The power of evidence in making care better Q&A with Professor Mary Dixon-Woods

THIS Institute has just launched a new strategy. Tell us what you’re proud to have achieved so far and where you want to focus your energies over the next 5 years? 

I’d describe our new strategy as evolution rather than revolution. We’ve taken what's really worked from the first 5 years at THIS Institute and refreshed and sharpened it, while adding some new big ideas. That means a particular focus on extending our values-driven approach, our commitment to participatory methods and co-design, and on building the infrastructure needed for long-term impact.  

Some of the ideas we had when we first set up the Institute seemed wildly ambitious. But I'm thrilled with what we’ve achieved so far. Our fellowship programme, for example. We’ve now funded 55 fellows in universities across the UK. They're extraordinary individuals, all driven by a commitment to producing evidence to support health and care organisations, staff and patients. 

Creating Thiscovery – our online platform designed to get more people involved in improvement research – was one of our riskier ideas. But it’s already proven its value many times over. It’s a real asset for the health system, enabling large-scale collaboration to understand problems, co-design solutions and evaluate them.

It's a challenging time for people working in the NHS. How is the work of THIS Institute relevant to those on the front line?

Our work is about making things better for staff and patients. There is a long history in health services of trying to implement improvements that don't end up working. That’s very demoralising and uses up valuable time and energy. We need to focus that energy on the things that are going to be effective – and that’s what THIS Institute is there to do. So, while our work is academic and rigorous, it is very much rooted in the sharp end of care.

Because our work boosts the ability of systems, organisations and teams to do things better, it’s more relevant now than ever. People want high quality evidence that can support doing things (or, just as importantly, not doing things) to improve care. There’s so much appetite for our work from across the NHS and around the world. All that enthusiasm and interest is what’s propelled us forward. 

Can you give some practical examples of how you’re developing evidence to underpin improvements? 

We’ve been doing a lot of research into the shift towards remote care. This shift accelerated during the pandemic and is increasingly becoming a permanent feature of care delivery. It’s critical we approach such a big and important change with a solid evidence base behind us. 

Using Thiscovery, we’ve engaged with large groups of people to build clear visions of what good looks like from the perspective of the different stakeholders involved. We’ve done research with people typically cared for in secondary care settings whose care shifted to remote during the pandemic, including people with severe mental illness and patients with Chronic obstructive pulmonary disease (COPD). This approach to holistic understanding of issues has identified that while patients and clinicians agree some areas are suitable for remote care, there are some things on which patients have very different views compared with clinicians. That’s really important information. 

We’ve also been looking at the shift to online antenatal care accelerated by the pandemic. Timely, high-quality antenatal care has a key role in optimising good birth outcomes and is critical in addressing the needs of under-served groups and those at risk during pregnancy. We’ve been able to build a clear framework for what good looks like for remote antenatal care, paying particular attention to issues of equity. 

Tell us more about the highly participatory approach you are taking to improvement research? 

We put the principles of co-design and co-ownership at the heart of everything we do. For example, we've spent the last year co-designing with staff, mothers and birth partners an approach to improving safety in childbirth through a unique collaboration with the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. Through co-design, we've given people a voice and ownership of the solution they’ve helped produce. 

Traditionally improvement activity has been dominated by making small changes, developed locally, which then need to be scaled. But what if we turned that on its head? What if we started big, by involving as many people as possible to build a prototype? That’s where we want to go next, to make improvement big. 

Our plan is to build new infrastructures to enable this to happen, including our new improvement research communities. We want to recruit huge communities of people with everyone – patients, porters, cleaners, managers, clinicians and many more – coming together to help understand what the problem is and to co-design and test solutions. The end product will be a robust, user-centred design that can be offered back to the health system. We will draw on the principles of citizen science, truly engaging people and crediting them for their involvement. And, crucially, we’ll use high quality, rigorous approaches so people can be confident in the evidence produced.

How are you building capacity and capability in health care improvement research? 

Through our fellowship programmes we’re developing capacity at different levels, from PhD student to professor. Our fellows come from many universities and disciplines – social science, engineering, human factors, law – but they’re all applying their knowledge to solve health improvement challenges, and when they come together a kind of magic happens. Our 55 fellows are already making a big difference. That capacity wasn't there 5 years ago, so it’s thrilling to see this new generation emerge.

We’re also focused on building and sharing the evidence base for improvement in highly actionable ways. We’ve produced academic papers almost weekly since we launched, which represents a significant contribution to the academic literature on improving health care. All this evidence is openly available on our website. But we haven’t stopped at producing manuscripts. We’ve sought to make our findings accessible and useful for staff and patients using techniques ranging from infographics and frameworks through to videos and animations. 

Another big contribution is The Cambridge Handbook of Improving Quality and Safety in Healthcare: THIS Institute’s Guide to the Evidence. This resource, published by Cambridge University Press, addresses the problem that there’s currently no single authoritative source if you want to learn about health care improvement research and methods. Over 30 chapters are planned, and each will provide an authoritative overview and critique of the evidence on a particular topic. Each chapter will be published online first and then the book will be published in about a year’s time. We’ll also create a new, simplified guide to improvement, with condensed versions of each chapter. 

Why is collaboration such an important part of how you work at THIS Institute? 

We’re developing new collaborations all the time. For example, we’ve launched our first joint project with the Q community, using Thiscovery to develop measures for improving NHS staff engagement. There are so many synergies and opportunities for THIS to work with Q. Both have created big infrastructures for doing things at scale, so bringing the two together just seems like a fantastic match. 

There’s so much that we want to do – but we can’t do on our own. What we can do is bring people together. We can convene and enable conversations that otherwise wouldn't happen. We can create different types of infrastructure for research, engagement and collaboration so people can contribute. We can recognise people, we can hear them. All of that feels very important to me. 

Find out more about the work of THIS Institute and its new strategy.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.