The Healthcare Improvement Scotland 4th Annual Research Symposium: ‘Mobilising evidence to drive improvement’ took place on Thursday 17 March 2016, at COSLA conference centre in Edinburgh. We have really enjoyed the day, the enthusiasm and the excellent ideas for strengthening the evidence base for improvement. Below are some of our brief reflections of the day:
Dr Nicola Gray, SISCC Associate Director (Programmes and Evaluation)
It was great to be at the HIS research symposium not least because of the diverse range of people, interests and disciplines in the room. A recurring theme not only in the presentations but also in my conversations with others was around the use and understanding of language. The discipline specific technical “speak” often illustrates to others which group we belong to and can work as a great short-hand when talking to people from your own discipline – health services researcher, practitioner, improvement scientist, implementation scientist, health economist, psychologist, social scientist…..but can really hinder how others understand us and how we understand them. It became clear during the day that, despite our diversity, most of us have similar goals in the work that we do and that we can learn a great deal from the different approaches and thinking that this diversity brings…if we can learn to understand each other and develop, if not a common language, then a common understanding.
The other key issue which resonated with me was the need to learn from others and their experience but that there are real challenges around locating what’s already been done (many improvement projects aren’t published in academic journals) and how well (or not) those projects are described and reported. Building and strengthening the evidence base for improvement is harder when you can’t find the evidence base to start with!
Dr Madalina Toma, SISCC Research Fellow
I was pleasantly surprised by the number and diversity of presentations that promoted the use of quantitative or qualitative methods to identify and monitor unintended consequences in quality and safety improvement. Improvements can often having completely unexpected beneficial consequences, but there were some interesting talks connecting the idea of unintended consequences with the existence of some sort of adverse or undesirable effect as a result of the ‘change’. For instance, Andrea Patton presented a poster which described how NHS Scotland changed recommendations for surgical antibiotic prophylaxis in order to reduce the risk of C difficile infection. Clinicians in one health board noticed an increase in acute kidney injury (the undesirable consequence) which they attributed to this change, and subsequent retrospective evaluation of routine data confirmed the association. Carolyn Tarrant and Barbara O’Donnell showed the value of ethnographic methods to uncover the mechanisms through which the SPSP sepsis VTE collaborative worked to drive improvement, and to explore how various innovative motivational strategies (for example, competitions for time to first antibiotic) can have some undesirable consequences for both patients and staff.
There were clear messages that collecting the data is not enough. We need to get better at understanding the data, interpreting it and most importantly acting upon what it tells us. As a consequence, we might decide to promote our findings (if we can identify any unexpected benefits), change the intervention (if the undesirable effects outweigh any other improvements) and make sure we share these data to prevent similar undesirable consequences in future projects. This of course raises the question of how to make our findings more widely available with explanations as to what consequences were identified and measured and how to interpret the evidence provided. I think we all need a better infrastructure for storing, managing and sharing such data across the health and social care systems to avoid silos of data collection and learn from both our failures and successes. However, as Wallis et al (2013) nicely concluded, ‘’data sharing should not be an end in itself, but rather a means to leverage knowledge for the advancement of science and innovation’’.
Dr Jenna Breckenridge, SISCC Research Fellow
The most striking thing for me about the HIS research symposium was the number of presenters who emphasised the importance and value of qualitative research within the improvement context. We heard about work with young people with Autism Spectrum Disorder and their families, and children and parents accessing dental services, that sought to bring service user voices to the forefront of improvement. There were also examples of using qualitative research to understand the higher level barriers and facilitators to improvement; a qualitative synthesis and my own presentation on understanding change at scale. But perhaps the most quotable statement of the day came from Barbara O’Donnell, who presented an ethnographic study of healthcare professionals ‘engagement with improvement initiatives: “If you want to understand the murky world of practice, go out and watch it”. I was reminded of just how powerful ethnographic methods can be and, in describing her detailed observations of staff-patient interactions, I was immediately transported into the ward setting. This kind of in-depth, qualitative data is essential if we are to understand and appreciate the contextual and behavioural factors influencing improvement work. In planning any improvement work, it is imperative that we open our eyes to the cultural nuances in practice and I was really encouraged by the number of presenters who had capitalised on the usefulness of qualitative research in achieving this.
Anne Marie Craig, PhD Student
The programme of this conference was very well balanced with insights into the mechanics of service innovation and improvement alongside presentations on projects delivering improvements in the practice context. I particularly enjoyed the poster sessions which provided information on ‘live’ projects which are delivering improvements to health and social care in Scotland today and also allowed us a glimpse of an evolving future where it is possible that innovation and improvement become closer entities.
You can find all the posters and presentations on the Healthcare Improvement Scotland website.
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