Dr Pradeep Ratnasekare joins CaHRU as an international visiting fellow

sigiriya2Dr Pradeep Ratnasekare joined CaHRU this January 2018 as our third international visiting fellow from the University of Colombo’s Postgraduate Institute of Medicine. Pradeep graduated as a bachelor of Medicine and bachelor of Surgery in 1996 from the faculty of Medicine, University of Ruhuna and then completed postgraduate studies at the University of Colombo, Sri Lanka, in the fields of respiratory medicine and then in medical administration where he gained his master’s in 2011 and MD in 2016.

davHe has worked for over four years as a primary care medical officer, and six years as a medical officer in respiratory medicine, health system manager and health care researcher. As a health system manager he developed experience in various fields of hospital and public health programme management. He has worked as a hospital director in many secondary and tertiary care hospitals in Sri Lanka and worked as deputy director of the Medical Research Institute, the premier national level reference and referral medical laboratory and medical research centre for public and private sectors in Sri Lanka for last 18 months. His main interests are in health technology assessment and management, modern hospital planning and architecture, health system research and quality improvement in health care. Pradeep has several publications into his credit in the Journal of Medical Administrators Sri Lanka and Sri-Lanka journal of Health Policy and Management mainly on interventions carried out to improve health systems. He is a member of several academic associations in Sri Lanka including the College of Medical Administrators of Sri Lanka and Sri Lanka Medical Association. He is a member of research evaluation committee of the Medical Research Institute.

lilypondWhile at CaHRU he plans to: study the prehospital care system in the UK with a view to adapting it to develop a suitable model for Sri Lanka; to study the primary health care system in the UK National Health Service (NHS) of United Kingdom with respect to quality improvement and clinical governance; to study the systems and methods in place for Health Technology Assessment (HTA) and Health Technology planning in the United Kingdom; to learn about hospital design and planning; and to actively contribute to CaHRU’s research programme in primary and prehospital care. Listening to classical music, singing and playing cricket are his favourite hobbies.

Hannah Henderson receives PhD for studies on exercise referral schemes

Dr Hannah Henderson, lecturer in the School of Sport and Exercise Science was awarded her PhD at this week’s graduation ceremony at Lincoln Cathedral attended by students, parents and friends, staff, and senior staff from the University of Lincoln. Hannah’s doctoral thesis entitled, “Intended actions, unintended outcomes: towards a processual graduationunderstanding of exercise referral schemes” investigated referrals for supervised physical activity by GPs and other primary care professionals. The these was supervised by Professor Siriwardena of CaHRU, Professor Jaqui Allen-Collinson (Sport and Exercise Science) and Dr Adam Evans (University of Copenhagen).

Exercise referral schemes (ERSs) have developed since the 1990s. Although the evidence for their effectiveness is still equivocal, the complexity of how schemes operate and individuals working with them interact, has been largely overlooked. Hannah was interested in how individual interpretations of ERSs might be co-produced by interactions between those central to the service, and how this might influence both service delivery and impact. The study therefore aimed to address this by exploring participants’ understanding of ERSs, and how these perceptions affected ERS service provision.

The research focused on one case-study ERS in the East of England, using semi-structured group and one-to-one interviews. A process sociological lens was adopted to provide novel insights into participants’ perceptions of ERSs, their role and their ability to influence ERS service provision. Data were also supported by self-elicited reflections from the researcher’s ‘insider’ position to the county’s ERS. The analysis revealed conflicting interpretations of ERS service provision, and perceptions of the scheme’s receipt and impact. The networks of relationships affected participants’ experiences and shaped the delivery of exercise referral. The findings suggested how the actions and interpretations of those central to a service fundamentally altered delivery which influenced the very existence of the scheme.

Prof Siriwardena gives invited lecture at North American EMS conference, San Diego

Prof Niro Siriwardena of CaHRU attended the North American Emergency Medical Services Physicians (NAEMSP) annual conference in San Diego, California from 10-12 January 2018 to deliver an invited lecture on ambulance quality measures and improvement.

