A warm hello from the Improvement Science theme team. We are delighted to share with you a flavour of our cross-cutting theme work over the past few months. Like so many applied health research teams around the world, our work has inevitably been affected by the current pandemic. However, whilst some of our projects are paused or progressing at a slower pace, others have been successfully adapted or newly-introduced to be able to consider the impact of COVID-19 on services, clinical practice and frontline NHS staff wellbeing. 

A&E Department Use: No doubt you have seen that visits to A&E departments in England dropped by 57% compared to last year. In partnership with our colleagues in the Urgent and Emergency Care theme, we are investigating how this has affected clinician decision making in A&E and whether this will have long term effects in emergency medicine practice. We have also been designing a large multi-site study to assess the degree to which patient outcomes are affected by A&E doctors’ ability to tolerate the uncertainty inherent in their practice. Previous research has shown that high uncertainty tolerance may lead to more risky decision making, such as reduced test ordering. If these conservative decisions don’t affect patients’ health then uncertainty tolerance may be a fruitful target for interventions, with the benefit of reducing overall service resource use.

We anticipate that the results of the study will, in future, inform more effective safeguarding of staff wellbeing as a crisis progresses and better tailoring of psychological interventions for those experiencing psychological distress after a crisis.

‘Patient and family choice’ reasons for delayed transfers of care: We have been busy collaborating with colleagues in the Older Adults with Frailty theme on a large project which is using a ‘systems thinking’ approach and involving various health and social care stakeholders in improvement activities to reduce Delayed Transfers of Care across the region. We are interested in understanding in more depth why 16% of all delays in English hospitals are due to ‘patient and family choice’ (NHS England data Feb 2020). We are reviewing the literature to inform our specific research questions. We hope to explore with patients and family members what they perceive to be the benefits and harms of hospitalisation, how their views change during the course of a hospital stay and how this relates to the choices made around the time of discharge.  

A new collaborative, cross-ARC Network: In March we launched a new Cross-ARC Improvement/Implementation Science Theme Lead (CrIISTL) Network, and held our first meeting to learn about each other’s themes and spark collaboration ideas. From this, we agreed to pursue a collaborative project on co-production in applied health research, and established a smaller working group to take this forward. Representatives from five ARCs (Greater Manchester, North East and North Cumbria, South London, East Midlands and Yorkshire & Humber) have met virtually and are making progress towards a critical evaluation of co-produced research implemented within the ARCs and previous CLAHRCs.

In the coming months, as our ‘new normal’ begins to emerge, we will continue to discuss with the core ARC themes how, as a cross-cutting theme, we can best support them by applying improvement science methods and embedding a behavioural science perspective across the ARC. 

To get in touch please email: R.Simms-Ellis@leeds.ac.uk

This blog was written by Ruth Simms-Ellis, Helen Smith and Luke Budworth, Improvement Science theme, Y&H ARC.