

Progress made: What have you learned from doing this?

We have collated stories from our big room meeting and will consult our Imperial Youth Forum, which consists of young people and patients at Imperial, to advise us on the best way to engage young people in this project. Staff have begun to liaise with local venues and exhibition spaces. Once the venue and dates have been confirmed, we will put out a call for submissions.

What’s your take home message

Patient stories are an impactful way of illustrating need, and the creative arts are an innovative medium through which patients and healthcare professionals can explore the patient experience. Through sharing stories, better ways to improve our services for the community can be found.

The Artist in Residence Programme at Imperial: Polychromy Plays

The Artist in Residence Programme at Imperial: Polychromy Plays

Key contacts

Dr Caroline Scott-Lang, Consultant Paediatrician, Imperial College Healthcare NHS Trust

Kate Pleydell, Imperial Health Charity Arts Team

Louise Shelley, Collaborative Projects Curator, The Showroom

Tina Halton, lead Play Specialist, Imperial College Healthcare NHS Trust

Navine G. Khan-Dossos, Artist

Introduction

The Artist in Residence programme was a collaboration between Imperial College Healthcare, Imperial Health Charity and The Showroom Arts Studio. 

Over six months in 2018, artist Navine G. Khan-Dossos held workshops with patients in the Grand Union and Great Western wards, the Allergy and Outpatients departments at the St Mary’s Hospital, as well as at The Showroom.  Together, they made a series of collages looking at the relationship between colours, and thought about what colours they would like to see in the hospital’s walls, the ceilings, the doors, and the furniture.

POLYCHROMY PLAYS is a functional colour palette generated from these discussions, collages, and paintings.  It was made by giving the patients agency in their environment, and allowing them to imagine ways to improve the spaces in which they found themselves for short, long, or intermittent stays. They, better than anyone else, know what it is like to spend time in these spaces and should be part of the dialogue about how to improve the way they feel during their treatment.  Colour has an important role to play in this discussion.

The POLYCHROMY PLAYS palette comprises both the colours and names given to each shade. These include a wide range of inspirations, from inside and outside the hospital, feelings, foods, politics, and bodily functions. They are sometimes light and playful and sometimes transgressive and troubling, showing that it is important to involve the light and the dark sides of hospital experience as a more holistic way to consider the reality of the environment. The colours use the NCS reference system so that future designers, architects, and artists working in the hospital can work with the exact shades picked by the patients. 

The finished piece is displayed outside Children’s Outpatients at St Mary’s with a feature wall painted in “Banana” and was available as a limited edition 500 print run on newsprint, designed to be taken away by visitors to the department.

SMART objectives

We aimed to deliver a series of art workshops over a 6 month period, both on and off site, with young people accessing our services, with a celebration to share the finished artwork at the end of the programme.

Progress made: What have you learned from doing this?

There was good engagement from the young people involved in the project with more than 30 collages produced.  They enjoyed the opportunity to work alongside a renowned artist and to create pieces together. 

We also learned that if you ask young people to name colours to expect the unexpected – some (“Urine yellow”, “Trump orange” and “Fly poop”) have raised an eyebrow or two!

Based on the success of this programme, we hope to host another residency in the future.

What’s your take home message?

Art is often utilised in hospital to help distract, relax and entertain young people during their stay, but the finished results are usually transient.  This programme took this a step further, engaging young people who use our services to create a lasting artwork that could potentially shape our environment in the future.  Young people have strong opinions about what our hospital should look like and this helped us to be more creative in how we engage with their feedback.

 

Resources?

This project was a collaboration between Imperial Health Charity and The Showroom Arts Studio as part of their Communal Knowledge programme (generously supported by John Lyon’s charity).

Practical resources included art materials but most valuable resource was Navine’s expertise and the energy and enthusiasm of the young people who contributed.

