Pushing the frontiers of improvement research

Since 2010 the Health Foundation has been investing in and promoting improvement research; the work they have supported has improved care and altered national policy. We are delighted that the Foundation is now investing around £40 million in the establishment of an improvement research institute. This new organisation is being set up and run by the University of Cambridge, working closely with a wide range of partners including the health service, university and charity sectors and from other sectors across the UK.

Our vision for the institute is bold and ambitious: we want to create the enabling infrastructure for the NHS to become the world’s largest producer of systematic learning about how to improve health care for patients. To do this, we will use innovative approaches ranging from citizen science through to large-scale research capacity building, and we will be working directly with patients themselves as partners.

The basic principle behind the institute is a simple but important one: we need to get better at getting better at delivering healthcare, and one way to make that happen is by creating a better evidence-base for improvement.

Much has been achieved in the NHS and globally in the last 10 years through quality improvement initiatives. We have learned about some things that work –such as structured, simulation-based training for handling obstetric emergencies. Just as importantly, we’ve learned about some things that don’t work: it turns out, for example, that getting nurses to wear a vest saying ‘do not interrupt’ does not reduce interruptions during drug rounds – and it had unwanted consequences, such as making the nurses feel too warm.  

But too often, quality improvement occurs without proper evaluation, so it’s not always clear what works, what doesn’t, or why – either for specific interventions or for quality improvement approaches. The learning is not always systematised or made available for others to learn and use. And too often, quality improvement stays too local. That can result in waste of learning – others have to start from scratch to solve the same problem. Worse still, risks are introduced because multiple locally-specific processes may introduce new risks and costs at a system level.  More could be achieved more quickly through more large-scale, genuinely participatory research that strengthens the evidence-base for improvement.  To achieve this vision, the institute will have a number of distinctive features.

First, we will strengthen capacity for doing research about improvement through an innovative fellowship programme open to researchers in universities across the UK, and, in addition, through providing on-line training in research skills applied to improvement across the NHS. Building on the Health Foundation’s investments in Fellowships and PhD studentships, we want to create a generation of world-class researchers with the skills and ability to make outstanding empirical and theoretical contributions to the field, acting as its ambassadors, inspiring and mentoring the next generation, and making a real contribution to the evidence-base.

Second, we are determined that research will be directly and practically relevant to the people who work in and use the NHS: staff and patients. The research questions that the institute will answer will be generated by them.

Third, using citizen science principles, we will invite individuals and organisations to participate in large-scale research programmes, coordinated and directed by the institute and its partners. Previous citizen science projects have shown striking success in areas as diverse as spotting cancer cells in tissue samples, tracking trends in the reproductive biology of birds, and mapping the surface of Mars. The institute will use these methods to create a novel, high-capacity facility that matches research resources with the wisdom, skills, ingenuity and expertise of NHS staff and patients on a grand scale.

One example of the kind of challenge the institute will tackle is that of measurement for improvement.  It’s a waste of time and resources to have each individual health care organisation coming up with its own quality measures, and it means that organisations can’t compare or learn from each other very easily.  One study showed, for example, that just 10 maternity units were using 352 different indicators between them, resulting in an excessive number of non-standard indicators. But equally, no-one wants a set of rigid measures imposed top-down. So, in situations like these, the institute will facilitate getting to an agreed set of measures using consensus-building methods where everyone gets a say and where the measures are tested to ensure they reflect the priorities of patients and staff and are useful, meaningful and actionable. 

By acting as a systems integrator, disseminator and enabler, we hope that the institute will curb the duplication of effort, energy drain, loss of learning and proliferation of locally-specific processes associated with much improvement work.

We are currently setting up the institute. We’re working to co-design principles and values, and to identify priorities for research. We’re creating everything from the fellowship programme through to the citizen science platform, as well as all the systems and processes needed to support high quality research. It’s all very exciting, and we have been enormously cheered by the goodwill and enthusiasm we have met.

The Health Foundation has committed to funding the institute over 10 years with the aim that it will ultimately become self-sustaining.

We will formally launch early in 2018. Please sign up to receive updates about the institute’s development. After the launch, we’ll be sharing details of how to join our activities, and look forward to pushing the frontiers of improvement research together.

Mary Dixon-Woods (@MaryDixonWoods) is RAND Professor of Health Services Research in the Department of Public Health and Primary Care at the University of Cambridge