Improvement research goes large!

It started like an Agatha Christie novel: a group of people from around the world, huddled together in an English country house, waiting for the ash from an Icelandic volcano to clear from the skies and allow them home. Unlike The Mousetrap, however, I can reveal the ending – which was published in a supplement of BMJ Quality and Safety in 2011. The group, drawn together by the Health Foundation, were experts in improving, studying and delivering health care. Their professions ranged from physician to social anthropologist, but the diversity of disciplines contrasted with a singularity of purpose – to lay out the way forward for research into the improvement of health care services and systems.

As a result of this meeting, the Health Foundation set up an Improvement Science Development Group, postdoctoral Improvement Science Fellowships, and, more recently, awarded PhD studentships to centres of excellence in the field. Our goal was to build capability in the applied field of improvement science – a broad area of study which did not fit with the classic academic career model of increasing specialisation within a single discipline. 

Our investment has been significant. Since 2010, the Health Foundation has funded around £3m a year in these activities, including 14 fellowships and 28 PhD studentships. We have also given financial support to two professorial chairs and commissioned original research in areas such as novel evaluation approaches with partners including the National Institute for Health Research, the Medical Research Council and others.

In building capability we not only wanted people who brought a range of research and practical experience to applied problems in health care, we wanted more - we wanted them to lead. A combination of mentoring and excellent personal development coaching has led to the fellows creating change and showing the value of this sort of research to both universities and health care practitioners. Last time we assessed the first cohort of our four Improvement Science Fellows they had secured around £23m in additional funding, produced 54 academic papers, four books and six awards. Their work has saved lives, given insights into greater efficiency and changed national policy.

When the Foundation started its work to help grow and develop improvement science, the field was under-developed and fragmented. Since then momentum has gathered and recognition has grown of its potential to make care better for patients. We are not the only ones seeking to bridge the research-to-practice gap. The Collaborative Leadership in Applied Healthcare Research partnership programme in England focuses on this very issue. And the importance of the ‘impact’ of research on practice is now part of the framework by which universities’ are assessed, again supporting this direction of travel. We have been part of a national movement that is growing and increasingly attracting funding. 

We have also been impressed by both the originality of the work we are funding and the volume – we currently fund around 120 person years of improvement research. So where next for improvement research? With all of this promising progress taking place, it prompted us to think that perhaps it is time to launch our fledgling from the nest, confident that it will fly... That perhaps our long term commitment to developing this field could be served by an even more substantial investment in improvement research.

To do this, we have taken the exciting decision to create an improvement research institute that will expand our fellowships and networks into an outstanding international centre of excellence. Our Board has approved up to £50m for us to establish the institute*, which will aim to: 

• create, acquire and disseminate outstanding research and new knowledge in the field of improving health care systems 
• build research capacity and capability 
• exchange knowledge for the good of patients through partnerships with the public, NHS bodies, other funders and similar international bodies.  

We will set up the institute in collaboration with others; potentially with one or more host universities. And we’ll aim to make it self-sustaining within 5-10 years. Over the coming months I will be leading a scoping exercise to consider different models of structuring and funding the institute. This will likely be followed by a two-stage UK-wide invitation to tender. The aim is to have a functioning institute by the end of 2016/early 2017.  

The formation of a new institute is one of the most exciting, and challenging, events in my career. Leading its development will require my full attention and to enable me to focus on it I am standing down from the role of Director of Research. Anita Charlesworth, our Chief Economist, will take the Health Foundation’s research work forward; supported, as I have been, by the outstanding Helen Crisp.

I cannot wait to start and am look forwarding to working with many in the field as we shape our plans for the future. To be kept informed of progress please sign up to receive our newsletter.

*Following the completion of the scoping exercise the Health Foundation has agreed to provide in the region of £30 million of funding over a period of 10 years to support establishment and development of the institute. Further information about our plans for an institute can be found at www.health.org.uk/institute.