In NHS Horizons we often talk about the power of connections. People who make and use their connections can be a real force for good in making change happen. Yesterday I was reminded of the power of connections as I spent the morning (and a good proportion of the afternoon) at North West Ambulance Service (NWAS) with a number of #ProjectA colleagues from across different services discussing Paramedic Darren Earley's Basic Step tool.

The first connection was made back in February of this year. A group of mental health and ambulance professionals gathered in London for the #ProjectA Mental Health collaborative to discuss the ambulance service's response to people with mental illness. There was a desire to move from an automatic risk adverse conveyance to A&E, to one that encompassed a human based approach with compassion and humanity. You can read more about the event here. 

Darren approached me during the morning tea break and said he was developing a conversational risk factor tool that had many of the component parts the room seemed to be discussing and would it be a good idea if he told the room about it? 

We did just that....we changed the morning's agenda around and gave Darren some space to introduce Basic Steps to the room and see where the conversation went. 

Essentially the Basic Steps tool allows a paramedic to have a good conversation/assessment with a person with mental ill health based on a number of risk factors aligned around the acronym BASIC STEP. It provides better recording in the paramedic's notes and assessment and also facilitates rationale decision making as well as providing a thorough means of explaining the risk factors noted when a paramedic is 'handing over' someone with mental ill health to another health professional.  

The room was interested - Darren was on to something, and hence we determined that we would keep close as the tool was piloted, assessed and taken through the formal committee structure in North West Ambulance Service. 

By May the initial pilot in Darren's own Cheshire locality had shown good results - increased self confidence amongst paramedics in dealing with responses that involved mental ill health, as well as vastly improved recording of risk factors and condition.

 It felt right therefore to organise a visit to North West Ambulance Service to discuss the tool in depth and see if others could take learning into their own environment. Colleagues from North West, Yorkshire, East Midlands, West Midlands and North East Ambulance services therefore gathered at North West's headquarters in Bolton for a morning of discussion and debate.

Here is where the second connection comes in. In traditional 'Horizons' style I began the session with a "check in" - asking to people to introduce where they worked, their role and what they were looking to get out of the session. During the 'check in' two colleagues from Yorkshire Ambulance Service had a lightbulb moment realising that they had made the trip to Bolton, with different interests in the Basic Step tool, had never met but worked just 10 feet away from each other back at their base. This provided a bit of amusement and if we accomplished nothing else that morning we knew we had connected two work colleagues together for the first time that had a common interest.

As I am sure most people will have recognised I am neither a paramedic nor a mental health professional and it would be impossible for me to describe the depth of discussion in such a short blog. All I can say is that I did very little facilitation other than open and close the proceedings as the conversation and questions literally flowed. People were curious and energised, eager to learn more and joining up the learning for what they wanted out of the session. Some of the quotes from attendees that I captured included :

"The number 1 objective says it all for me 'Improves staff confidence and competence'. I'm all for it'"

"Yes it needs developing and measuring but I'm fully supportive, as a leap forward for the service it is absolutely "bob on".

Darren and colleagues (Gill and Clare) were very much receptive to the questions asked and the contrasts and similarities of other services in the room. Thoughts were shared openly and even a small adjustment to the tool agreed as part of the debate.

What struck me is that people wanted to continue the conversations even when the session ended. I heard new connections being used to facilitate improvement on other areas of work - different services sharing real work on bereavement response, non conveyance leaflets, NEAS Care App and a request to use #ProjectA connections in a similar manner for the work one attendee was doing in relation to violence and aggression towards ambulance staff (something we will look to build in as part of the #ProjectA programme for the next 12 months). 

We ended up being 'booted' out of the room an hour after our scheduled finish and still some of us kept chatting away - potential to review QI strategies together and a similar day for NEAS to showcase and have critique of their Care App.

Using connections not only helps bring change to the fore and in many instances facilitate it but also it can provide a spark and a bridge to other things. 

The next stage for the NWAS Basic Steps tool is a full roll out across the Cheshire and Mersey locality and impact assessment completed by 2020. Don't worry we'll be there supporting through #ProjectA where we can and I think I may have persuaded Darren to do an 'Improvement' webinar on the Basic Steps tool in the Autumn. Look out for it - we'll make sure it is well publicised. We also agreed yesterday to have a repeat session after the impact assessment on the full 'roll out' to Cheshire and Mersey is completed in May 2020. 

As Dave Morgan (QI Lead NEAS) said to me just before we left: 

"for me Ian, sessions like this are vital - just to get the connections and hear what others are doing, see what we can learn and what we can help out with."