As an emerging multi-disciplinary field improvement science is in its infancy, with academics and researchers still defining concepts and methods of inquiry. The International Improvement Science and Research Symposium, as part of the annual International Forum on Quality and Safety in Healthcare, will see a range of scholars and practitioners within the Improvement Science arena debate and discuss the future of the field by outlining its frontiers.

 

A range of Frontiers of Improvement Science have been developed through a series of meetings between UK and Swedish improvement science fellows in conjunction with international improvement scientists from Europe and North America. Dr Julie Reed and Dr Tom Woodcock, Health Foundation Improvement Science Fellows based at the NIHR CLAHRC Northwest London, have been pivotal in the organisation of the event and helping to define some of these frontiers. The event will see a range of presentations and discussions that hope to build on many of the perspectives that are in development and provide an opportunity to elaborate on them further.

 

Julie Reed provides a general introduction to Improvement Science and makes the case for the need to define the current boundaries of the field, using examples from other fields in the history of science. Julie goes on to outline the unique role and perspectives different disciplines bring to improvement science using the example of the Anamorphic cube, which represents different images or figures, depending on the angle which the viewer takes. The cube offers an analogy to the way that perspectives in improvement science might be viewed to explore their different facets.

 

Tom Woodcock expands on one of the frontiers related to measurement in quality improvement in his talk ‘Translating Measurement Theory into Improvement Practice: Planning to Avoid the Pitfall’. Tom draws on his vast experience of working directly with quality improvement projects and programmes both in the UK and internationally, as well as his post-doctoral research in developing measurement systems. Tom elaborates on the development of the Measurement Plan Assessment Tool (MPAT), which aims to provide a structured way to support the creation of measurement plans in QI programmes. You can find out more about the work that was undertaken to develop MPAT here.

 

A number of Imperial College London researchers based with CLAHRC Northwest London also contribute to discussions on the day, after recently presenting their work at our April Research Partners Meeting.

 

Laura Lennox, Associate lead for Improvement Science and Quality Improvement, presents on her doctoral work that includes a systematic review of sustainability methods used in healthcare Improvement and their impact on supporting long term success. The work highlighted a range of constructs consistently seen across the studies, which included:

  • The Initiative Design and Delivery;
  • Negotiating Initiative processes;
  • The People Involved;
  • Resources;
  • The Organisational Setting;
  • The External Environment
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References:

  1. Stirman SW, et al. The sustainability of new programs and innovations : a review of the empirical literature and recommendations for future research. Implement Sci . BioMed Central Ltd; 2012;7(1):17.
  2. Williams L, et al. A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators. BMJ Qual Saf.2015;(August).
  3. Schouten LMT, et al. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ. 2008 ;336(7659):1491–4.

 

Alan Poots, Principal Information Analyst, introduces the challenges in selecting appropriate interventions for use in quality improvement initiatives. Alan uses the Bradford Hill criteria to outline how quality improvement initiatives themselves may generate types of knowledge that may support attribution of causality.

PowerPoint Presentation
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Grazia Antonacci, Research Associate at Imperial College Business School, presents her empirical work undertaken as part of her PhD. Interviews of healthcare and quality improvement staff across eight QI initiatives revealed details about the success and utility of process mapping as a quality improvement method. This included 26 factors that were identified as important in supporting process mapping, at the level of the activity itself, the project and the wider organisational context.

PowerPoint Presentation
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References

  1. Richardson, W. C., Berwick, D. M., Bisgard, J., Bristow, L. R., Buck, C. R., & Cassel, C. K. (2001). Crossing the quality chasm: a new health system for the 21st century.
  2. Edwards, N. “Can quality improvement be used to change the wider healthcare system?.” Quality and Safety in Health Care 14, no. 2 (2005): 75-75.
  3. Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ quality & safety, 23(4), 290-298.
  4. Kaplan, H. C., Provost, L. P., Froehle, C. M., & Margolis, P. A. (2012). The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement. BMJ quality & safety, 21(1), 13-20.
  5. Bandara, W., Gable, G. G., & Rosemann, M. (2005). Factors and measures of business process modelling: model building through a multiple case study. European Journal of Information Systems, 14(4), 347-360.
  6. Trebble, T. M., Hansi, N., Hydes, T., Smith, M. A., & Baker, M. (2010). Process mapping the patient journey through health care: an introduction. BMJ, 341(7769), 394-397.
  7. Jackson, T. L. (2013). Mapping clinical value streams. CRC Press.
  8. Glaser, B. G., & Strauss, A. L. (2009). The discovery of grounded theory: Strategies for qualitative research. Transaction publishers.
  9. Bate, P., Mendel, P., & Robert, G. (2008). Organizing for quality: the improvement journeys of leading hospitals in Europe and the United States. Radcliffe publishing.
  10. Repenning, N. P., & Sterman, J. D. (2001). Nobody ever gets credit for fixing problems that never happened: creating and sustaining process improvement. California management review, 43(4), 64-88.

 

In her presentation Sophie Spitters, a PhD student, explores how innovations are spread between organisations, focussing on the influence of context on both the intervention and the process of implementation. Sophie draws on a case study of a community paediatric allergy service that was developed in one area of northwest London and subsequently spread to two other areas. Sophie has traced that intervention modifications and implementation process in the new sites and compared this to the original site.

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References

  1. Craig,P., Dieppe,P., Macintyre,S., Michie,S., Nazareth,I., & Petticrew,M.(2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ, 337(September), 979–983. http://doi.org/10.1136/bmj.a1655
  2. Damschroder,L.J., Aron,D.C., Keith,R.E., Kirsh,S.R., Alexander,J.A., & Lowery,J.C.(2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4(1), 50. http://doi.org/10.1186/1748-5908-4-50
  3. Denis,J., Hébert,Y., Langley,A., Lozeau,D., & Trottier,L.H.(2002). Explaining Diffusion Patterns for Complex Health Care Innovations. Health Care Management Review, 27(3), 60–73. http://doi.org/10.1097/00004010-200207000-00007
  4. Warner,J.O.,& Lloyd,K.(2011). Shared learning for chronic conditions: a methodology for developing the Royal College of Paediatrics and Child Health (RCPCH) care pathways for children with allergies. Archives of Disease in Childhood, 96(Supplement 2), i1–i5. http://doi.org/10.1136/adc.2011.212654
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