From theoretically informed to theoretically informative improvement research

A new BMJ Quality and Safety editorial by Dr Roman Kislov, Senior Research Fellow at the Alliance Manchester Business School, has highlighted CLAHRC work as an example of successful engagement with management theory by researchers.

Dr Kislov’s research focus is the processes and practices of knowledge mobilisation, and his editorial highlights our recent paper on how different NHS Boards implement a quality improvement intervention – the QUASER guide.

He cites the paper as “an example of successfully deployed theoretically informative approach, highlighting some practical tips for researchers who aspire to move from merely applying theory towards entering into dialogue with it and, through doing so, refining its assumptions.

Read the editorial

Engaging with theory: from theoretically informed to theoretically informative improvement research

Repeated calls have been made for the increased use of theory in designing and evaluating improvement and implementation interventions.1-4 The benefits are argued to include identifying contextual influences on quality improvement (QI), supporting the generalisability of findings and anticipating how future phenomena might unfold.2 5 Most importantly, the ability of

Read the iQUASER paper

Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service

Background Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Read our BITE sized summary of the iQUASER paper

Complications following hip or knee surgery are more likely for people with long-term illness, but benefits are still worthwhile

The work of CLAHRC researcher Dr Bélène Podmore has been highlighted as “high quality” by the National Institute for Health Research. Bélène’s work, recently published in BMJ Open investigated how having a long-term condition impacts access to and benefit from hip and knee surgery. The research was promoted by NIHR via their “Signals” service. NIHR Signals summarise the latest important research on health care, public health and social care, along with implications for practice.

Joint replacement benefits and harms for people with other illness

Why was this study needed? In the UK, over 210,000 hip and knee replacements were performed in 2017 at an average age of 68 for hips and 69 for knees. One in six of these people had an illness affecting their day to day life.

Read the paper

Podmore B, Hutchings A, van der Meulen J, et al
Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis
BMJ Open 2018;8:e021784. doi: 10.1136/bmjopen-2018-021784

 

Capturing the views of patients in emergency care

CLAHRC researchers highlight potential to use patient-reported outcomes for emergency admissions.

Patient-reported outcome measures or PROMs are a well-established method of capturing the views of NHS patients, allowing the service to assess the quality of care delivered, from the patient perspective.

PROMs use pre- and post-operative surveys completed by patients to calculate their health gains after surgical treatment.

While there is an extensive PROM programme across the English NHS, they have yet to be used in emergency admissions. These account for nearly 40% of all hospital admissions and are an area of increasing demand. However, this is also an area where the NHS knows least about;

  • the quality of patient outcomes,
  • whether resources are being used effectively,
  • and whether there are unexpected variation between different providers

CLAHRC researcher and PhD Dr Esther Kwong investigated how to use PROMs to evaluate the quality of acute and emergency hospital care in the NHS. Esther developed and tested PROMS with patients who underwent emergency admissions, establishing that it is feasible to use PROMS in this clinical area.

They are presented in four new CLAHRC BITEs – postcard summaries of Esther’s published academic papers.

Can Patient Reported Outcomes Measures (PROMs) be used in emergency admissions?

Feasibility of collecting retrospective patient reported outcome measures (PROMs) in emergency hospital admissions

Using patient-reported outcome measures (PROMs) for primary percutaneous coronary intervention

Assessing Patient Reported Outcomes (PROMS) for emergency admissions: laparotomy for gastrointestinal conditions

Clinicians and research leaders’ views on barriers to involving children and families in research

Within the UK, 32 out of every 10,000 children are living with a life-limiting condition or life-threatening illness (LLC/ LTI).

Research, from genetic studies to drug trials is vital to improving care for these children and their families, but the inclusion of this vulnerable population into research studies has been difficult.

Barriers to Research Access: Voices, Experiences, and Solutions (BRAVES) is a CLAHRC study focusing on improving access and participation in research for children and young people with LLC/LTI and their families.

A new BITE – a postcard “need to know” summary of our published research – shares the perceptions of clinicians and research leaders on their perceptions of the barriers preventing children and their families becoming involved in research.

The BRAVES team surveyed palliative care clinicians, often “gatekeepers” to children and their families getting involved in research asking them

‘In your experience, what have you found to be the biggest barriers to palliative care research with children?’

We also consulted Chief Investigators (CIs) – leaders of NIHR research studies involving CYP with LLC/LTI and their families. CI’s were invited to complete an anonymous, web-based questionnaire and three key barriers to research were emerged, alongside four potential solutions.