NIHR CLAHRC North Thames welcomed over 40 leaders and board members from our partner organisations and beyond for a seminar focusing on the Role of Boards in Quality Improvement.
We welcomed Tim Melville-Ross CBE, Chair, Homerton University Hospital NHS Foundation Trust who chaired the event , drawing on his long experience on boards in both the private and public sectors.
Our keynote speaker was Professor Naomi Chambers, Professor of Healthcare Management of Alliance Manchester Business School who drew on her extensive research on different Board models across sectors and geographies to set out the characteristics of effective board working for quality improvement in health care.
Professor Naomi Fulop, Professor of Health Care Organisation and Management at University College London and Principal Investigator of our iQUASER project hosted the event and presented some early findings of note from the project
This CLAHRC North Thames workshop held on 13th January 2015 at BMA House, brought together over 40 clinicians, commissioners, individuals from the voluntary sector and patient representatives to stimulate learning about delivering and evaluating quality improvement in primary care.
Professor Elizabeth Murray, UCL Professor of e-health and Primary Care, presented evidence from a review on achieving change in primary care.
Dr Jessica Sheringham shared initial findings emerging in the final stage in the CLAHRC’s evaluation of the ‘Year in the Life’ quality improvement programme, comprising educational initiatives underpinned by relationship building and data sharing that took place across 189 practices in outer North East London. Researchers from the ‘Year in the Life’ (YiL) evaluation shared initial findings.
Workshop participants then took part in round table discussions.
The event had two areas of focus
Firstly – delivering quality improvement in primary care. We summarise key themes, on two key questions illustrated by comments and examples from the field given by participants2:
How can interventions in primary care work best?
What is needed to improve care for COPD patients and others with long term conditions?
Secondly, we focus on evaluating quality improvement in primary care drawing on observations and suggestions from workshop participants and learning from the Year in the Life evaluation to cover.
How can we tell if we’ve made a difference? Lessons for evaluating interventions in the real world
As part of our engagement with the public Dr Linda Pomeroy presented the CLAHRC’s iQUASER study at a recent Bart’s Health research evening.
The event gave us a chance to showcase the project which is evaluating the impact of implementing QUASER – a Board-level intervention NHS Trust leaders can use to diagnoses the strengths and weaknesses in their approach to delivering quality improvement.
Linda discussed the importance of NHS Boards setting the direction for Trusts and leading on efforts to improve quality and safety, and how this impacts patient care at ward level.
Our thanks to Bart’s Health for giving us the chance to present our work.
Samantha completed an undergraduate Masters of Nursing Science (MNurSci) degree at the University of Nottingham before working as qualified Intensive Care nurse at the East Midlands Major Trauma Centre in Nottingham. She later completed a MSc at The London School of Economics and Political Science in International Health Policy before joining UCL for her PhD. Her research interests include patient safety, specifically avoidable harm, quality improvement and the role of external and internal governance systems- having previously worked with the Care Quality Commission as an Inspector of NHS Trusts in the UK.
This PhD aims to carry out observational research on wards to ascertain the attitudes and cultures of safety in regards to medicines safety. The methods will be ethnographic in nature, involving spending an extended period of time in each clinical setting to acquire a detailed understanding of the tacit conventions and social relations practiced within and between different professional communities that constitute different ‘safety cultures’. In each setting, non-participant observations and formal and informal interviews will be used to study the everyday practice of medication safety and develop ideas for the intervention in consultation with healthcare professionals. Different settings within the hospital will be studied (for example surgery, admissions areas and intensive care) to ascertain the importance of ward culture upon safety cultures and medicines safety.
The Innovations to improve pathway for people with COPD project is evaluating what works to better manage this respiratory condition. The team are measuring whether a variety of interventions will make GPs’ management of patients with the condition more effective and efficient in the long-term.
As part of our engagement with patients the project’s Senior Research Associate and Research Associate visited Havering Breathe Easy Group. The Breathe Easy network provides support and information for people living with a lung condition, and those looking after them.
As well as getting insight on living with COPD and variations in service patients’ can experience, researchers wanted to get a feel for what aspects of GP care were most important to patients’ health and quality of life.
We asked patients to identify what they thought were the most important interventions general practices provided to support COPD sufferers.
Our choices were based on a list of activities that the National Institute for Health and Care Excellence (NICE) – the independent organisation which decides which drugs and treatments are available on the NHS in England and Wales – has recommended should be delivered as part of COPD care from general practice.
What GP service patients valued most
What GP services patients valued least
Annual reviews with their GP
Smoking cessation advice
Pulmonary rehab (exercise and education and to manage their condition)
Spirometry Testing/Diagnosis (to diagnose a condition and monitor lung function)
Rescue Packs (of emergency medicines)
Self-management of care
How this will help our research
If we need to decide what weight we give to different outcomes, patients’ views of their relative importance could be one factor we consider.
Whether the measures we are using in our research are the ones patients consider most important
Patients’ views will provide useful pointers and questions for interviews with general practice staff that are part of our research
Dr Natalia Lewis is a Research Fellow at the Centre for Primary Care and Public Health, QMUL. She was trained as a physician and completed her PhD at the North-Western State Medical University, Russian Federation, investigating prevalence and associations of domestic violence and abuse among women patients attending Russian general practice. Her post-doc projects included longitudinal analysis of HPA axis functioning in abused women (CEASE study), evaluation of a training intervention for general practice on domestic violence and child safeguarding (RESPONDS study) and review of grey literature on interventions for children exposed to domestic violence and abuse (IMPROVE study). She is a member of the IRIS/ CLAHRC research team working on post-implementation evaluation of IRIS intervention in five northeast London boroughs (https://www.clahrc-norththames.nihr.ac.uk/iris/).
NIHR CLAHRC North Thames conducts ground-breaking research that directly impacts the health of patients with long term conditions and the health of the public.