New ideas, tools and research evidence about how to improve health and care services are rife. Improvement Science focuses on creating the evidence for how best to create these ideas/tools and how to embed them into practice to achieve positive change for individuals, teams, organisations and systems. We are a team of improvement researchers (including psychologists, sociologists, designers and health service researchers) with extensive experience of improvement and research methods. Our theme is led by Professor Rebecca Lawton.
The key goal of our theme is to support the core themes in ARC by applying and adapting these improvement methods and embedding a behavioural science perspective across the ARC. Specifically, this entails supporting our colleagues with:
diagnosing the problem
evidence based implementation
evaluating complex interventions.
We support the adoption and spread of new ideas/research findings by working closely with the Improvement Academy and act as a translational pathway for emerging ideas from the NIHR Yorkshire and Humber Patient Safety Translational Research Centre.
As a cross-cutting theme, we support other themes to optimise their methods and impact through advising on improvement science methods and approaches. We also design and lead on improvement science projects that complement the work of the other themes. Examples are provided below.
We are setting up an ‘implementation laboratory’ which will test different enhancements to audit and feedback to promote better uptake of best practice in primary care.
We are supporting the Urgent and Emergency Care theme with their Managing Uncertainty in the Emergency Department project. Dr Luke Budworth is leading on the design of this research which aims to assess the association between doctors’ tolerance of uncertainty and i) resource use, ii) patient management decisions and iii) patient outcomes, to identify targets for a behaviour change intervention. In close collaboration with colleagues, Luke has so far developed a data extraction form for the collection of key variables from patient records across 4 sites and developed a measure of clinical uncertainty for administration to clinicians.
We are leading on an improvement science project within the Older People’s theme, which is part of the delayed transfers of care project. Dr Helen Smith has designed a qualitative study to explore patients' and caregivers' perceptions of the risks of hospital stays and of discharge from hospital. This will provide insight into factors influencing delayed transfer of care and anticipated to influence implementation of the NHS Hospital Discharge Service policy which sets out the new ‘discharge to assess’ model to be implemented across England for all people aged over 18 (HM Government, 2020). The insight will inform development of a behaviour change intervention, targeting patient and caregiver-related barriers.
We are facilitating a cross-ARC group of researchers with expertise in co-production to lead on a package of work exploring the concept and processes co-production. Dr Helen Smith is leading on a scoping review of the co-production literature, and a review of the use of co-production in the 1st and 2nd round of Collaborations for Leadership in Applied Health Research and Care.
We are collaborating with the Mental and Physical Multimorbidity theme, exploring the potential to apply the positive deviance approach to help mental health trusts to support their service-users to give up smoking.
We are involved in an independent evaluation of the acceptability of WireSafe to clinicians. WireSafe is a novel human factors device designed to prevent guidewire retention after central venous catheterisation (a ‘never event’ in the NHS). We are undertaking interviews with clinicians routinely using the device. We also plan to introduce the device into new sites and to then explore clinicians’ perceptions of its acceptability.
Improvement science snapshots: We also design and deliver a series of improvement science snapshots. These are short videos to introduce practitioners, researchers and anyone else with an interest in improvement science to key methods and approaches in an accessible way. Topics include:
How to identify barriers to improving clinical practice
Behaviour change techniques: what are they and how do I use them?
Co-designing quality improvement interventions to optimise impact
Learning from positive outliers: using the positive deviance approach for improvement
The videos will be uploaded to our YHARC YouTube channel (https://bit.ly/30kOip9) as they become available.
We also offer methodological and theoretical support to a range of additional projects conducted within the ARC YH including:
Supporting the Born in Bradford team in a mixed methods study to understand the impact of covid-19 on pregnant women and new parents.
Caring in a Crises: understanding the stressors and uplifts for NHS frontline staff and those supporting them during Covid-19 crisis. This is a qualitative study led by the PSTRC.
Supporting work-stream 2 within the Health Data Research (HDR) North grant to co-develop decision support tools and resources to optimise deprescribing of anti-cholinergic medications.