 

Weblinks:

https://www.imperialcharity.org.uk/arts/patient-engagement-programme/artist-in-residence-programme

https://www.imperialcharity.org.uk/application/files/6915/3961/3076/Polychromy_Plays_downloadable_PDF.pdf

https://www.theshowroom.org/projects/navine-g-khan-dossos

https://www.itsnicethat.com/features/navine-g-khan-dossos-polychromy-plays-art-181018

 

Fighting child poverty in clinical practice

Fighting child poverty in clinical practice

Key contacts

Hannah Zhu (hannah.zhu@nhs.net) – Kingston

Kingston team: Isabel Ng (SHO), Joanna Morris (Consultant), Sarah Bidgood (ANNP), Phoebe Cotterill (ANNP), Nicola Vaughan (Nurse in charge), Hind Thomas (Senior Nurse in charge), Jamie Patel (Nurse Educator), David Mummery (GP)

Guddi Singh (guddi.singh@nhs.net), Kiran Rahim – Newham

Emma Sunderland (emma.v.sunderland@gmail.com) – Hackney

Akudo Okereafor (aokereafor1@gmail.com) – North Middlesex

This project was piloted in Kingston Hospital with data pending from multiple centres listed above. 

Introduction

Poverty is the most important determinant of child health in the UK, associated with adverse health, developmental, educational and long-term social outcomes. Paediatric nurses and doctors feel powerless when faced with child poverty, with training gaps and underdeveloped pathways leading to missed opportunities to help poor families. To meet this need, we used QI methodology to develop clinical screening tools and resources for addressing poverty in clinical practice.

SMART objectives

AIM:

By June 2019, >80% of paediatricians in the paediatric assessment unit (PAU) to screen for child poverty and offer local resources when appropriate.

MEASURES:

  1. Percentage of paediatricians per shift who screened for child poverty for the last patient they assessed on PAU.

2. Percentage of paediatricians per shift who were aware of local poverty resources

3. Resources given and patient feedback

Progress made: What have you learned from doing this?

Stakeholders co-designed tailored screening questions, in addition to identifying established poverty risk factors including: single parent, unemployment, >3 children, chronic health conditions and social worker involvement. Our bespoke, local child poverty leaflet (with resources that increase income, provide essentials and increase participation) was offered when appropriate.

Screening questions:

 Nurses: “How did you get to hospital/how will you get home?”

 Doctors: “Have you been on holiday in the last year, UK   or abroad?”

At baseline, no doctors or nurses screened for child poverty or signposted to relevant local resources. Plan-do-study-act (PDSA) cycles tested screening questions and resource leaflets while improving stakeholder buy-in. Screening for child poverty increased from 0% to 89% in 2 months (March-May 2019), with resource awareness increasing from 0% to 100% in the same period. Qualitative patient feedback has been positive e.g.“Thank you for being to thoughtful, you really helped me”. Further work will include capturing the resources are accessed by families, adapting this to different sites and ongoing sustainability. 

Test #

PLAN

Do

STUDY

ACT

1

Brainstorm screening questions for child poverty

Practise asking questions and reflect on how this felt 

Most questions too direct, need more context

Refine with senior colleagues and patients

2

Focus group of senior nurses who know local area well

Screening developed to be used with family and social history

Non-intrusive, high yield questions

Implement screening questions

3

Design, teach and display local MDT resources

Screening and knowing resources

0% to 50%

Doctors feel that it’s stimatising giving “poverty” resources, 3 leaflets given

Disseminate in clinical and waiting areas, review leaflet phrasing and design

4

Increase awareness and compliance

Email, texts, removed “poverty” from leaflet

50 to 89%

Screening better, 100% resource awareness, 15 leaflets given

Improve confidence in offering resources

 EXAMPLE CASE:

Dad brought a 5 month old baby to A&E at 3am with an URTI. Dad was very stressed about getting home since he would have to take 2 buses. Family history: mum has postnatal depression, has not touched baby for 1 week, 2 other young children at home. Social history: dad gave up work (in a factory) to look after mum and baby, no income or family support nearby, no holidays in the last year. Dad is very worried he will not be able to support his family when their money runs out.   

Signposted to: Citizen’s Advice, HomeStart, Welcare, Relate

Additional referrals: health visitor, social services, GP

What’s your take home message?

Our project shows a dramatic improvement, from zero to almost 89%, in screening and  100% in resource awareness for child poverty amongst paediatricians in 2 months. This is an example of how we can all use quality improvement to play a role in helping families fight poverty in our clinical practice. 

Resources?

