Embed Size (px)
DESCRIPTION
2013 Canadian Knowledge Mobilization Forum Cathy Howe NIHR CLAHRC for Northwest London
Citation preview
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
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
Northwest LondonPopulation = 2 millionBudget = £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
CLAHRC NWL Approach
Quality Improvement Quality Improvement
Methods
Patient and Public
Involvement Engaging Patients and Staff
ResearchRigorous Design and Use of
Data
Education Training, Support and
Collaboration
A collision of different worlds…
NIHR CLAHRC For Northwest London
Health OutcomesPatient
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 staffsystematic approach
CLAHRC NWL AchievementsBeneficial 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):
Cycle for Improvement
1.Patients &
CarersExperience &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
What did the literature say?
• What, where, who & how?
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
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
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
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….
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 R
eso
urc
es
and
H
eadro
om
Polit
ical and
Str
ate
gic
A
lignm
ent Invest in Continual
Improvement
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 knowledgeIterative DevelopmentCapture and produce new knowledgeActive engagementFacilitate dialogueFreedom to act and willingness to learnUnderstand services and processesUnderstand variationIdentify and act on systemic issuesProvide headroom and resourcesPolitical and Strategic AlignmentInvest in continual improvement
Values
Principles
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!
CLAHRC NWL QI tools and methods
Systematic and scientific approach to implementation using quality improvement tools and techniques
NIHR CLAHRC for Northwest London
Find us at…
W: www.clahrc-northwestlondon.nihr.ac.uk/home
T: @CLAHRC_NWL
Find me at…
W: www.cathyhowe.net
T: @cathgreenhalgh
