The BMJ Awards 2020: showcase of this year’s winning teams
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4341 (Published 11 November 2020) Cite this as: BMJ 2020;371:m4341
The BMJ Awards, held virtually on 7 October 2020, have once again highlighted the best teamwork the NHS has to offer across a wide area of medical and healthcare practice.
This year the judges praised the way winning projects had harnessed the energy and enthusiasm of staff and patients to craft better services, deploying novel and inspirational approaches.
Here we highlight the winners, and we recommend readers to find out more from the teams themselves in showcase videos at https://thebmjawards.bmj.com/showcase.
Anaesthesia and perioperative medicine team of the year
Sponsored by the Royal College of Anaesthetists
Manchester University NHS Foundation Trust won this category for the Improving Tracheostomy Care project. This was an “ambitious” quality improvement project, praised by the judges for “great patient engagement” and for “national impact and potentially global reach.”
The needs of tracheostomy patients are often complex. Until recently there was no universal guidance package for staff to treat patients fitted with a tracheostomy. The team carried out a pilot study in four Greater Manchester hospitals, which showed that as many as 30% of tracheostomy patients experienced an underlying incident and that delays in talking, eating, and drinking were common owing to poorly coordinated care. The team worked across diverse sites and with a range of clinicians to improve safety and care quality.
Brendan McGrath, consultant anaesthetist, and colleagues led the set-up of the UK National Tracheostomy Safety Project, which includes standardising care and provides training for over 4000 members of staff. Patients, families, and healthcare staff benefited from a series of short educational videos. Key patient safety elements of the programme have been adopted by the National Patient Safety Improvement Programmes and are being introduced throughout the NHS in England.
The improvement programme reduced the harm from incidents by 55% and showed a 47% decrease in patient reported anxiety and depression. The introduction of the programme has also seen patients talk, eat, and drink considerably earlier.
Cancer care team of the year
Oxford University Hospitals NHS Foundation Trust and Oxfordshire Clinical Commissioning Group won for creating a new cancer pathway for patients with non-specific cancer symptoms.
This “outstanding project” saves lives and improves cancer outcomes for patients with early non-specific symptoms by reducing the time to diagnosis. The team worked across secondary and primary care, developing the Suspected CANcer (SCAN) pathway for eligible patients with “low risk but not no risk” cancer symptoms.
Patients are referred to the service by their GP if they have symptoms such as unexplained fatigue or unintended weight loss. If they meet the SCAN pathway criteria they undergo a CT (computed tomography) scan and blood tests. If cancer is detected they are referred to the appropriate consultant so that they can start treatment quickly.
The judges noted the team’s “authentic and thoughtful” approach.
More than 2000 patients have been scanned since the service was launched in 2018. A total of 201 patients have received a confirmed cancer diagnosis from the pathway—a 9.4% conversion rate—and have gone on to receive the care they need.
Fergus Gleeson, consultant radiologist, says, “We are absolutely thrilled that the SCAN pathway has been recognised in this way.”
Clinical leadership team of the year
Sponsored by the General Medical Council and the Faculty of Medical Leadership and Management
Public Health Wales and all health boards in Wales won for the Hepatitis C Elimination Wales project. Judges unanimously agreed that the breadth of this collaboration was “phenomenal” and praised its “breathtaking” results.
Many people in Wales, especially in disadvantaged communities, had struggled to access testing and treatment for hepatitis C because guidance and prescribing varied widely. National treatment guidelines were developed, and a national network was set up to ensure equitable and transparent access to treatment.
The programme has improved access through the development of testing and treatment services in pharmacies and community services throughout Wales. “Postcode prescribing was eliminated, and we delivered a completely fair system,” the network lead, Brendan Healy, told The BMJ.
Since the network was set up in 2014 some 2809 patients have been treated, achieving cure rates of around 95%, which is at least equivalent to other major European centres. The development of national treatment guidelines has saved NHS Wales over £40m by allowing freedom of choice but promoting the use of cheaper drugs, central procurement, and home delivery.
The judges said, “This was patient focused and cost effective, with excellent clinical leadership across all aspects of the NHS and outside organisations.”
Dermatology team of the year
Sponsored by LEO Pharma
Chelsea and Westminster Hospital NHS Foundation Trust won for its teledermatology cancer clinic.