  1. RCPCH Health Policy Team, State of Child Health Report 2017: www.rcpch.ac.uk/resources/state-child-health-2017-full-report
  2. RCPCH and Child Poverty Action Group, Poverty and Child Health: Views from the Frontline 2017: www.rcpch.ac.uk/resources/poverty-child-health-views-frontline
  3. http://www.4in10.org.uk/
  4. https://www.bacaph.org.uk/advocacy/child-poverty-introduction
A user-friendly proforma to ensure children seen in the specialist nurse-led Down syndrome clinic have the necessary health checks for their age (based on Down’s Medical Interest Group guidelines)

A user-friendly proforma to ensure children seen in the specialist nurse-led Down syndrome clinic have the necessary health checks for their age (based on Down’s Medical Interest Group guidelines)

Key contacts

Down Syndrome Specialist Nurses, Community Paediatricians

Introduction

Patients with Down syndrome have an increased incidence of health problems compared to the general population. The Down’s Medical Interest Group (DMIG) has provided evidence based surveillance guidelines for health care services for children with Down syndrome. These guidelines advise exactly which health checks are required for different age groups, and at what frequency. The checks advised include: thyroid function tests (TFTs), vision and audiology checks, and growth monitoring [all at regular intervals]. For those under 6 weeks of age, an Echo and bloods are recommended.

A north London borough provides an annual, specialist nurse-led, clinical review for children with Down syndrome. A customised health check proforma was designed as an aide memoir for the specialist nurse leading the clinic. The proforma was based on the DMIG guidelines and detailed which checks are necessary for each age group, and at what frequency.

SMART objectives

To determine whether the patients seen in the Down syndrome specialist nurse led clinics, over a year long period, met the suggested schedule for health checks for their age at their annual follow up appointment.

Progress made: What have you learned from doing this?

Methods

A data collection sheet was designed on Excel with a list of health checks that were supposed to be addressed in clinic. Patients were identified for audit from the Down’s specialist nurse led clinic lists, over a one year period. All the relevant information was inserted onto the Excel data collection sheet using the information found on the profomas (available in the medical records) and on the electronic results system.

Results

29 patients had been booked into four separate Down syndrome clinics over a one year period. 21 patients were actually seen in clinic as there were 8 ‘did not attends’. The average age was 9.4 years (range 3 – 17 years old). 86% of patients had had their TFTs checked, 95% had had growth monitoring documented, 71% had had their vision check and 52% had had their hearing check. No children were eligible for cardiac or haematology tests (based on their age > 6 weeks). Other health problems identified in clinics included: obesity, malnutrition, enuresis, cessation of periods, snoring/sleep apnoea, hypermobility, constipation and poor dentition. Where issues had been identified, appropriate referrals had been made in most cases.

What’s your take home message?

The introduction of the proforma has led to a high number of patients being seen in the specialty nurse led clinic receiving the recommended health checks for their age: in particular, thyroid function tests and growth monitoring. Referrals for other clinics (e.g. vision and hearing) appeared to be being made appropriately but there did not seem to be a system in place to check whether referrals were actioned. This led to a lower than expected % of patients having had their vision and audiology checks. Further focus is needed to ensure vision/audiology referrals are made, received and actioned, and to encourage children to attend these additional appointments. The proforma can be further adapted to include a range of additional problems (such as those that were also identified in this audit), with information on how and who to refer to for each specific health issue. This would further contribute to the provision of a thorough and holistic service for this vulnerable patient group.

Resources?

https://www.dsmig.org.uk/information-resources/guidance-for-essential-medical-surveillance/

Authors:

Dr Philippa Stilwell, Dr Indrani Banerjee

Teaching Paediatrics in the Nu Po Refugee Camp (Thai- Burmese border)

Teaching Paediatrics in the Nu Po Refugee Camp (Thai- Burmese border)

Key contacts

Dr Neil Anthony-Pillai – neil.anthony-pillai@nhs.net

Dr John Greenall  – johngreenall@doctors.org.uk

Dr Aaron Anthony-Pillai – aaron.anthony-pillai1@nhs.net

Introduction

There are over 140,000 Karen people who have fled war in Myanmar, a war ongoing since 1949. Most of these now live in refugee camps on the Thai-Burma border. There are another 400,000 people still living in the Karen State, located in Eastern Burma. They have had to endure years of fighting, torture, systematic rape and forced labour; their living conditions are harsh and there is limited access to education or healthcare.

