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How does the 100 day challenge work?

Frontline practitioners and people who use public services have unrivalled expertise in how the system operates, but often have little influence or ownership over change. This approach empowers and connects those closest to delivery, to drive change, over 100 days.

Empowering those on the frontline 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.

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.

The approach draws upon and combines the best aspects of evidence-based leadership and change management theories, and theories used in other fields including:

  • Design - human-centred design and user-led innovation.
  • Leadership development practice - adaptive and network leadership.
  • Quality Improvement - plan-do-study-act, and evidence-based practice.
  • Group dynamics and team effectiveness - deploying a range of facilitation and coaching, and behaviour change techniques.

The approach creates the conditions for successful innovation in complex systems.

The 100 day challenge method works best on complex/wicked issues, which require collaboration across organisational and professional boundaries, and a range of interventions to be tested simultaneously. Over the past few years we have been testing the applicability of the approach to tackle the following issues in the healthcare system:

  • Improving care and support within a community setting to reduce unplanned hospital admissions.
  • Improving approaches to hospital discharge to reduce avoidable delays.
  • Supporting areas to develop proactive approaches for those at risk of developing long-term conditions – such as diabetes.
  • Working nationally to reduce the rising demand for elective care – helping to make sure that people see the right person, in the right place, first time.
  • Supporting health systems to develop and scale person and community-centred approaches, through place-based/ neighbourhood working
People Powered Results wheel graphic

The People Powered Results '100 day challenge' methodology

Nesta's work on the 100 day challenge

In 2015, Nesta, working in partnership with Rapid Results Institute, pioneered the People Powered Results ‘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 older people, reduce unplanned hospital admissions, improve discharge from hospitals and even helped develop a new preventative care process for people at risk. Our first challenge started in Essex in 2015; over the past two years the team’s work has spread across England.

Since 2015, the People Powered Results team has worked directly with over 63 frontline teams across 17 local places. Alongside this we have built the capacity within local and national transformation teams to enable the approach to be used in a further 15 local places.

We have used 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 to testing and implementing personalised care, including Integrated Personal Commissioning, and to support the transformation of elective care services.

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

This work put into practice from Nesta’s wider work on People Powered Health. This includes Realising the Value, a programme which was funded by NHS England and led by Nesta and a consortium of organisations including the Health Foundation and Voluntary Voices. The programme developed evidence and practice, which enables people to take an active role in their own health and care.

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

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 among the local leadership in the area grew in scale and quality and the work was awarded for improving outcomes in the frail population.

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.

Further resources