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What do hospitals need for a board-level quality improvement intervention to work?

Healthcare systems around the world are becoming more concerned with strengthening board level governance of quality. In England, national healthcare regulators are developing approaches, resources and interventions aimed at supporting senior hospital leaders in their role in the governance of quality.

New CLAHRC research investigates the organisational response to an improvement intervention in six hospital boards across England. The research, published in a new BMJ paper and BITE-sized summary shows the results a 30-month period of fieldwork, involving interviewing NHS board members, observing board meetings and analysing relevant documentation.

The findings will be relevant to NHS Boards, the staff and clinicians they lead and all those in the NHS working to improve the quality and safety of care.

As well as researchers, the results will be of interest to policymakers, regulators, knowledge mobilisation organisations and thinkers on boards and leadership across all sectors.

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 a BMJ editorial highlighting the paper as “an example of an empirical study that successfully enters into dialogue with management theory

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 our “need to know” summary

What do hospitals need for a board-level quality improvement
intervention to work?

Supporting our partners in Becoming Research Active

Local research bodies join forces with patient partners to deliver an introduction to research

We ran our Becoming Research Active course on November 14th offering our partners in front-line care a primer in research and the research process.

CLAHRC North Thames Academy collaborated with other NIHR funded research organisations in the region – the Clinical Research Network and Research Design Service – to deliver the training, with vital contributions from patients and members of the public.

The day-long course is structured to reflect the research cycle – from defining a problem, through securing funding to dissemination and evaluation. Attendees, who came from across the NHS and local authorities were encouraged to bring a research idea they could develop over the course of the day.

“The course has provided me with lots of resources and a clearer sense of direction, which is what I hoped for.”

We joined forces with NIHR infrastructure across the North Thames region – the Research Design Service which provides support to those preparing research proposals for submission to peer-reviewed funding competitions for applied health or social care research; and the local Clinical Research Network which makes it possible for patients and health professionals across England to participate in clinical research studies.

The training aimed to highlight the processes involved in planning and carrying out successful research, in partnership with patients and the public, and signpost attendees to the support available to them.

We were also very fortunate to have some patients and members of the public bringing their unique lived experience – of working with researchers, leading research and being a clinical trial participant respectively to offer tips to attendees.

CLAHRC Research Advisory Panel member Ayath Ullah (below left) joined the CLAHRC’s involvement officer Steven Towndrow to offer a lay perspective on how researchers can make patient/public advisers welcome and valued.

One of the CRN’s Patient Research Ambassadors (PRAs) Phillip Wingfield spoke about his experience of taking part in two clinical trials, offering a perspective from a participants point of view. 

We were also joined by community researchers Sultana and Farzana from the NEON project, where they have led research into improving nutrition practices among the Bangladeshi community in East London.

“Useful to have a range of speakers with varied experience. Great place to come prior to starting research.”

Researchers, staff and health professionals delivered a range of presentations with small group work and regular exercises to reinforce learning, and were on hand to facilitate each part of the day.

Feedback from attendees was overwhelmingly positive;

“Very useful and informative.”

“Lots of information to move forward my idea. Thank you very much.”

“A good overview of processes. Helpful to know all the help/support available.”

“Very well designed and delivered. It kept my attention throughout. The content/sessions were well balanced and provided me with the basis to build on”

We are offering follow up sessions with attendees to support the development of research ideas into action, and we plan to run the course again in summer 2019. Get in touch to join our mailing list to find out when courses are planned – clahrc.academy@ucl.ac.uk.

Introduction to Economic Evaluation

February 27, 2019 @ 9:00 am – 5:00 pm

Do you need to demonstrate the economic impact of projects in your organisation?

Do you want to assess the outcomes and sustainability of a new service?

Are you tasked with carrying out an economic evaluation, but don’t know where to start?

This one day, hands-on workshop aims to provide an introduction to addressing these challenges.  It is run by the NIHR CLAHRC North Thames Academy.  The course is aimed at staff in frontline services in the NHS and local government, who have limited experience of conducting evaluations and decision making analysis.

After attending this course, you will have the skills and knowledge to undertake your own simple economic evaluation of a local intervention or service, and be able to appraise other evaluations.

The course will cover:

  • introduce the basic principles of economic evaluation methods
  • explain how to assess the costs of an intervention/service
  • explain how to measure and value outcomes of an intervention/service
  • give practical examples of economic evaluation analysis
  • help to understand how to use economic evaluation in decision making
  • offer the opportunity to discuss in small groups the economic evaluation you are doing or thinking of doing.  A facilitator will help scope your economci evaluation, draft its core elements, identify the data you will need to use, think how you could overcome information or data gaps.

This workshop is suitable for staff from NHS Trusts, Local Authorities and CCGs who need to evaluate local programmes or services from an economic perspective as part of their work. It is not aimed at academics and/or researchers.

In order to be most beneficial for the participants, we invite applications from individuals who are carrying out or soon will need to carry out an economic evaluation of a service/intervention. In the selection process, we will give priority to applications providing a detailed description of such projects. Groups of people working on the same project are encouraged to apply.

No previous knowledge of economics is required (or experience of study design and statistics), however an interest in economics and being comfortable with numbers is desirable.

All participants will receive a certificate of attendance.

Cost – This course is free for staff working in NIHR CLAHRC North Thames partner organisations (please click here to see a list of our partners). There is a delegate fee of £250 for other attendees.

Registration – Please complete the registration form and email it to clahrc.academy@ucl.ac.uk by 5pm, Wednesday 19th December 2018.  