 

Hope 4 The World, an NGO specialising in medical education, has partnered with the Karen Department of Health and Welfare (KDHW) to train local people as healthcare workers (titled ‘medics’) so that they can staff the 50 medical clinics which provide healthcare to the Karen people in the mountainous Karen State in Myanmar. This medic training programme takes bright and dedicated Karen nationals, most with only one or two years of secondary education and a basic knowledge of community health, and puts them through an intensive yearlong training programme designed to equip them with the knowledge and skills to act as competent providers of healthcare to their remote communities.  This programme includes practical training in a hospital and clinic environment to consolidate their skills, providing full accommodation and board during their education. The training initially took place in Nu Po refugee camp, but at time of writing the programme has moved to Mae Sot due to security issues in Karen state.

 

The Project

 

S

provide specific training in paediatrics to community healthcare workers in the Karen State

M

the effectiveness of the training was measured by testing them on a pre-determined set of practical skills and a theory test

A

established that the goal was attainable by performing detailed planning which included reviewing sessions carried out by other trainers

R

the training was designed largely based on the Burmese Border Guidelines (BBG) ensuring it was relevant to the local community

T

the entire training had to delivered in a strict time frame of a week as this was part of an yearlong training programme where each topic was allocated a specific length of time

We contacted the  ‘Hope 4 the World’ charity to indicate our interest in delivering the paediatric element of the training in their established training programme. We received information on where to go, what to expect and what to teach during our week. We booked and funded our own flights and accommodation, guided by the charity.

 

We made a lesson plan to cover all the topics required which included visits to the hospital and clinics inside the refugee camp. During the training we were provided accommodation within the refugee camp.

 

 

The day started with worship led by participants. We were assisted by a Karen trainer who performed the translation. Our week of Paediatric teaching included a wide range topics from recognising an acutely ill child to managing nutrition and treating malnutrition. We adjusted and used some creativity to facilitate efficient learning in these challenging circumstances; our teaching skills have improved a great deal. We had practical sessions both in the classroom as well as the hospital based inside the refugee camp.

 

At the end of the week the students were tested on what they had learnt. And they all performed really well averaging over 75%. The amount of knowledge and rate at which students assimilate it, translated from a language they may not understand, is remarkable. Their commitment is astonishing.They had left their families for at least one year. They stay in shared accommodation within the refugee camp. They work diligently into the night, reading and preparing for the next day. Despite the long hard hours, students remained enthusiastic and supportive of each other. We witnessed a level of dedication that is unparalleled, and will stay with us forever. 

 

 

 

Community Action Project – Youth Champions

Community Action Project – Youth Champions

 

Key contacts

Isabel Raynaud – isabel.raynaud16@imperial.ac.uk

Kajal Ruparell – kajal.ruparell16@imperial.ac.uk

Dr Nina Dutta – n.dutta@imperial.ac.uk

Dr Arti Maini – a.maini@imperial.ac.uk

Introduction

During Year 3 all Imperial College medical students spend 9-10 weeks on a general practice placement as part of their Medicine in the Community Apprenticeship. During this placement, all students complete a Community Action Project. This is a project that aims to improve an aspect of health and welfare of the communities in which they are based. They are encouraged to engage with members of the community (including patients, community groups, third sector organisations and health professionals) and use quality improvement principles including building sustainability into their project.

Since 2017, there have been 179 student projects. A significant proportion of these have related to child health, encompassing a range of topics from addressing cultural barriers to childhood immunisations to raising awareness of childhood asthma via teaching at local schools and creating a video. The community action projects have allowed our students to engage in meaningful community engagement and make real impact on the health and welfare of the communities in which they are working. Student feedback following the projects showed that students engaging in this service-learning approach felt empowered to make positive change and were more engaged in their learning. We will be continuing the project in the 2019/20 with research addressing the impact of the project on both the student learning experience and impact on local communities.

An excellent example of a Community Action Project completed by two Imperial College students, Isabel Raynaud and Kajal Ruparell, in March 2019 is the development of a Youth Patient Participation Group. Isabel and Kajal have described this project in their own words below.

CAP project – Youth Champions – Objectives and Delivery

As part of our university course at Imperial College School of Medicine we were given the challenge of setting up a Community Action Project. We were placed in a GP setting in Mottingham, South London, for 10 weeks and used the time to spot, analyse and produce an intervention that could help the community. During the placement, we soon realised that the practice was struggling to keep the local youth satisfied with their services and we wanted to help address this.

