Case Studies

Benchmarking progress across regions on the health visiting call to action

Added 10/04/2014


Following the successful Sustain Rapid Appraisal programme across the Midlands and East in 2012/2013, Health Education East of England asked us to develop a refreshed model to re-evaluate 13 services within its area. Its aim was to:

  • update the services and stakeholders on the progress made since the last review;
  • reflect changes in the landscape and new areas of focus; and
  • allow direct quantitative benchmarking against the earlier review. 
The refreshed model was also designed to give peer reviewers a greater role in the appraisal while also reducing the amount of time Sustain spent on site, therefore minimising the impact of the process on staff and services.

Key challenges
Carefully updating the appraisal to make sure it accurately reflected the current health visiting landscape would be key to the success of the project. Coupled with this was a necessity to ensure the results of the initial appraisal would be comparable with the refresh so that services could meaningfully measure their progress.
To achieve this, Sustain carried out a question-by-question analysis of the previous appraisal, revising its content wherever necessary and recalibrating the results of the first appraisal where necessary to ensure both would be comparable.  
Another important element was the increased involvement of the peer reviewers. Sustain began by identifying volunteers with the necessary skills before completing training programmes and supporting their use within the appraisal until they were fully embedded into the review team.
While the original reviews were organised by the commissioners, the refreshed programme was taken on by providers, which made engaging with stakeholders more challenging. In addition, the process took place against a background of wide-scale change in the structure of the NHS, to which many of the teams were still adjusting.

Main actions

To ensure the appraisals would be meaningful and delivered quickly and effectively, Sustain:
  • reviewed and updated the appraisal questions and breadth of meetings, which reduced the onsite element from three days to just two;
  • redefined the diagnostic tool used for the appraisal and amended the report templates;
  • developed full briefing materials and standard operating procedures for both internal and external audiences;
  • selected peer reviewers with the necessary skills and seconded them to the Sustain team;
  • completed a two day assimilation programme for peer reviewers and associates, which included role play exercises to ensure everyone taking part understood the unique style and approach used within the rapid appraisal; and
  • developed a coordinated programme to visit all 13 sites in the Health Education East of England area, with the first appraisals taking place in January 2014.

Outcomes and achievements
The refreshed Sustain Rapid Appraisal programme received some excellent feedback from participating clinicians, who valued the brief yet robust outcome reports produced as result. Consisting of around 20 pages, the focussed reports were produced and concluded within two weeks of the appraisal and were predominantly well received, the majority requiring no amendments between the draft and final copy. The careful development of planning tools, templates and standard operating procedures also ensured consistency across all services.
One of the project’s largest successes was the increased use of peer reviewers who provided the process with an essential clinical perspective and operational experience, both of which helped shape the line of questioning. The reviewers also valued the process as an opportunity for personal development and broaden their outlook, in turn enhancing their skills and experience for the wider benefit of the NHS and their own individual service in the future.

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