A winning combination: programme management with system convening to develop and spread the BASIC STEP tool in North West Ambulance Service (NWAS)

In Horizons, we talk about the need for both programme management and system convening skills (including enabling new types of conversations between diverse groups of people) when working with complex change. Darren Earley and Gill Drummond provide a great example as we'll see in this blog.

Darren (Senior Paramedic Team Leader) and Gill (Head of Mental Health & Dementia Services) describe in this video how using their different but complementary skills and extensive experience, they have created, tested, modified and enabled the spread of the BASIC STEP tool in the North West Ambulance Service (NWAS). 

The BASIC STEP tool allows all ambulance staff to have a good conversation/assessment with a person experiencing mental ill health, based on several risk factors aligned around the acronym BASIC STEP (Behaviour, Appearance, Speech, Insight, Cognition, Safeguarding, Thought, Emotional State, Plan). 

Darren presented the tool at #ProjectA Mental Health collaborative event, convened by Horizons, in 2019 to discuss the ambulance service's response to people with mental ill health. It was at this event that Darren and Gill first connected.

"different people, different backgrounds, different roles with a common purpose and common goal coming together’"

Darren brings an ambulance and paramedic experience and frontline understanding and Gill brings a nursing, mental health experience and managerial understanding. Key is a willingness to learn from each other. The mutual respect Gill and Darren have for each other is clear in the video, true ‘kindred spirits’.

BASIC STEP: why and how was it developed?

The BASIC STEP tool was developed as ‘a solution to something really fundamental and really essential for mental health patients’.

A need was identified to improve staff knowledge of mental health conditions and their training so as to enhance assessment of mental health patients presenting to NWAS. The Paramedic Pre-registration curriculum has historically included variable, and often inadequate, training in relation to mental health. This coupled with variable in-house training in relation to supporting those in mental health crisis resulted in Darren feeling that both staff and patients were being let down. Darren and Gill united to fix this situation and developed a solution specifically for ambulance staff.

Taking a 'BASIC STEP' in pre-hospital mental status examination as part of a structured format: a screening tool for ambulance staff.

Darren researched the evidence and developed a tool which was piloted and evaluated and has evolved since 2016 from a robust, in depth tool into a succinct and refined version. The development was a ‘dynamic process’ taking the approach ‘that this is not a rigid tool that we are going to stick with no matter what’. The approach was a tool based on good evidence with further development informed by staff, patients, persons with lived experience and key stakeholders.

Success and spread 

Following the pilot, and becoming runners up in the Sir Peter Carr award in December 2019 which gave credibility to the tool, the tool was spread to all of Cheshire and Merseyside [>1,200 staff]. This spread was completed in March 2020 achieving better than expected results. Compliance was 100% in every metric compared to the previous 13%. From April 2021 the tool will go Trust wide across NWAS. Funding from Health Education England will allow a unified approach to training across England which is anticipated to include BASIC STEP.

Working with complexity and working together

Gill explains how complexity exists in the mental health clinical groups and also in the ambulance environment. This complexity requires being flexible, having a plan and then evaluating and modifying based on feedback. Being flexible means that what exists now, the plan and the tool, is different from the original 18 months previously.

..what we started off with was actually quite different ....we've modified, we've been flexible.

Darren and Gill demonstrate the benefit of working in partnership using both programme management and systems convening skills.

In addition to the complementary knowledge and skills described earlier, Darren explains the importance of preparation, correct measurement tools and milestones along with communication to the right people. Gill describes working with the NWAS Programme Management Office and linking to existing support and frameworks and navigating the complexity of the management system. Key to the spread of BASIC STEP across the ambulance trust was its inclusion, by Gill, in the NWAS Mental Health and Dementia Strategic Plan 2019 – 2022, which demonstrated support from the Executive and Board.

Further information on:

BASIC STEPS

Darren.earley@nwas.nhs.uk NWAS Senior Paramedic Team Leader & BASIC STEPS author/ pilot lead.

Clare.bradley@nwas.nhs.uk NWAS Clinical Quality Team (copies of infographic)

#ProjectA Mental Health Basic Step Tool: Sir Peter Carr Award Finalists, blog by Lynsey Oates

The Power of Connections as a Force for Change, blog by Ian Baines on NWAS visit and BASIC STEP

System convening

NHS Horizons website 

If you're interested in how to enable the spread and adoption of innovations in healthcare, there are previous blogs and further blogs to follow. Please do subscribe to this blog and follow @DianeKetley @HorizonsNHS, #nhsspread.