Through discussion with our GP lead and other doctors at the practice, it became clear that there was an issue with getting and sustaining the interest of young patients. It seemed that they were dissatisfied with the services being provided at the GP but were not taking the opportunity to voice their opinions through the means available to them (e.g. family and friends questionnaires, PPG). We wanted to do something to bring young people on board, giving them a bespoke platform to express their views.

The practice already had an adult Patient Participant Group (PPG) so it seemed a logical step to try and introduce a similar concept to 16-19 year olds. This would be in the form of a focus group, giving young patients a platform to openly discuss what the practice was getting right and which improvements could be made to keep them satisfied as patients. Our aim was to create the foundations of this practice-based Youth Patient Participation Group (PPG) by the end of our 10 week placement.

Patient safety was an important factor in the group we targeted. We chose to speak to patients between the ages of 16-19 because we felt they could speak for themselves and that there would be less concern from parents and carers should the group meet in person. From the age of 16, patients are deemed competent to take their care into their own hands, unless evidence is provided to the contrary. We also felt that above the age of 19, patients should be encouraged to join the adult PPG.

Initially, as this was a pilot project, we wanted to ensure that the patients we invited to the youth PPG would be regular visitors to the practice. The idea behind this was that they would have more experience of the practice and the way it runs and would therefore be able to provide us with more extensive opinions. To ensure the young people we invited to the meeting had a regular attendance record, we selected our initial group by using the GP’s records to put together a list of patients with chronic conditions. These conditions included asthma, type 1 diabetes, sickle cell anaemia and mental health conditions (e.g. depression and/or anxiety).

We put together a shortlist of patients and made initial contact via telephone. We were happy that many of the young people we contacted seemed excited at the opportunity to have their views heard. We also used the initial contact to ask a preliminary questionnaire and start collecting data on the changes young patients would like to see being made. We also took further contact details to maintain contact with these patients via email.

Finally, we invited the group to take part in a face to face meeting. We were pleased with the initial feedback and we were able to use it to gain some constructive feedback for the surgery. We did however have limited attendance and it became clear, that more needed to be done to entice the youth to attend meetings.

The poor attendance to the meeting made us think harder about how we could get young people fully involved with the idea. We decided a change of branding might help – changing the name from “Youth PPG” to “Youth Champions”. We also wanted to keep the project fun and fresh, putting together some memes for the GP to put out on their social media inviting young people to get involved. We also thought hard about how we could incentivise people to come – in the future there is scope to make the meetings more of a social affair with fun activities for the young patients to get involved in before discussing their feelings about the practice.

Progress made: What have you learned from doing this?

We learnt a lot from the young patients at the practice. Through our telephone interviews we found that they were largely satisfied by many aspects of the surgery and its services but that there were a few key concerns. They were not only worried by the usual concerns of waiting times and admin, but by the more pressing issue that their doctors were not taking them seriously because they were young. This message came through a number of times – it was especially prevalent in those we had short-listed due to their diagnoses of mental health issues.

We also recognised that there were issues with communication at the practice. Some patients felt that they were sometimes “dropped” or left without an explanation or diagnosis after their visit. It became clear that the follow-up process needed to be clarified with patients. 

In terms of improving the Youth Health Representative project itself, we wanted to work on incentivising the young people in the local area to attend the group, improving numbers and getting a broader range of opinions. We are considering adding a social element to the meetings, as well as potentially opening a lottery system where patients are entered to win a prize if they attend meetings. In addition to this, we recognise that between the ages of 16 and 19, people are thinking hard about their futures – we thought it would be a nice addition to add a workshop element to the meetings so people could learn something from the meetings. We also wanted to provide certificates for the patients that attended which could be useful additions to UCAS applications and CVs.

We also want to work on communication with the young people. Telephone interviews were useful, but there were a number of constraints – including the fact that the majority of the patients we contacted were in school during the hours we tried to make contact. Email is also useful, but had a limited response. We need to think of appropriate ways to get into contact with young people – we are currently considering an online forum/group chat approach, but need to reflect on how we can do this safely and without impacting patient confidentiality.

We would also like to open the group out to more people to hear a more varied group of people. This would mean extending the invitation to all patients between 16-19, not restricting it to those with chronic conditions. This would hopefully improve numbers and increase the pool of opinions represented.

What’s your take home message?

