This year, London hosted the 34th international scientific meeting on quality and safety in health care. Members of the CLAHRC Northwest London team attended to present in a variety of sessions over 4 days that contributed to the theme of the conference: ‘Learning at the System Level to Improve Healthcare Quality and Safety’.
Dr Julie Reed, Improvement Science Fellow and Deputy Director, was the first member of the team to present at the pre-conference, contributing to the session: Small to All – Meeting the Challenge of Spread and Scale up for Improvement, sponsored by The Health Foundation. The session outlined some of the challenges of spread and scale-up, developed as the Frontiers of Improvement Science. Julie provides an outline of 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. Following the presentation Julie also contributed to the panel discussion on how some of these challenges maybe met.
Laura Lennox, Associate lead for Improvement Science and Quality Improvement, presented some aspects of her doctoral work, which included 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 examined, which include:
- The Initiative Design and Delivery;
- Negotiating Initiative processes;
- The People Involved;
- The Organisational Setting;
- The External Environment
Dr Alan Poots, Principal Information Analyst, presented research that has been undertaken to unpack some of the complexity of media reports on emergency department performance. The research analysed correlations between ED attendance and the 4 hours waiting time of units across the different countries of the UK. The results suggest that the commonly reported relationship between increased attendance leading to decreases in performance does not represent the array of factors that affect performance.
Julie Reed led a presentation describing how the concept of ‘Hard Core’ and ‘Soft Periphery’ can be applied to complex clinical interventions to support shared learning between quality improvement initiatives. In this presentation Julie focused on a case study that introduced an intervention within a hospital setting to identify potentially inappropriate prescriptions. The research applied the concepts of ‘hard core’ and ‘soft periphery’, as defined by Denis (2002), Greenhalgh (2004) and MRC (2008) to describe the intervention to better support how interventions can be shared with clinical teams.
Stuart Green, a public health research fellow, presented on a quality improvement initiative developed as a collaboration between Imperial College London and Central and North West London NHS Foundation Trust. The initiative, called SHINE, was established to support the implementation of clinical guidelines to improve the assessment and monitoring of physical health in patients with serious mental illness within an acute mental health setting. The presentation oulined the steps and stages the initiative moved through using different quality improvement methods to support the co-design of interventions with frontline staff and service users and their subsequent implementation.
Within the ‘Data to drive decision making and health policy’ session Dr Julie Reed introduced several researchers involved in measuring frailty from different perspectives. The sessions were delivered by a number of PhD candidates: Dr Lotte Dinesen, Tomasz Symanski and David Sunkersing and Dr John Soong, who recently completed his PhD and is now a consultant in acute medicine. The presentations outlined methods that have been applied to assessing frailty across different points in the patient journey. In addition, the interactive session explored what frailty meant to the delegates and, importantly, what aspects of frailty matter to them, both professionally and personally, to populations and to healthcare systems. The presenters offered a unique perspective through the “eyes of the patient”, using examples of the patient narrative and other methodologies to measure aspects of frailty, at each step of the patient journey from the community into acute secondary care. This included clinical risk stratification, a cost-effectiveness model for medication review and mapping health services.
Whilst the theme of the conference emphasises the need for learning at the system level, it’s also important to recognise that many initiatives that aim to improve quality and safety in healthcare are delivered at the clinical front-line and need nurturing and support to be able to respond to local needs.
This is reflected in the research showcased at ISQUA that has been undertaken by CLAHRC researchers, which ranges from conceptual discussions about sharing learning, case studies demonstrating what it takes to improve healthcare and data-driven studies to better understand issues with understanding quality. CLAHRC Northwest London is in a privileged position to be able to offer day-to-day support and development to clinical initiatives but also to affect change within the system, both locally and nationally, through capacity building and our research activities.