Among the various significant moments in Thiscovery’s development, perhaps the most pivotal was when suddenly everything that could go online had to go online. That month - March 2020 - everything changed.
Which urgent problem to solve first?
When the pandemic hit the UK, normal procedures in hospitals and their maternity wards needed to adapt overnight, but professionals couldn’t come together to come up with the best possible solutions. Remote consensus-building wasn’t now just a viable concept, it was essential.
The team at Thiscovery responded by swiftly pivoting to a new direction - expanding the platform’s functionality to make rapid, responsive online research and consultation available at scale. After talking to colleagues from the PROMPT Maternity Foundation, the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, a team from THIS Institute focused their efforts on obstetric emergencies.
“There was an existing process and we were asking ‘how could you adapt it for Covid?'”
Trying something new
Knowing they had to achieve successful results at speed, the team worked with Thiscovery to develop and apply a ground-breaking online consensus-building approach; the five-step framework methodology.
What's interesting is that none of these steps on their own were new: project scoping; prototyping; recruitment; designing the exercise; and finishing with recommendations for further improvement. But nobody had brought them together before for an online approach.
Improving healthcare through remote, large-scale collaboration and consensus-building
1. Gather recommendations
Ask for recommendations from participants on how to improve the draft solution.
2. Synthesise
Group recommendations together and remove duplicates.
3. Rate
Participants rate how useful each recommendation is. Identify which ones the majority of participants agree on.
4. Re-rate
Re-rate the recommendations that didn’t reach the consensus, showing participants what others said.
5. Finalise
Make a list of final recommendations that have reached consensus.
Understand the problem to be solved
Identify and characterise a problem in healthcare, working with the people affected by it - including experts by experience, such as patients and staff. Work out who else needs to be involved to solve the problem, then set the objective for improvement.
Produce a first version of the solution
Draw on existing evidence and practices as well as views and experiences of people with different perspectives, to develop a draft solution to the problem.
Recruit a large, diverse group to build consensus
Invite a larger group of people to participate in building consensus on proposed solutions – this could be patients, carers, NHS staff and others.
Build consensus on improvements
Ask for recommendations from participants on how to improve the draft solution. Group, rate and re-rate the recommendations to build consensus on which ones should guide the solution.
Use the learning to produce and share a solution
Use the recommendations to optimise the improvement. Work collaboratively to communicate the improvement to people who can put it into practice.
“The vital innovation was combining existing steps in such a way to make this happen rapidly. We'd devised something new and exciting that can be developed and applied to other clinical areas.”
Thiscovery hosted the exercise, gave the research team access to relevant tools, and made it easy for participants to access and take part. But the overall success of this project was down to the team’s thorough planning, collaboration and ability to swiftly flex and iterate.
Reaching the right people
To generate useful, evidence-based recommendations the project needed input from people with relevant expertise. When scoping and designing the exercise the team identified three key specialist groups to involve: staff working in maternity care; experts in infection prevention and control; and human factors specialists.
A recruitment plan was – as it always is for a consultation exercise – essential. There’s rarely an easy option for accessing the people you need to involve in your project. For this one, THIS Institute and PROMPT Maternity Foundation had to think laterally about the channels available to them.
Using their personal connections and networks, they were able to engage with professional networks of maternity professionals, infection prevention experts, anaesthetists, and human factors specialists. While it’s typical to involve around 15 to 20 people face-to-face, in total the team were able to engage more than 100 people to take part in this project - all of this during an extremely pressing time for the professionals involved.
“Thanks to Thiscovery we could involve far more professionals, experts, and specialists than was previously possible. This allowed us to benefit from the collective expertise and ingenuity of a significant number of people.”
What it looked like
The exercise on Thiscovery was held over three phases. Phase one needed to help people tap into their creativity and come up with as many recommendations as possible. Phases two and three aimed to reach consensus on which would be the most powerful and practical ideas to implement.
For phase one the team wanted something for participants to respond to, something to stimulate opinions and generate ideas. The PROMPT Maternity Foundation had already developed a scenario video showcasing practice to get feedback – demonstrating a possible way of managing obstetric emergencies in women suspected or confirmed with COVID-19.
“We showed participants this video and asked which processes can be improved in light of their own professional experience.”
It’s a lot easier for people to respond to something in front of them than to come up with something out of thin air. Participants watched the scenario and were asked for their suggestions for how the practices illustrated in the video could be improved. This stimulus material proved immensely successful – from the 105 participants this phase generated more than 800 ideas.
Analysis then helped the team to rationalise those 800 ideas down to 22 of the most frequently suggested recommendations. In phase two, participants were asked to score those 22 recommendations. This showed firm agreement across all groups that 12 of the recommendations should be implemented.
In the final phase participants were asked to re-review any recommendations where agreement wasn’t clear, and to consider their scores again in the light of scores from others (particularly those from other groups). Ultimately this exercise reached agreement on 16 practical recommendations for improving care for parents experiencing an obstetric emergency during a pandemic while having suspected COVID-19.
Getting better results
The project team worked closely together alongside Thiscovery to learn more from this project, even after it was finished. The combination of project methodology and the tools and accessibility of the platform meant they could generate even more practicable insights than they hoped at the outset.
Involving people with different professional backgrounds meant the team got a full range of ideas and recommendations. Being able to then show the professional groups their recommendations from one another resulted in richer ideas and further suggestions which wouldn’t have come about from people working in isolation.
The accessibility of Thiscovery - and the team’s approach to informing and recruiting participants - increased engagement and offered ways of working that could also be applied in other projects.
“In using Thiscovery I learnt to rethink how we presented things so we could reach the same goals quicker, with better engagement, and at a much larger scale.”
Project outputs:
16 recommendations were generated for improving processes for responding to obstetric emergencies in women with suspected or confirmed COVID-19.
Themes included: preparation and team roles; use and wear of PPE; layout and design; communication; and doffing
- Resources were produced at speed for NHS staff urgently seeking online resources and training in new COVID settings:
The recommendations and resources were disseminated by the team through all the channels available to them, to reach as many maternity specialists as possible. The project was described as "gold standard" by Martin Bromiley, Patient Safety Advocate and founder of the Clinical Human Factors Group. It was also praised by the Chief Midwifery Officer for NHS England and the former Head of Safety and Learning for NHS Resolution.
THIS Institute and Thiscovery are immensely proud of what they achieved alongside PROMPT Maternity Foundation, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Obstetric Anaesthetists’ Association, Each Baby Counts and the Infection Prevention Society. They have also continued to build and improve the processes they follow for online consensus-building for critical patient care.
Has this story piqued your interest? Would you like a chat about a project you have in mind? We’d love to talk to you.
