Innovations in Improvement Science:

Our PhD students and their projects

In this blog you are introduced to three PhD students and their projects within the Improvement Science theme of the Yorkshire & Humber ARC. Megan Smith, Bethany Pritchard and Qandeel Shah discuss their projects and the impact they hope to achieve for healthcare staff, patients and the service

De-implementation of low value practices (clinical and non-clinical): A patient perspective - By Qandeel Shah

As healthcare services face increasing demand and a lack of resources, it has never been more important to consider the de-implementation of practices that have little or no benefit to patients. Although there has been some progress in de-implementing low value care, little research has focused on the patient perspective or mental health care in this regard. Therefore, my PhD identifies mental healthcare practices perceived by patients to be of low value and considers how they can be de-implemented. Whilst my PhD focuses on patient perceptions of practice value, Daisy Halligan, a third year PhD student also within the Yorkshire Quality and Safety Research Group, is focusing on staff perceptions: https://www.thisinstitute.cam.ac.uk/about/people/daisy-halligan/.

My interest in this project was sparked whilst studying patient safety at MSc level. My MSc dissertation used qualitative methods to explore healthcare staff’s understanding of patient safety in inpatient settings. Whilst conducting interviews within this study, I developed an interest in how low value practices come to be embedded, and what to do about them to free up staff time but wanted to focus on mental healthcare due to my experience of working in an inpatient mental health service. Within my role, I supported service users from diverse backgrounds and became familiar with some of the issues they face.

Service users will play a vital role in my PhD. I will use qualitative methods including interviews and focus groups to allow them to share their opinions on low value care and use their experiences to identify potential targets for de-implementation. They will play a vital role in establishing which practice to de-implement and together with healthcare staff, to develop a de-implementation intervention.

You can find out more about co-producing research with stakeholders by accessing this improvement science snapshot on co-production, presented by Dr. Helen Smith: Improvement Science Snapshot - Co-production of applied health and research - YouTube

Improving support for people with severe mental illness to quit smoking: Comparing a bottom up with a top-down quality improvement approach - By Megan Smith

People with severe mental illness (SMI) die 15-20 years earlier than people without, with smoking being one of the most modifiable risk factors. Although these individuals can quit smoking, evidence suggests general smoking cessation services are not tailored to their needs and are, therefore, often ineffective. My PhD project will develop and compare recommendations for how to better support people with SMI to quit smoking derived from the literature, with recommendations borne out of a positive deviance study that I will run. Positive deviance is a bottom up approach to quality improvement, learning from people and services who perform better than others, despite facing the same barriers and constraints. Ultimately, I hope to produce a gold standard for cessation methods within the SMI population. You can find out more about the positive deviance approach in this book produced by Dr Ruth Baxter and Professor Rebecca Lawton: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/506CA2D446210E1FE76740B7F835D87C/9781009237116AR.pdf/the-positive-deviance-approach.pdf and by watching this improvement science snapshot presented by Dr Ruth Baxter: Improvement Science Snapshot - Ruth Baxter April 2022 - YouTube.

Prior to my PhD, I completed my Masters degree in Psychology at the University of York. During my time at York, I was fortunate enough to volunteer at York Neuroimaging Centre where I was involved in a project using fMRI to investigate linearity responses to colour vision in the visual cortex. Being involved in this project introduced me to research and led me to conduct my Masters dissertation within the centre where I used fMRI to investigate familiar face processing.

I really enjoyed conducting my own research throughout university, so PhD study was something I had dreamed of. I am particularly excited to develop my skills in qualitative research, work within research teams and communicate with a variety of stakeholders throughout my project. The potential impact of my current project on the SMI population, an under-researched population who face more barriers to quitting smoking, is what attracted me to apply. I hope the ‘gold standard’ approach I develop will improve healthcare staff and patient’s knowledge of appropriate and effective services and influence policy in a way which improves quality of life and life expectancy for patients with SMI.

Using Individualised Feedback to Optimise Recall Rates in Screening Mammography - By Bethany Pritchard

My PhD explores mechanisms of individualised feedback and how they can be applied to screening mammography. Within this, my PhD has two focuses:

1) How individualised feedback nurtures the continued clinical development of radiographers and allied clinicians in mammography film reading.

2) How this feedback influences mammographic recall rates.

The clinicians I have interacted with so far have expressed a strong desire to receive more intuitive forms of feedback beyond what is currently available. My PhD draws on audit and feedback literature to deliver an individualised feedback intervention supporting healthcare staff. This has the potential to reduce recall rates and the associated psychological trauma for patients being ‘recalled’ for further tests after a seemingly innocuous initial mammography screening appointment. You can find out more on audit and feedback in these improvement science snapshots delivered by Dr Robbie Foy: Improvement Science Snapshot - A quick guide to effective audit and feedback - YouTube and Dr Sarah Alderson: https://www.youtube.com/watch?v=3gClX3cXL9k.

Before being awarded this NIHR PhD studentship, I acquired a BSc in Biomedical Sciences before completing an MSc in Cognitive Neuroscience and Human Neuroimaging. I have previously worked as a Cadet within various NHS hospitals, completing rotations in vascular access, cardiac physiology, stroke, renal wards, and occasionally in the community. I also received the National Award for Outstanding Child and Social Care Student of the Year 2016 in the House of Commons. My previous volunteering experience allowed me to develop and implement a feedback mechanism for healthcare staff; something I am keen to reflect and draw upon throughout my PhD. I was immediately drawn to this PhD when I learned that the work would follow a similar theme and felt that this PhD was ‘made’ for me.

I enjoyed writing both my undergraduate and postgraduate dissertations, and my motivation to pursue a career in academia is that as researchers, we can develop something novel that can have real impact. I feel this is an opportunity unique to research which will continue to inspire me for as long as I am lucky enough to work in the field as a (very) early career researcher and beyond. I am particularly looking forward to developing my statistical analysis skills, as well as learning about implementation science and working with incredible clinicians at Bradford Royal Infirmary and St. Lukes Hospital as part of my PhD.

This blog was written by Qandeel Shah, Megan Smith and Bethany Pritchard, PhD students within our Improvement Science theme, Yorkshire and Humber ARC.

25 October 2022