What is Improvement science? How can our resources help you better understand improvement science methods and approaches?
A bit about the team
Our improvement science team has changed over the past year, saying goodbye to Helen Smith and Luke Budworth who have moved on to new and more senior roles, and welcoming Emily Parker and Laurie Cave. Emily is completing her PhD on tolerance of uncertainty amongst emergency care doctors. And, Laurie, a dietician at Leeds Children’s Hospital, recently completed her PhD developing a care pathway for children with cystic fibrosis to be better supported in dietary self-care. Between us – Laurie and Emily, Andria Hanbury (theme manager) and Rebecca Lawton (theme lead) – we have expertise in behavioural science, evidence-based approaches to improving health and social care quality and safety, quantitative and qualitative research methods including ethnography and psychometrics, and intervention development, implementation and evaluation.
Defining improvement science and links with implementation science
Improvement Science is defined by the Health Foundation as being about finding out how to improve and make changes in the most effective way and systematically examining the methods and factors that best work to facilitate quality improvement(1). It is a broad term and covers three elements.
The development of evidence and theory-based interventions aimed at improving the quality and safety of health and/or social care.
The piloting, testing and evaluation of these interventions.
Investigation into how to optimise the introduction of such interventions into health and social care practice.
Example improvement science interventions include those targeting individual, team or system level behaviours and/or processes and include behavioural science. Example improvement science methods include evidence-based audit and feedback, video reflexive ethnography (collecting real-time video footage which is reviewed by healthcare teams, prompting bottom up learning, change and improvement) and the positive deviance approach (a ‘bottom-up’ approach, identifying and learning from exceptional performance). All of these are topics in our Improvement Science Snapshot series (see below). At its core is the development and testing of theories/models/frameworks to inform systematic, evidence-based, intervention design, and evaluation and introduction into practice.
Improvement science is sometimes used interchangeably with ‘implementation science’, although the latter focuses more on the successful embedding and sustainment of proven innovations into practice, rather than on intervention development and testing per se. We work closely with our colleagues in the improvement Academy, who work directly with frontline teams to ‘do’ improvement drawing on the evidence we have generated in our work and elsewhere. This experience then informs our future work and priorities. Th Improvement Academy are effectively the implementation arm of the Yorkshire and Humber Applied Research Collaboration: YHARC).
We have also established a cross-ARC improvement and implementation theme network for sharing ideas and the development of collaborative projects. This is attended by leads for improvement AND implementation science themes within the other ARCs (East Midlands ARC, North East and North Cumbria ARC, Greater Manchester ARC and South London ARC) as well as the THIS Institute (The Healthcare Improvement Studies Institute). Two recent outputs of our collaborative work include a scoping review paper on co-production: how it’s conceptualised and implemented in applied health services research and the lessons that can be learnt from this (https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00838-x), and an Improvement Science Snapshot (https://www.youtube.com/watch?v=24o5w_egPoE&list=PLaUHM9a-DQN00r7YmguFvwUS68zU7H5Q5&index=5) on this topic. The importance of co-production is increasingly recognised, including in funding bids, so it is important to be clear on what it is (and is not) and what the lessons are for using it effectively in practice. Our next collaborative project will identify the benefits for health care staff of being involved in applied health services research, as well as the best ’models’ for achieving this. The findings will provide guidance for researchers and the NIHR more broadly on how best to engage health and social care professionals in applied health research. We know that there are benefits- for HCPs and for organisations and patients – but research is scarcer on those for HCPs and for how best to realise these benefits. This is an important topic given associations between involvement and staff retention, especially given the current retention and recruitment challenges facing the NHS and social care.
Could improvement science benefit my study?
Within the Yorkshire and Humber ARC, we are a ‘cross cutting’ theme, and so we support other themes to consider and include an improvement science angle in their work. Examples of such projects are the tolerance of uncertainty project in collaboration with the urgent and emergency care theme (which found an association between tolerance of uncertainty in decision making and junior doctor wellbeing) and the delayed transfer of care project with the older people’s theme. A summary of these projects and resources are available here: https://www.arc-yh.nihr.ac.uk/what-we-do/improvement-science.
We also work closely with colleagues within the Yorkshire Quality and Safety Research Group, whose current projects can be seen here (https://yqsr.org/), and the Yorkshire and Humber Patient Safety Translational Research Centre. This recently won a prestigious second round of funding from the NIHR, alongside six other centres.
Improvement Science Snapshots
If you are interested in knowing more about improvement science, and to get a flavour of the sorts of methods that we use, we have the Improvement Science Snapshot series: https://www.youtube.com/playlist?list=PLaUHM9a-DQN00r7YmguFvwUS68zU7H5Q5. These are short, pre-recorded sessions delivered by different presenters and covering different improvement science methods and approaches. They are accessible and introductory in their pitch. They cover a range of topics, from best practice audit and feedback, through to a whistle stop tour of what normalisation process theory is, and innovative methods like the positive deviance approach to improving health care quality. In our previous blog (https://www.arc-yh.nihr.ac.uk/news-events-and-media/blogs/what-is-uncertainty-tolerance-and-how-can-we-measure-it) our three PhD students discussed their innovative projects, one of which is on positive deviance applied to smoking cessation within mental health care services.
We are happy to take requests for snapshot topics, so please email any suggestions to the theme manager, Andria Hanbury (firstname.lastname@example.org).
And, if you would like to use the snapshots as a resource, for example, you teach improvement science methods, or work in a trust and have a quality improvement library of resources, again, please contact Andria (email@example.com). We can also share a banner to link to the snapshots which are available on the YHARC YouTube channel.
This blog was written by Andria Hanbury, Improvement Science Theme at Yorkshire & Humber ARC.
27 February 2023