A year in the life of AQuA: Tracey Rawlinson

As we near the end of the year, we start to think back on the months gone by, and having time to reflect on the year offers us the opportunity to celebrate achievements, learn some lessons and reassess for the New Year.

We asked some of our programme leads to share their thoughts and reflections on 2019, covering the expert work that AQuA have done to support our members and customers on their improvement journeys and what they’re looking forward to in 2020.

Our next blog in the series comes from Tracey Rawlinson, our Whole System Flow (WSF) Programme Manager, who joined AQuA in July 2019.

AQuA’s WSF programme combines Quality Improvement methodologies and system leadership approaches to enhance the likelihood of a successful and sustainable optimum pathway and overall shift to systems improvement. The programme supports systems to improve flow based on the Four Arrows Whole System Flow Model.

Source: AQuA (2018) Whole System Flow 2017/18: Learning Report

The model spans the four key domains that constitute any health and social care system: people; information; workforce; and finance and resources. The programme was structured according to the Design Council Double Diamond Model, which emphasises a balance between diagnosing problems and designing solutions.

The Programme consists of two discrete phases: a Diagnostic Phase and a Design and Implementation Phase. Each phase takes between 4-6 months, with an intentional pause in-between each phase to assess system readiness and create an improvement action plan. There are also bespoke WSF programmes according to the needs and status of the local system.

Since joining AQuA, I have supported two systems in their Design & Implementation phases, one bespoke programme, and launched two new systems in their Diagnostic phases.

My first event took place on just day 3 of the job – and was a Lymphoedema bespoke event with Liverpool CCG and system partners. It was a great event, well attended, and as a result of patient feedback facilitated by one of AquA’s Lived Experience Affiliates, has led to the development of a peer support group for patients with lymphoedema.

When I joined AQuA, a number of systems were in their Design Phase. Heywood, Middleton & Rochdale CCG had been working with their local system to make improvements to their Paediatric Urgent Care pathway. They held a successful System Visibility event in the Spring of 2019. Strategic changes following the integration of Rochdale’s commissioning arrangements have meant that HMR CCG are now taking this learning into their wider Urgent Care Strategy to help further accelerate the paediatric urgent care agenda.

Lancashire Care NHS Foundation Trust were also in their Design Phase to improve their Personality Disorder Pathway. In 2019 we led a System Visibility event where key issues were identified, and plans are now in place to use the learning in a new Programme of Quality Improvement.

The WSF programme team have also worked closely with North West Borough Mental Health NHS Trust across St Helens and Warrington systems to develop an optimal urgent mental health response pathway. Their Design phase commenced in January 2019 and provided the platform for services to take their aim statements and systematically develop designs for their area of focus. In November 2019, AQuA held a reflection event where their successes were shared, and work continues within the NWB organisation to test, scale and spread quality improvements.

In my first couple of months we have also had successful applications for two new systems.

Support for Bury LCO started in August through the tried and tested methodology of WSF to support the development of an optimum pathway for Palliative and End of Life Care. We have had lots of engagement and enthusiasm for the local systems in Bury, and held a System Visibility event in October 2019 where we heard many patient stories and the service providers were able to identify key hotspots in the local system.

In October 2019 a second programme launched their Diagnostic phase with Clatterbridge Cancer Centre and their aim to develop a unified acute pathway for patients with Cancer of Unknown Primary (CUP)/Malignancy of Unknown Origin (MUO) across Cheshire & Merseyside. This has kept the team busy supporting seven acute sites in understanding their current systems, and gathering patient stories prior to their System Visibility event in early 2020.

My time as the Programme Manager so far has been interesting and exciting, working with system commissioners, providers, service users and their families to develop optimum flow through designated pathways, and improve locally agreed outcomes. As a clinician by background I am passionate about improving patient care, and am delighted to be working with my colleagues across AQuA to ensure patient care, safety and experience is at the heart of everything we do.

Prior to coming into post an external review of the WSF programme was commissioned. I am looking forward to receiving the review and considering what improvements can be made to AQuA’s WSF programme in the future.