Using a Plan Do Study Act (PDSA) approach, we explore the Diabetes Care Pathway in detail. This can be challenging if the process highlights areas which require discussion or correction before training can be delivered.
This Gap Analysis has huge value because it empowers the frontline teams to identify and resolve shortfalls within their own service.
Reaching consensus on the changes needed can be challenging and time consuming, often involving multiple stakeholders. Lively discussions will need strong leadership to manage difficult conversations about change. It is important to ensure that this is a positive constructive process for all, and my role is helping to lead and support teams through this process as they develop their bespoke programme.
Developing positive relationships with teams is pivotal to the success of the implementation and it is important to be aware how negative feelings towards change can derail the process if not recognised and addressed.
The PDSA model of improvement engenders engagement and collaboration of staff, building strong and honest partnerships, to get buy-in and support for implementation.
Pre and post training self reported confidence questionnaires are used in all programmes to assess staff confidence and acceptability of training and all attendees are asked to state what they would do differently after the training.
National Diabetes Inpatient Audit data has been helpful. Training implemented in Poole Hospital demonstrated significant improvements in patient safety in the National Diabetes Inpatient Audit results. The Trust moved from the highest to the lowest quartile for insulin errors. Nurses confidence levels increased ensuring safer and better quality nursing care.
In North West London we have an integrated service specification with common outcome metrics and have data since 2015 on 5 of the clinical commissioning groups. We will therefore compare outcomes as the training rolls out.
The Diabetes 10 Point Training Programme is part of our Diabetes Inpatient Transformation and we are exploring hospital foot checks, incident reporting, effect on length of stay, biomedical markers such as Hba1c as well as measuring the incidence of urgent unscheduled diabetes admissions and referrals to specialist teams.