We were excited by the simplicity and potential for the project to have a direct impact on how the practice helps young people. We tried hard to organise the meetings and get people onside, but a key issue presented in how to contact and incentivise young people to attend. We recognise that patient administration is always complex and difficult to manage, but feel we have laid a foundation for a youth PPG. Through further liaising with the adult PPG and our GP consultant, we hope the group we have put together can be further supported to make it more useful in the future.

It is critical that young people are made to feel welcome and appreciated by their practices and that they feel they are being taken seriously. 

This project taught me the importance of enthusiasm and persistence in Medicine. It was tricky getting young people to engage but by staying keen and trying different ways of contacting people we gained some traction. I have also learnt that creativity is vital and that there is nothing wrong with trying to make projects fun and inventive to get people on board. A major part of creative thinking is collaboration and it was a pleasure to work with people from different backgrounds, both patients and colleagues at the GP.

We would love to keep working beyond our pilot and keep coming up with fun and inventive ways to get young people to keep talking about the changes they would like to see in this GP practice.

Passion For Paediatrics

Passion For Paediatrics

Key contacts

Priyen Shah – Paediatric Trainee

Su Laurent – Paediatric Consultant

Introduction

Rota gaps, service cuts and record patient numbers have made working in the NHS more stressful than ever.  As doctors we train for years to treat our patients, yet we are surprisingly bad at looking after ourselves and our colleagues. Paediatric services are being affected more than most, with a drastic decline in doctors applying to paediatric training and an increasing number of unfilled posts.

With this in mind, we organised Passion for Paediatrics with one simple aim – to support the mental and emotional wellbeing of paediatric trainees and help them manage the strain associated with working for the NHS in the current climate.

First, we highlighted the services available to trainees finding it difficult to cope such as the Practitioner Health Programme and the Tea and Empathy movement that was formed in the wake of the suicide of a doctor during the implementation of the new junior doctors’ contract. Professor Clare Gerada, medical director of the Practitioner Health Programme and former chair of the Royal College of General Practitioners, shared some of her experiences in identifying and supporting doctors in difficulty.

We then focused on examples of morale-boosting projects from across the NHS, such as ‘Barnet Bopping‘, a project utilising dance lessons to improve the working relationship between doctors, nurses and patients, was demonstrated by Dr Guddi Singh and Karelle Evans. ‘Balint Groups’ led by Dr Lucy Fullerton and Dr Susannah Pye showed how peer-based discussions can help doctors work through difficult and emotional cases in a supportive and confidential environment.

Finally, we heard about ‘Learning from Excellence’, a project by Dr Adrian Plunkett at Birmingham Children’s Hospital, which has been introduced at Barnet General Hospital by Dr Dominic Fenn and Dr Patricia Lutalo in an effort to highlight and share examples of excellence in healthcare practice. The hope is that others will be inspired to initiate similar projects in their own departments.To finish, we highlighted ways that doctors can protect themselves. Dr Michael Farquhar outlined the importance of sleep hygiene, especially on night shifts while Dr Caroline Fertleman, Dr Serena Haywood and Dr Reina Popat Shah showed the benefits of cultivating mindfulness and creativity in everyday life.

The feedback was incredibly positive and we had a number of requests to make this an annual event.

SMART objectives

Specific: To support the mental and emotional wellbeing of paediatric trainees and help them manage the strain associated with working for the NHS in the current climate.

Measurable: Feedback during and after the event.

Achievable: The project requires collaboration with paediatric trainees and consultants, speakers, caterers, venue managers and sponsors. It also needs to attract sufficient attendees to make it financially viable.

Relevant: In the current climate, it is more important than ever that doctors have the tools and support they require to manage the physical, emotional and psychological burden associated with working in the NHS. If we can master this, trainees will not only manage, but will thrive.

Time: In line with sponsorship requirements, the event had to be held before the end of the tax year.

 

Progress made: What have you learned from doing this?

Event management – the importance of setting a realistic budget and timescale. Early liaison with venue managers and caters. Effective advertisement of the event and the power of word-of-mouth recommendation,.

Leadership – The importance of early delegation with clear, well defined roles and an effective way to keep up to date with the progress of the team.

What’s your take home message?

If we can look after and support ourselves and our colleagues, we will have more capacity to care for our patients and improve their care.