Please note, a cancellation fee of £100 will be charged to both partner and non-partner delegates in the event of non-attendance without notice after 5pm, Wednesday 20th February 2019

 

 

 

Projects

Mental Health in Emergency Departments

How effective was a programme to improve NHS orthopaedic care in England? Evaluating Getting it Right First Time (GIRFT)

NHS 111/Urgent Care Patient Relationship Manager Evaluation

Impact and experiences of delayed discharge: A mixed studies systematic review

Linkage of Health and local authority data at household level

Using MRI perfusion images to stratify brain tumours

Application of multi-state models to prostate cancer screening

Social Care Prevention

Effectiveness and acceptability of metformin in preventing the onset of type 2 diabetes after gestational diabetes in postnatal women: A feasibility study for a randomised, blinded placebo-controlled trial

Effectiveness and acceptability of myo-inositiol nutritional supplement in the prevention of gestational diabetes: a pilot placebo-controlled double-blind  randomised trial

Prevention of progression to type 2 diabetes in women with gestational diabetes: A feasibility study for randomised trial on a Mediterranean diet

 

 

 

 

Could you be an ambassador for research?

Patient Research Ambassadors needed to promote health research from a patient point of view

We have teamed up with colleagues at the NIHR Clinical Research Network (CRN) to support their Patient Research Ambassador (PRA) initiative.

The Network is looking for patients, carers, and members of the public who have taken part in research and who are passionate about it.

The Ambassadors will help improve how local people across the North Thames patch find out about and participate in clinical research and also help to increase awareness of the importance of supporting clinical research. The PRAs will play their part in ensuring research is patient and public focussed.

Examples of the type of work PRAs do are below – 

Full training and support will be available. As well as a chance to learn new skills and improve how research is planned and carried out in your area you will be part of a network of PRAs.

To find out more contact CRN North Thames patient and public involvement manager Christine Menzies by emailing christine.menzies@nihr.ac.uk or calling 0207 679 9763

You can read a role description here..

Read tne full 10 things you can do to promote health research document here

Premature mortality twice as high in most deprived areas compared to most affluent

A major new paper in the Lancet highlights rates of premature mortality that are two times higher in the most deprived areas of England (Blackpool) compared to most affluent (Wokingham).

Dr Harry Rutter, Clinical Research Fellow at the London School of Hygiene and Tropical Medicine was among the prominent experts in the field who authored the paper.

Dr Harry Rutter

Dr Rutter, a public health physician, was Principal Investigator of the CLAHRC’s evaluation of the Greater London Authority’s Healthy Schools London programme. 

All-cause age-standardised years of life lost due to premature mortality (YLL) and years lost due to disability (YLD) per 100 000 population by UK country and English Upper Tier Local Authorities, 2016

The work presents findings from a new Global Burden of Disease (GBD) Study funded by the Bill & Melinda Gates Foundation and Public Health England. 

The Global Burden of Disease includes evidence collected and analyzed by a consortium of more than 3,000 researchers in more than 130 countries and provides a tool for goverments and policy makers to measure health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and inequalties tackled

The authors of the Lancet paper used the data to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. They estimated the burden of disease by cause of death, condition, year, and sex.

You can view via an interactive ‘Lost Years’ map – which reveals the extent of health inequality across the UK.

Changes in health in the countries of the UK and 150 English
Local Authority areas 1990–2016: a systematic analysis for
the Global Burden of Disease Study 2016
Nicholas Steel, John A Ford, John N Newton, Adrian C J Davis, Theo Vos, Mohsen Naghavi, Scott Glenn, Andrew Hughes, Alice M Dalton, Diane Stockton, Ciaran Humphreys, Mary Dallat, Jürgen Schmidt, Julian Flowers, Sebastian Fox, Ibrahim Abubakar, Robert W Aldridge,Allan Baker, Carol Brayne, Traolach Brugha, Simon Capewell, Josip Car, Cyrus Cooper, Majid Ezzati, Justine Fitzpatrick, Felix Greaves, Roderick Hay, Simon Hay, Frank Kee, Heidi J Larson, Ronan A Lyons, Azeem Majeed, Martin McKee, Salman Rawaf, Harry Rutter, Sonia Saxena, Aziz Sheikh, Liam Smeeth, Russell M Viner, Stein Emil Vollset, Hywel C Williams, Charles Wolfe,  Anthony Woolf, Christopher J L Murray

Our work is award winning

CLAHRC researchers enjoyed success at the recent Public Health England Annual Conference in Warwick.

They were among the authors of an award winning poster representing our partnership work with Islington Council.

We are working with the borough as it seeks to link NHS data with its own datasets to build a clearer picture of  local population needs and better target services and interventions.

Linking these sources of data can build a picture of how social determinants of health – the conditions in which people are born, grow, live, work and age – might impact on residents’ wellbeing and use of health services. Examples would include how housing conditions impact on hospital admissions or how serious childhood illnesses could affect school attendance and attainment.

The poster was presented by Laura Scott, Principal Data Specialist at Islington Council and highlights how 90 data sources within the council are being joined up, already proving valuable in understanding local risk factors for ill health and improving access to services.

Islington insights population register: linking council data to understand local population needs for a fairer, healthier society

Laura Scott, Helen McDonald, Mahnaz Shaukat, Lawrence Vandervoort, Logan Robertson, Jessica Sheringham, Sarah Dougan

Over 1500 participants visited the PHE annual conference representing a wide range of organisations working to improve the health of the public. 

The CLAHRC’s Dr Jessica Sheringham (Senior Research Associate) was an author of the poster chosen from over 350 submitted – the award was presented at the conference dinner.

The project is funded by the Health Foundationas part of its Advancing Applied Analytics programme, aimed at improving analytical capability in support of health and care services.

Read more about this work via the link below

Linking health and local government data at household level to understand social determinants of health