Putting the standard into practice

Wound Care
1.
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About this toolkit

2.
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Getting to grips with the standard

3.
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Getting people on board

4.
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Taking stock and planning

5.
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Putting the standard into practice

6.
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Shared resources and learning

Putting the standard into practice

Having agreed your roadmap with stakeholders, you can now begin making the changes and putting the standard into practice in your organisation. From piloting the information standard and developing a training programme, through to monitoring and measuring its successful adoption.
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Develop a detailed timetable

Based on your high-level roadmap, develop a detailed timetable for change with dates and responsibilities clearly identified. This will signal to stakeholders when the change programme will begin, how long it will take and prepare them to fulfil their role in making it happen.

Consider the following when pulling together your timetable:

Phases – a phased approach to implementation is often helpful to manage systems and stakeholders. It also reduces the risk of issues accumulating, as you can address them at each phase.

Piloting – a small scale trial at the start of a project can help to refine your plan and test systems and requirements.

Stakeholder management – share your timetable for change as early as you can and provide regular updates to stakeholders, so they are engaged in whether progress is being made with implementation and how they can contribute, as needed.

Plan and procure system changes

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Procure the system changes needed ensuring that systems will be delivered that are conformant with the standard. See NHS England procurement guidance.

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Agree how the team will be involved in testing the software to ensure it is conformant and meets local requirements.

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Technical message standards can be found in the NHSE API catalogue. 

Piloting

We recommend piloting a small-scale trial; implementing the information standard for a small number of users or in a small locality. After these users have been trained, the project team can make charts of the processes involved – these charts will form the basis for training all users to access and utilise the information standard.

There are several advantages to running a pilot:

Reduces the risk of a full-scale implementation as adjustments and modifications can be made as a result of the pilot

Improves processes through evaluation of the process charts produced during the pilot
Develops training materials through conversations with users from the pilot who can share their learnings.

Training

When you are ready to implement the information standard on a wide scale, you will need to develop training materials. You can use our example slides as part of your training initiative.

Your training plan

Make a list of stakeholders who will need to be trained and produce a timetable of training

Work through the example training schedule to develop your plan.

Multiple training sessions can be helpful for your staff to engage and have a greater lever of understanding

Different groups of users will have different learning styles. Take this into account when designing the type of training you offer.

Safety case and hazard log

Every information standard built by PRSB includes a safety case and a hazard log. These additional documents are written based on the NHS guidance – PRSB, as developers of the data model, use DCB0129 guidance (for manufacturers of health IT systems).

 

Why use a safety case and hazard log?

The purpose of the safety case and hazard log is to identify the hazards which could cause a person harm because of using the standard, along with how that hazard can be mitigated. There are different types of mitigation – through system design, testing, user training or business control processes.

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When implementing the Wound Care Standard you should consider and mitigate hazards using the documentation. Any suppliers you work with must:

  • Develop their own safety case and hazard log, using NHS guidance DCB0160, this should reference a DCB0129 assessment created by the system supplier
  • Have registered clinical safety officers to ensure the systems implemented are safe for use and person care
  • Run risk assessments to determine the likelihood and consequence of a risk happening

As part of ongoing clinical risk management, regular clinical risk assessments are recommended. This can be done using a recognised tool e.g., SWIFT or Bow tie.

 

Resources

Information Standards Notice

Information Standards Notices announce new or modified standards. Their release is managed by the Data Alliance Partnership Board (DAPB) who ensures the quality of these standards.

The ISN provides details such as standard confirmation, implementation date, mandate status, legal or contractual basis for data requests, and key contacts.

The Wound Care Information Standard has achieved ISN Status following rigorous quality assurance by the NHS Data Alliance Partnership Board. Find out more about ISN status here.

 

Resources

Digital Technology Assessment Criteria

If a new system is proposed (or an existing contract renewed) to support the implementation of the Wound Care Implementation Standard, the healthcare organisation should ask the supplier (developer) of the system to complete the digital technology assessment criteria proforma. 

 

What is it used for?

DTAC (Digital Technology Assessment Criteria) is a set of standards and guidelines used to evaluate digital health technologies. They are designed to ensure that any digital health technology used by the NHS is safe, effective, and offers value for money.

The DTAC criteria cover a wide range of factors including clinical effectiveness, patient safety, data protection and security, usability, accessibility, and interoperability. They are used to assess digital health technologies across different stages of development, from early-stage prototypes to fully developed products.

The purpose of the NHS England DTAC is to provide a consistent and transparent framework for evaluating digital health technologies, and to support the adoption of innovative technologies that can improve patient outcomes and enhance the quality of care provided by the NHS. 

By following these criteria, digital health technology developers can ensure that their products meet the standards required for use within the NHS, and that they have the best chance of being adopted by healthcare providers.

 

Is it UK wide?

DTAC is specific to the healthcare system in England. However, there are similar frameworks in Scotland, Wales and Ireland. Each have their own set of standards and guidelines for evaluating digital health technologies that are specific to their healthcare system.

 

Resources

Monitor, measure and adjust

Once you have implemented the Wound Care Information Standard, you’ll want to measure the success of your implementation, e.g. how often the elements within standard are being used and whether it is improving care and/or patient experience. 

Analysing the results

  • Are the expected benefits being achieved?
  • If not, why not and how could this be improved?
  • What has been learnt that would improve the process and outcomes?

You should expect to go through iterations to get your implementation right over time. This gives you a chance to review data on the effectiveness of the changes and course correct as needed in iterative cycles:

Define clear roles and responsibilities

Reflect on the data you have gathered

Make adaptations to your system or processes

Celebrate and publicise successes

Repeat

Go to

Putting the standard into practice
Develop a detailed timetable
Plan and procure system changes
Piloting
Training
Safety case and hazard log
Information Standards Notice
Digital Technology Assessment Criteria
Monitor, measure and adjust

PRSB Standards Explained

Why we need standards to record our health and care information in a consistent way so that it can be made available whenever it is needed.

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Making change happen

Transformation programmes need clear goals, the right leadership and engaged staff and stakeholders. Get started by reading our information on transformational change.

Read More

PRSB Support Available

If you have a question for PRSB, please contact our support team. We have an expert team who can help you find the answer, or direct you to the right place.

Read More

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”