Improvement research: making a difference to how health care is delivered

As the Health Foundation embarks on an exciting journey to establish a new institute to develop and apply research to improve health services, we take a look back at the work of two of our Improvement Science Fellows: Davina Allen and Julie Reed.

Improvement research – the theory and research behind what works in quality improvement in health care – is an emerging field. Since 2010, the Health Foundation has funded fourteen senior, post-doctoral Improvement Science Fellowships for applied research dedicated to improving health care in the UK. The work and impact of our fellows has been astonishing and is contributing to the growing interest in this area of research.

There’s a palpable spark of excitement in the air when we talk to Davina and Julie about their research and the difference they are making to the way health care is delivered.

Davina Allen

Professor Davina Allen is a sociologist at Cardiff University who originally trained as a nurse. Her work explores the effects of working practices on service delivery, combining social sciences knowledge with a clinical sensitivity to think about issues in a new way. As a fellow her research programme aimed to deepen understanding of the high-quality coordination needed between teams to deliver effective health care, identifying why care can sometimes break down and the range of approaches that might improve coordination.

Davina is developing new theory to explain the way nurses work within health care systems and the changes in the balance of their work from direct care-giving to organising, administrating and facilitating processes of care. Her work has great potential to influence the design of nurse training and future workforce planning.

Julie Reed

Dr Julie Reed trained as a chemist, and is Deputy Director and Academic Lead for the National Institute for Healthcare Research CLAHRC (Collaboration for Leadership in Applied Health Research and Care) for North West London.

Julie’s work as a fellow examined how improvement research could support people at the front line to put evidence into practice to deliver better care. She believes quality improvement tools and methods could help health care professionals and patients work collaboratively to solve these problems. However, there is uncertainty as to how well these work and they are not used routinely in the NHS. She has worked to develop a scientific framework that will help people working in the health service to learn from existing quality improvement projects and programmes; support the effective use of tools and methods; and improve education and training to allow more staff in more settings to successfully use quality improvement.

The value of the fellowship: making space and making connections

Davina and Julie were part of our first cohort of Improvement Science Fellows. They met regularly to learn from and support each other, and also had access to the Health Foundation’s broad networks. We asked both fellows to tell us how the fellowship has been valuable to them in their careers.

Julie believes making connections has been an important benefit of the fellowship. ‘We’ve been very privileged to work with the Swedish cohort of improvement science fellows and have made international connections more widely through a group of international experts as part of the Improvement Science Development Group. That has been really amazing and very tangible,’ she says.

Davina Allen had been a director of research for eight years when she applied for the fellowship. She says it’s relatively unusual, at a senior level, to be given a significant period of time to take a step back.

‘It has re-energised my intellectual work. It was partly about space, and partly thinking about things in the context of interactions with the other members of the cohort and the wider improvement research community.’

Julie echoes the importance of this aspect of the fellowship, ‘It gave me the space to understand myself better, and be much more aware of what I wanted to do and the direction I wanted to go in.’

Impact of fellowships: spreading improvement research

Julie is passionate about the endpoint of improvement research – how what we do makes an impact – and has a real-world understanding of the practical challenges to implementing improvements. During the fellowship, she published a systematic review of research using PDSA (plan, do, study, act) cycles in the BMJ Quality and Safety journal.

‘Given the complexity of the problems we’re trying to solve, we’re always going to need local enquiries – engaging people, and adapting knowledge to our own situations. I knew from my own experience that doing this in practice is really hard, so I was curious about how other people were doing it. We showed that very few papers actually adhered to the principles and methods – so we could say, this is a method that we’re meant to be using, but actually we’re not using it well.’

Her research struck a chord and the paper has been downloaded more than 100,000 times. ‘Having it well received, it feels like we’re starting a whole new line of research enquiry about the practical reality of using quality improvement methods.’

Davina’s sociological work is deeply reflective. Her book, The invisible work of nurses, brings together thinking from across her career. ‘As a piece of research I’m very proud of it, and I’m very excited and passionate about it as something that potentially could have a significant impact on health care. I’ve just been granted £25,000 from the Economic and Social Research Council to work on translating those ideas into tools for the workplace.’

Developing the field of improvement research

Both Fellows are clearly inspired by the broader field of research. For Davina, some of the most interesting new work is in the development of structures and frameworks which help to connect this kind of sociological work and theories to clinical interventions. ‘It’s an exciting area to be involved in’, she says.

One new and interesting challenge the Fellows are engaging with is defining the frontiers of improvement research. As Julie explains, ‘Many established sciences will regularly review where they are and what challenges mark the boundaries of their current knowledge. Improvement science is new and it would be really helpful to have some definition of its frontiers that would help unite the community, while respecting our differences.’

Find out more and apply for the next round of Improvement Science Fellowships on our website – the closing date is 5 July.