As part of a series of blogs from prominent members of the research community CLAHRC Director Professor Rosalind Raine pays tribute to Michael Marmot, who has consistently and eloquently pointed out the unequal distribution of the social determinants of health.
Professor Raine’s piece in the British Medical Journal, the last of a series of”research legends” blogs highlights the ongoing relevance of Marmot’s work in light of the widening health gap between the socially advantaged and disadvantaged.
Describing Professor Marmot as an “iconic figure” Rosalind highlights his drive to keep health inequalities high on the policy agenda, and his impact on the NHS, in particular the 2010 Marmot review examining health inequalities in England.
What is the role of evidence in decisions about introducing or spreading innovations in health care?
Faced with a myriad range of innovations – in technology, medicine, ways of working and in organising services what do those who plan and commission services have to call on?
We know that a range of evidence informs healthcare decision-making, from formal research findings to ‘soft intelligence’ or local data, as well as practical experience or tacit knowledge. However, cultural and organisational factors often prevent the translation of such evidence into practice.
New guidance from the“DEcisions in health Care to Introduce or Diffuse innovations using Evidence” (DECIDE) study has been published to support decision-makers and evaluators in the use of evidence in their work.
A team funded by the Health Foundation and led by researchers at the University of Manchester and University College London has investigated decision-makers’ use of diverse forms of evidence, exploring how and why some evidence does inform decisions to introduce health care innovations, and why barriers persist in other cases. The guidance was developed in consultation with clinicians, health managers, commissioners, patient representatives, and researchers.
The guidance is the end point of two years work involving a review of current evidence; examination of three case studies of real world decision-making on innovations in NHS acute and primary care; and a national survey and discrete choice experiment of decision-makers’ preferences for evidence, including providers and commissioners.
The accessible document – available as an interactive PDF, is aimed at anyone concerned with informing or making decisions about introducing or spreading innovations within the UK National Health Service, including providers and commissioners of care. It provides a summary the team’s findings, questions for decision-makers to consider, and potential ways of addressing them using examples from case studies. The document also sign-post users of this guidance to further resources where appropriate.
Read more from the DECIDE team below –
Turner S. (2018) ‘Accelerating innovation in new ways of delivering health and social care’, Manchester Policy Blog, published 28 March 2018.
Turner S, D’Lima D, Hudson E, Morris S, Sheringham J, Swart N, Fulop N. (2017) ‘Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback’, Implementation Science 12:145. View bite-size summary.
Turner S, Morris S, Sheringham J, Hudson E, fulop NJ. (2016) ‘Study protocol: DEcisions in health Care to Introduce or Diffuse innovations using Evidence (DECIDE)’, Implementation Science 11:48.
Current debates on the NHS workforce include discussions on the best balance between
- specialists – with highly specialised skills who are brilliant at doing a small number of things extremely well
- and generalists – who can do a wider range of things in less depth
Rising multimorbidity, an ageing population, and the increasing specialisation of medical treatment are all seen as driving the need to increase the number of doctors with generalist skills. Generalists breadth of expertise enables them to manage both acute and chronic health problems and have been put forward as the way to provide better care for the increasing numbers of older and more complex patients requiring emergency medical admission.
A team of researchers from University College London and the Nuffield Trust is investigating the models of medical generalism currently in use in smaller acute hospitals in England and need your help.
A brief survey is asking for patient, professional and service perspectives on the balance of care between specialist and generalist models in hospitals for patients with acute medical conditions.
- If you are a hospital doctor working at a hospital that admits patients with acute medical conditions, please access the online survey here: http://www.dcdo18co.myonlinesurvey.co.uk/
- If you are a patient, carer or a member of the public, you can access the online survey here: http://www.dcpa18co.myonlinesurvey.co.uk/
- If you are a manager working at a hospital that admits patients with acute medical conditions, you can access the online survey here: http://www.dcma18co.myonlinesurvey.co.uk/
We would be very grateful if you could complete the survey within the next three weeks please, and we would like to encourage you to complete it at your earliest convenience. This will ensure we capture your views on models of care in small hospitals. The survey will take at most 5-10 minutes to complete. All responses will be handled securely, kept strictly confidential and anonymous, and stored in line with the Data Protection Act 1998 and new General Data Protection Regulation (GDPR).
Further details about the study are available here:
Your views will provide vital evidence as part of this research, which will impact decision making around ways of working in hospitals relating to
- issues around workforce education
- continuing professional development and contractual arrangements
- and the future of smaller hospitals and their role in the wider healthcare system.