Resources?

https://www.huffingtonpost.co.uk/priyen-shah/healing-from-within-impro_b_18039656.html?ncid=engmodushpmg00000006

Parkview Olympics

Parkview Olympics

Key contacts

Beatrice Liddell

Dr Sarah Blackstock

Introduction

Parkview Olympics was a six-week pilot health and wellbeing programme in White City, London. Parkview Olympics is a community-based initiative designed and delivered by Practice Champions who are volunteers at their local GP Practice, supported by Imperial College Healthcare Trust’s Connecting Care for Children (CC4C) team.  This grass-roots approach is targeted at children from low socio-economic groups aged 8-12 years within the White City Estate, an area of deprivation. The pilot was available for up to 30 participants.

The programme was not funded and did not plan to create any new activities within the area. This bottom up approach aimed to bring organisations together, support capacity building and empower and mobilize community members to create behaviour change across sectors. The programme is a collaboration between Queens Park Rangers (QPR) football club, London Sports Trust, Access Sport, Better Gym, My Time Active (the local authority obesity service, who provide nutrition and behaviour change support) and the Hammersmith Community Gardens (who support food education, growing and production of food locally).

SMART objectives

The initiative was developed following the desire of Practice Champions (volunteers from local GP Hubs) to do something to tackle obesity within their community. They were frustrated that children in the community were being sent letters from school saying that they were overweight and they perceived that there was not enough provision of interventions to prevent or tackle this issue locally that parents were aware of.

The Practice Champions were aware that local organisations delivered activities for children and families but they didn’t know how to access them. Furthermore, it wasn’t clear if the stakeholders were already collaborating. Parkview Olympics was not just about improving health and well being for children and families but developing a collaborative relationship, improving promotion and access of all the local services.

It was really important that the Practice Champions developed a programme that could be sustained, therefore they didn’t ask stakeholders to develop new activities that would need a lot of funding but promote existing services.

Anthropometric measurements were completed on 17 participants. Four (24%) were obese (>95th centile), 3 (18%) were overweight (85th-94th centile) and 10 (58%) were healthy weight (5th-85th centile). This is higher than the local average population statistics; the National child measurement estimated in 2015/16 that 34.6% were overweight and 21.0% were obese within this area.

All participants who recorded their postcode were from the target population, the majority living within the White City Estate. Based on 2011 census data this area is predominantly purpose-built flats with a higher than average level of social housing 76%, (compared to national average of 18%.) 41% of the population in this area as from social grade DE classed as semiskilled or unskilled workers. It is also a diverse area.

Parkview Olympics ran from January to March 2017, the six week programme was agreed by all stakeholders and seen to be an achievable commitment for parents and children. However, due to the time it took to design and develop (factoring in the Christmas period), there were fewer activities available in winter. As we were working with QPR Football club we had to work at a time that suited everyone.

Progress made: What have you learned from doing this?

Parkview Olympics highlighted the importance of listening to patients and really understanding what matters to them. It is crucial that professionals don’t act on behalf of a patient before knowing how they feel about their healthcare. But the real learning was that we can not only listen to patients but work with them and encourage them to make changes for themselves and others. Here is some of the feedback from Practice Champions, parents and participants:

Wow! What a journey! I wanted to help and make a difference and now that it’s come to reality I am speechless. How can we thank the stakeholders enough for helping us to make a difference. Thank you, thank you! I have learnt during this journey that you don’t have to be a Doctor or have a degree or PHD all I needed was to care! I am so grateful’

Myself and Sade would like to thank you for a day at the closing ceremony’

‘Thank you so much for a wonderful programme, Aya and myself had a fantastic time today and during the 6 weeks. I look forward to carrying it on with her and the rest of my children’ 

‘Thank you for a wonderful day’ – ‘Thank you to everyone for the Parkview Olympics, we had a lot of fun’ 

‘Thank you to everyone at Parkview for the 6 week Olympics programme, my daughters really enjoyed it’

Evaluation highlighted that this intervention was acceptable and feasible could be a useful strategy to improve Physical Activity, Nutrition and Self Esteem of children within the White City Estate. Longer term follow-up is required to see if self-reported behaviours are sustained.

What’s your take home message?

Qualitative and quantitative data was used to evaluate this 6-week health and well being programme. Data suggests that this intervention is acceptable and feasible. The programme reached the appropriate target audience and recruitment was successful, achieving 26 participants for 30 places. Qualitative data was very positive, highlighting that participants and parents felt that the programme was enjoyable and had physical, mental and social benefits. Stakeholders also highlighted positive benefits to the intervention emphasising improved organisational relationships.

Resources?