The team improved its pathway for patients with suspected skin cancer after seeing rising referrals. In July 2019, 40% of dermatology departments missed the 93% two week target. An audit of skin cancer referrals to Chelsea and Westminster Hospital showed that only 6% were ultimately malignant or squamous cell carcinoma and that the majority (63%) were benign.
Patients are now referred by their GP for an appointment with an in-house medical photographer. The images and clinical questionnaire are reviewed by a consultant dermatologist, and appropriate management is initiated.
The service has been running since 2017 and has treated several thousand patients. It has been associated with a 10% reduction in non-attendance, and a third of patients are immediately discharged without a face-to-face clinician appointment.
Skin cancer diagnoses have increased despite a 15% reduction in the number of biopsies requested, leading to savings of more than £300 000 a year.
The judges said, “It was impressive to see that the service is already expanding into other areas, and the judges could see an opportunity for it to be scaled up further.”
Diagnostics team of the year
Sponsored by Alliance Medical
The healthcare innovation company Healthy.io and the Modality Partnership, a partnership of general practices, won for digital home albumin screening.
Diabetes is a known risk factor for the development of chronic kidney disease. Urine testing for the protein albumin can pick up signs of kidney disease. National treatment guidelines recommend annual screening using an albumin creatinine ratio (ACR) test, but audits have shown that as many as a third of patients don’t have a recorded result.
“Patients don’t always bring in a urine sample because they forget or are too embarrassed,” says Deborah Livesey, a GP. To improve uptake of testing, 10 Modality general practices in Hull, Airedale, Wharfedale, and Craven tested Healthy.io’s home albumin testing kit using smartphone technology.
Patients with type 2 diabetes and no previous urine ACR assessment were invited to receive a test kit through the post and download an app. It allowed patients to test their own ACR, where the results are sent digitally to the patient’s GP records and reviewed by a clinician at the practice.
An evaluation of nearly 500 patients who used the kit showed that 54 (11%) had an abnormal ACR, indicating previously unknown chronic kidney disease.
The judges said that the innovative solution was “scalable across different geographies and [would benefit] a large patient population with exciting potential for future development.”
Digital innovation team of the year
Explain my Procedure and Barts Health NHS Trust won for animation supported consent. Judges said that this “superb entry” tackled an important problem: how to improve patients’ understanding of clinical procedures and the trade-off between benefits and risks.
The website Explainmyprocedure.com features short video animations of procedures across different medical areas, including cardiac care and orthopaedics. They are available in several languages as well as English, including Bengali and Hindi, and can be easily accessed by patients using computers or mobile devices.
The animations were written and directed by David Wald, with input from patients and adoption by clinical staff. “They help encourage a dialogue needed for shared decision making before consent,” he says.
After the animations were introduced in 2019 their impact was evaluated. This showed an approximate threefold improvement in patients’ understanding of the procedure and its risks when compared with results from a pre-animation audit. In emergency situations the appreciation of risk increased 10-fold.
The initiative, if expanded across all specialties and trusts, could save the NHS an estimated £40m a year.
The judges said that the innovation helps to tackle health inequalities and empower patients and that it could be rolled out in different situations “to improve patient understanding and the consent process.”
Environmental sustainability and climate action in healthcare team of the year
University Hospital of North Midlands won for Saving Lives with Solar, a successful community energy scheme now being rolled out throughout the UK and internationally.
Almost 15% of households in the Stoke on Trent area in Staffordshire are classified as being in fuel poverty, with some areas nearing 50%. The team partnered with a local charity, Beat the Cold, and the Southern Staffordshire Community Energy social enterprise to channel energy saving investments into help for vulnerable groups.
The judges said, “The project tackles a real life issue of fuel poverty and the carbon impact of heating. As well as improving the quality of life of people in the local community, it sets an excellent example for other NHS trusts to replicate similar projects.”
As part of the project over 1000 solar photovoltaic panels were installed on hospital roofs. This provides cheaper energy at reduced tariffs and will reduce carbon emissions over a 20 year period.
The project has helped patients whose conditions can be exacerbated when they are discharged from hospital to cold and damp homes. The savings will fund “clinical intervention” by addressing heating and dampness, including new boilers and advice on energy bills.
