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The People Powered Results team are pioneering new approaches to achieving change and innovation in complex systems that are smarter, faster, more collaborative and more inclusive of citizens and the front line.

Frontline practitioners and people who use health and care services have unrivalled expertise in how the system operates, but often have little influence or ownership over change. Our approach empowers and connects those closest to delivery to drive change.

Empowering those on the front line not only brings a renewed energy and power for change across a system, but also brings a detailed level of insight into the real issues and challenges that are faced by a system to inform longer term strategic ambitions and plans. We think a place-based, people-focused, rapid approach to change has been a missing part of the jigsaw in complex system change, and a reason why top-down reform on its own often fails to achieve its potential.

The 100 day challenge is an innovation method

The 100 day challenge is a structured innovation process, combined with coaching support. The approach enables frontline staff from across a system to collaborate and rapidly experiment with new ways of working, to achieve real results for people and communities.

The method complements traditional top-down approaches to change. The method works with leaders of a system to mobilise those closest to the action - driving change from the bottom up, in real time and at pace. 100 day challenges are intensive periods of action and collaboration that typically involve representatives from health, social care and voluntary organisations. System and organisational leaders are supported to break down longer-term strategies into challenges with measurable objectives. Frontline practitioners and citizens set ambitious goals, and develop and test creative solutions in real conditions.

As an innovation method, it typically focuses on achieving the following objectives:

  • Providing insight into the feasibility and impact of longer-term thinking
  • Accelerating the pace of change
  • Stimulating new ways of working together, building relationships and an energy for innovation across a system.

Performance and learning goals are clearly set from the start of the process. It was developed by the Rapid Results Institute and customised with Nesta.

Nesta's work on the 100 day challenge

Nesta has long focused on driving innovation to create a more people-powered and data-driven health system.

Committed to stimulating better ways for people to remain healthy, we research, test and scale new ideas to see what works. We also make the most of all the resources available - from a patient’s motivation and experience of the system, to new data and the knowledge of health professionals.

In 2015, Nesta’s People Powered Results team, working in partnership with Rapid Results Institute, pioneered the ‘100 day challenge’ method in the UK health and care system. Since then, it has successfully generated new ideas about how to improve care for the elderly, reduce unplanned admissions, improve discharge workflows and even helped develop a new preventative care process for people at risk.

We first implemented the method with five teams in West Essex in 2015. Here, people in the community were empowered to test out new ways to solve the problems that mattered most to their communities, such as diabetes and caring for older people.

After this pilot, we have been adapting the method to tackle some of the most complex challenges faced by the UK health and care system. In 2017, we partnered with NHS England to apply the method as part of national efforts to bring about personalised care and Integrated Personal Commissioning and to support the transformation of elective care services.

In the same year, we worked across the country, in areas such as Hertfordshire, Stockton, Bolton and Tameside, to mobilise frontline teams to place people at the centre of their own care and improve outcomes for frail elderly patients, people with diabetes and those in the last years of life.

This work drew on recommendations from other national health and care programmes Nesta has also been involved in, such as Realising the Value. In this programme, Nesta and the Health Foundation worked together to enable people to take an active role in their own health and care.

Our goal is that by 2021, the 100 day innovation method will support the transformation efforts of at least 40 local health and care systems in the UK.

Case studies

To date, Nesta has worked in partnership with over 25 local health and care economies, and alongside regional and national bodies and teams including the NHS England Strategy Group and the Greater Manchester Health and Social Care Partnership.

Rapid Results Institute (RRI) Pilot Program: West, Mid and South Essex

From 2015 to 2017, RRI worked alongside Nesta to address the challenge to improve outcomes for frail older people by integrating the provision of care. A team of frontline professionals were brought together to address questions including how to transform the care and support system to prevent people going into hospital on an unplanned basis, assess when patients need hospital services, and how to work with people to reduce their risk factors against diabetes.

By exploring a new commissioning approach for frailty, the team’s results included a 40 per cent reduction in unplanned admissions in the first cycle ‘model month’, and was recognised as the only scheme to show a real reduction in unplanned activity. As a result, the collaborative relationship amongst the local leadership in the area grew in scale and quality and the work was awarded for improving outcomes in the frail population.

NHS England’s Elective Care Transformation Programme: Transforming Gastroenterology Elective Care

In 2017, the NHS England Strategy Group brought together local systems, including leaders, clinicians and patients, to design and test innovative ways to transform elective care services. Teams were encouraged to rethink referrals, maximise shared decision making and self-management support, and transform outpatient services.

In Somerset, to address the theme of rethinking referrals, the team tested whether a telephone-based advice and guidance service for GPs to access advice from local specialists and triage referrals could reduce the number of inappropriate referrals. Tested in 71 GP practices across Somerset, at Day 100 a referral was avoided in 54 per cent of the calls from GPs. In Stockport, a referral was avoided in 48 per cent of calls from GPs who could access real-time advice from specialists. By triaging referrals, patients received the most appropriate and effective treatment for them.

Meanwhile, to address the theme to transform outpatient care and improve access to care for people with Inflammatory Bowel Disease (IBD), the Stockport team found that providing patients with direct access to telephone advice and regular weekly appointment slots held for patients with flare-ups reduced average waiting time for a hospital outpatient appointment. Patients' needs were also met by creating a ‘one-stop’ clinic jointly run by clinicians and diagnostic services.

Nesta tools and resources

Other useful reading materials