From Theory to Improvement: A conceptual framework for delivering improvements in healthcare
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The document presents a conceptual framework for delivering improvements in healthcare developed by the NIHR CLAHRC for Northwest London. It identifies 12 objectives across 3 perspectives that must be considered: what improvements should be made, where and who is involved in improvements, and how improvements should take place. It emphasizes understanding existing knowledge, producing new knowledge through research, and iterative development through active engagement and understanding variation. The framework recognizes the complexity of healthcare systems and the need for transdisciplinary work and multiple perspectives. It provides implications for moving the research agenda to understanding how improvements work in practice and the necessity of its counter-cultural approach.
From Theory to Improvement: A conceptual framework for delivering improvements in healthcare
- 1. From Theory to Improvement: A conceptual framework for delivering improvements in healthcare Julie Reed, Cathal Doyle, Cathy Howe, Derek Bell NIHR CLAHRC for Northwest London
- 2. Collaboration for Leadership in Applied Health Research and Care National (~£90 million, 9 programmes) • Conduct high quality applied health research • Translate the findings from research into practice • Increase the capacity of NHS organisations and public, private and third sector partners to engage with and apply research Northwest London (£10 million 2008-2013) • Systematic approach to delivering improvements NIHR CLAHRC for Northwest London
- 3. Northwest London Population = 2 million Budget = £3.4 billion 400 GP practices 14 different NHS Trusts Most ethnically diverse population in UK Very wealthy and very poor = 17 years difference in life expectancy
- 4. CLAHRC NWL Approach Quality Improvement Quality Improvement Methods Patient and Public Involvement Engaging Patients and Staff Research Rigorous Design and Use of Data Education Training, Support and Collaboration A collision of different worlds… NIHR CLAHRC For Northwest London Health Outcomes Patient Experience Improve health outcomes and patient experience through delivery of clinically effective care. Primary aim: 4 Rounds: 21 Projects over 55 Sites engaging over 500 NHS staff systematic approach
- 5. CLAHRC NWL Achievements Beneficial impacts on care quality, outcomes, experience and costs • COPD discharge care bundle: – Improved compliance with „best care‟ (from 0% baseline - 70%) – reduced length of stay (e.g. by 2.5 days) – costs savings (e.g. estimated at £123,410/year) • Medicines Management: – ADR identification (e.g. 70% potential ADR) – medication reduction (e.g. 52% meds) – cost avoidance (e.g. estimated net £145,000/yr) – co-designed “My Medication Passport” (paper & app, c.9,000 copies) • Diabetes Improvement through Peer Led Education (DIMPLE): – Built capacity: 31 “community champions‟, 6 peer educators and 9 peer mentors – engaged over 9,182 people through 352 events inc BME groups, – Social return on investment estimated at £11 for every £1 invested. Demonstrated Patient & Public Engagement & Involvement benefits Include (3 examples):
- 6. Cycle for Improvement 1. Patients & Carers Experience &Outcome 2. Identify needs 3. Priorities 4. Identify Solutions 5. Implement Experimental Medicine Randomised Controlled Trials Basic Sciences Public Health StatisticsSociology Psychology Management Education Epidemiology Health Economics Engineering
- 7. What did the literature say? • What, where, who & how?
- 8. What improvements should be made to improve care? • Translating Medical Research into Practice • Multiple evidences need to be considered at once – continual growth of EBM • Evidence needs to be relevant to local context considerations • Staff and patients are not passive recipients, individual, group perceptions affect uptake, acceptance & behaviour • Translation is not a linear process
- 9. Where does improvement take place and who is involved? • Healthcare systems and context • Healthcare complex multi-level system • Healthcare is an organic/social system – relationships, identity, power, emotion (inc stress) • Quality of care is dependent on collaboration between multiple individuals as well as individual behaviour • Care is delivered by many individuals and organisations • Perpetually evolving and adapting, unpredictable
- 10. How should improvement take place? • Change management and high performing organisations • Knowledge management and valuing knowledge – external and internal • Value staff and patients – necessary engagement • Political alignment (shifting political landscape) • Continued learning and feedback loops – responsive and dynamic
- 11. What? Where and who? How? 3 separate perspectives on improvement What should be done to improve care/improvements should be made? Where does improvement take place and who is involved How change and improvement should take place Considering 3 perspectives together….
- 12. What should be done to improve care/improvements should be made? Where and who How Understand and utilise existing knowledge Capture and Produce new knowledge Iterative development Reveals the complexity and overlap/interdependency of these 3 different perspectives (shows the 12 objectives plus 4 extra concepts (internal knowledge, org memory, external knowledge, research and evaluation) which help expand the knowledge/acting scientifically theme) Internal knowledge External knowledge Organisational memory Research and evaluation Understand system and services Understand Variation Identify Systemic Issues Freedom to act and learn Active engagement Facilitate dialogue ResourcesandHeadroom PoliticalandStrategic Alignment Invest in Continual Improvement
- 13. Conceptual Framework for delivering improvement in healthcare Act scientifically and pragmatically Engage and empower Embrace Complexity Support for long term success Understand and utilise existing knowledge Iterative Development Capture and produce new knowledge Active engagement Facilitate dialogue Freedom to act and willingness to learn Understand services and processes Understand variation Identify and act on systemic issues Provide headroom and resources Political and Strategic Alignment Invest in continual improvement Values Principles
- 14. Implications • Recognition of the complexity of the problem • Need to move the research agenda to the ‘black box’ of improvement • Value (necessity?) of transdisciplinary working and multiple perspectives • A framework that is applicable in all situations but it’s counter-cultural!
- 15. CLAHRC NWL QI tools and methods Systematic and scientific approach to implementation using quality improvement tools and techniques
- 16. NIHR CLAHRC for Northwest London Find us at… W: www.clahrc-northwestlondon.nihr.ac.uk/home E: clahrc.nwl@imperial.ac.uk T: @CLAHRC_NWL Find me at… W: www.cathyhowe.net E: c.howe@imperial.ac.uk T: @cathgreenhalgh
Editor's Notes
- #3: Hosted at the NIHR CLAHRC for NWL - tasked with translating research into practice - taken an approach of support improvement teams - informed the thinking behind my research
- #5: Or you may prefer this slide to the previous one
- #7: What academic disciplines contribute to this?Could pause here and ask for discussion re how Social Medicine fits in?
- #16: Body of text size: pt 25, TahomaTitle size 50+, TahomaNHS Red R216, B30, G5Formatted to A1 landscape