The judges said that the partnership was a remarkable example of collaboration that “isn’t easy to achieve.”
Innovation in quality improvement team of the year
The Western Health and Social Care Trust in Northern Ireland won for its gestational diabetes pathway. Judges hailed this as a fine multidisciplinary project that “truly encompasses what quality improvement (QI) should entail.”
Gestational diabetes, which increases the risk of complications in pregnancy for mother and baby, is a growing public health concern that affects 8-14% of pregnancies a year in the Derry (Londonderry) area. The team sought to tackle the increasing pressure on services: a woman with gestational diabetes in pregnancy can expect to attend as many as 13 extra appointments during pregnancy, depending on when she has the condition diagnosed.
The team used flow coaching improvement methods and regular “big room” improvement meetings, including service users, to improve the care experience for patients and reduce inefficiencies. It tested possible solutions to improve the flow of appointments and introduced virtual video clinics.
The use of app based blood glucose monitors and video clinics resulted in fewer hospital clinic visits. System changes led to 31% fewer diabetes hospital appointments and 23% fewer obstetric appointments. During the first 18 months the team hosted over 658 video clinics, saving thousands of miles of travel.
Athinyaa Thiraviaraj, consultant physician, said that the award recognises teamwork and “all the mothers who have collaborated with us, helping us to redesign our service for the better.”
Mental health team of the year
Cornwall Partnership NHS Foundation Trust won for its Local Radio and Mental Wellbeing project.
A regular mental health radio programme on Radio Cornwall has been running once a month since 2011, helping to overcome stigma and discrimination against people with mental health difficulties and to provide valuable public education. The predominantly rural region is one of the most deprived in the UK, and many people are reluctant to talk about their mental health.
“We have managed to shine a light on a very dark corner and make people more accepting of mental health issues,” said Rohit Shankar, consultant in adult developmental neuropsychiatry.
The project features a five minute pre-recorded case study that airs during the morning. A psychiatrist and a non-medical clinician or patient expert are briefly questioned by the host, and the public are invited to ring in. Messages are also received through email and social media, while a trainee psychiatrist provides an information sheet to post on the BBC website giving facts about the condition, self-help organisations, and local services.
Judges hailed this “imaginative and innovative” project for showing “sustained effort to support people in an area with high rates of suicide, involving experts by experience and a significant investment of time by clinicians.”
Primary care team of the year
Hyde Neighbourhood (now a primary care network in Greater Manchester) won for the Healthy Hyde Team project. The key aim of the intervention in care homes was to give vulnerable patients an effective voice in how their care is managed and improve their quality of life.
The judges described the project as a “shining example” of how to provide individualised and high quality care to patients, “led by an approach that puts the needs and priorities of residents first and . . . delivered with kindness and empathy.”
The area had seen high numbers of care home patients, many with memory problems and dementia, being admitted to hospital and experiencing adverse outcomes. A complex care nurse intervention service was set up, with three complex care nurses and a project manager. It ensured that advance care plans were developed to better reflect the personal wishes of residents and families, as well as residents’ ongoing clinical needs.
The judges were struck by the impact of the team on patients and their loved ones, “with evidence to show improved process outcomes supported by moving stories from relatives and staff.”
The intervention enabled more efficient working across clinical and social care, the judges found. Benefits have included a 19% reduction in emergency department attendances from care homes in Hyde (April to November 2019) from the same period a year earlier.
Respiratory team of the year
This award went to the respiratory infection team at University Hospitals of Derby and Burton NHS Foundation Trust.
Community acquired pneumonia is a major cause of hospital admission, but patient outcomes are often poor, as antibiotics are often overprescribed and most low severity patients remain in hospital. The respiratory infection team helped raise the quality of care for patients admitted to hospital with pneumonia, reducing their length of stay and improving support during their recovery. The project was developed with a patient and public involvement group.
The team includes specialist nurses with consultant and pharmacist support. It has promoted adherence to national clinical guidelines, identifying patients with low severity community acquired pneumonia (CAP) for outpatient management and implementing early telephone supported discharge and follow-up. This has facilitated streamlining of antibiotic treatment using point-of-care microbiological tests within 48 hours of admission, reducing the total amount of antibiotics prescribed.
The team’s effectiveness has been confirmed in a review of outcomes when compared with a pre-intervention CAP cohort. Length of stay in hospital was reduced, the rate of microbiological diagnosis almost tripled, and a reduction was seen in the amount of broad spectrum antibiotics prescribed.
The judges said that the team had made “a substantial difference to patient centred outcomes and experience, as well as cost savings.”
Stroke and cardiovascular team of the year
Sponsored by the Medical & Dental Defence Union of Scotland
The Royal Cornwall Hospitals NHS Trust and University of Exeter won for their project to help patients with heart failure achieve better quality of life from the comfort of their own homes.
The benefits of cardiac rehabilitation for people with heart failure are well known, but in 2019 a national audit showed that fewer than one in 10 patients participated in any cardiac rehab programme. The team established a 12 week cardiac rehab and self-management programme called Rehabilitation Enablement in Chronic Heart Failure (Reach-HF). It was developed and evaluated with contributions from clinical and academic partners around the UK.
Cardiac nurses visit patients at home to introduce the programme and then provide telephone support. The intervention includes self-care activities, symptom management, chair based exercises, a walking plan, and relaxation exercises. Patients record their symptoms, and caregivers receive a support manual.
A randomised controlled trial showed that the intervention produced significant improvements in health related quality of life. And an economic analysis found that the mean cost for delivering the Reach-HF intervention was £418 per patient, making it cost effective. The programme is being rolled out and evaluated as part of routine clinical practice in eight NHS cardiac rehabilitation centres in England, Scotland, and Northern Ireland.
“Founded on research and patient involvement, this is an impressive example of excellent teamwork producing a real world solution,” the judges said.
Women’s health team of the year
The GooD Pregnancy Network at Basildon and Thurrock University Hospitals Trust won for their well established, innovative service for pregnant women with diabetes or at risk of the condition.
The trust was seeing rapidly increasing numbers of pregnant women with diabetes, causing overburdened specialist clinics, poorer patient experience, and worsening clinical outcomes. This prompted a remodelling of care pathways by a multidisciplinary team, with the launch of the General Ownership of Diabetes (GooD) Pregnancy Network in 2014.
A range of professionals from the obstetrics and gynaecology department worked with colleagues in diabetes services and with patient representatives to develop the service. They aimed to improve experiences and outcomes for patients—for example, by providing more telephone clinics with midwives and expert input from nutritionists.
The initiative strategically connects a midwife teleclinic “hub” to Educating Gestational Diabetics Group Sessions and standard antenatal clinics. Results have included shortening the “diagnosis to first consultation” intervals, eliminating overbooked specialist clinics (none since January 2016), and improving clinical outcomes.
The judges said that the interventions could be used in other trusts and other clinical areas. “The team showed excellent leadership and dedication to their patients,” they concluded. “Their project will have a really long term impact, not only improving the health of women during pregnancy but achieving health benefits for the rest of a woman’s life and for her children too.”
Workforce and wellbeing team of the year
The Joint Fatigue Working Group was a winning collaboration between the Association of Anaesthetists, the Royal College of Anaesthetists, and the Faculty of Intensive Care Medicine.
Judges said that it raised the profile of a key issue—the harms to healthcare staff caused by fatigue—and delivered “highly impressive outcomes.”
The tragic deaths of healthcare professionals driving after night shifts had prompted the collaboration to improve fatigue management through changing attitudes, behaviours, and work cultures. This involved survey work in which large numbers of trainees and consultants reported adverse effects of fatigue on health, wellbeing, and personal relationships. Some 57% of trainees and 45% of consultants described having had accidents or near misses when driving home after working overnight.
The group’s #FightFatigue social media campaign was effective in raising awareness. The team emphasised how important it was that healthcare workers, their employers, and national policy makers understand the impact of night shift working on patient and staff safety and that they implemented good fatigue risk management.
They created many education and support resources to help units access proper rest facilities for the workforce, delivered talks to groups of staff, and sought support from MPs. Several organisations now include fatigue awareness in staff induction and have improved their rest facilities.
The judges said, “The project is already achieving positive impacts. This is a great example of collaborative working.”
Footnotes
Find out more at thebmjawards.bmj.com
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.