SD2The conference opened with a keynote address, ‘The patient as a mission with a very critical outcome, how to get that right – the first time and every time’ given by Dr Story Musgrave, child labourer, mechanic, farmer, scientist, doctor, pilot, astronaut, artist and university professor. This was followed by Dr Dave Williams of the Institute for Health Improvement in the US who spoke on ‘Improvement science and safety in EMS’ including an example from CaHRU of development of prehospital indicators and their use for quality improvement.

SD6The following day included session on the Canadian Prehospital Evidence-Based Practice Project, National Model EMS Clinical Guidelines and Ethical Challenges in EMS, simulation, cognitive bias and medical error. The afternoon sessions focussed in quality included ‘Mission: Quality – Can Mission Lifeline Help Your Performance Improvement Program?’ presented by Dr Jeremy Cushman MD. He described how a the programme Mission: Lifeline is designed to transform care for patients with myocardial infarction, stroke, and cardiac arrest using national performance benchmarks, and sharing best practices to enhance provider feedback through hospital outcome information.

Niro_EMAS4Prof Siriwardena then spoke on how new quality measures for ambulance services have been developed and implemented over the past decade in England in his lecture entitled ‘Developing Ambulance Quality & Performance Measures that Make a Difference to Patients’. This was based on research conducted by Prof Siriwardena with UK ambulance services and academic institutions as part of the Ambulance Services Cardiovascular Quality Initiative (ASCQI) and the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) program. There was discussion of the successes as well as the barriers to development of new quality measures, and the underpinning research and quality improvement initiatives that have been vital to progress in this field.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/01/NAEMSP2018_Siriwardenav3.pdf” width=”640″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

CaHRU contributes to international EMS quality & safety programme

Professor Niro Siriwardena recently contributed to ‘Safer, Better and Stronger: Quality Improvement for EMS Leaders’ a one-day preconference course at the North American Emergency Medical Services Physicians (NAEMSP) Annual Conference in San Diego, on January 10, 2018.

SD1Around 60 EMS physicians attended the day to learn about quality improvement methods from experts based in the US and UK led by Dr Michael Redlener, EMS and Emergency Department physician based in New York city and chair of the NAEMSP Quality and Safety Committee together with Dr Scott Bourn, president of the National Association of EMS Educators, supported by Mike Taignan, Associate Professor in the Emergency Health Services Management graduate program at the University of Maryland Baltimore County, Dr David Williams, Executive Director at the US Institute for Health Improvement, and Prof Siriwardena from CaHRU.

SD4The preconference course began with an overview of the day by Dr Scott Bourn. This was followed by Dave Williams leading a session on the science of improvement including the ‘red bead experiment’ and an outline of Deming’s theory of profound knowledge. Niro Siriwardena led a session on understanding the model for improvement and Mike Taigman helped delegates get to grips with the plan-do-study-act cycle using the coin-spinning game. The later sessions were focussed on application of these ideas to selecting a good project, identifying measures, developing a measurement strategy, managing change and understanding what changes will result in an improvement faciltated by other faculty members including  Joseph Grover MD, Jeffrey L. Jarvis, MD, MS, EMT-P, Kevin Mackey, MD, FACEP, Kim D McKenna, PhD, RN, EMT-P, and James “Tripp” Winslow, MD, MPH.

SD3The day will be followed by a year-long course for around 25 delegates from the US and Canada who will take part in monthly moderated online educational sessions on key aspects of quality improvement, read relevant articles and conduct a ‘capstone project to implement quality improvement methods to a problem in their agency or system, supported by a mentor from the course faculty to help guide their progress. Participants will present their work to colleagues and members of the NAEMSP community to share the impact of quality improvement.

The preconference has been summarised by Dr Catherine Counts, one of the delegates in a blog entitled: ‘Quick take: Quality and safety gain prominence at NAEMSP‘.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/01/FLYER-QI-2018.pdf” width=”640″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

CaHRU receives university team award for achievement in research

CaHRU2017webThis year members of the Community and Health Research Unit received the University of Lincoln team award for Achievement in Research at the Individual Merit and Team Achievement Awards 2017. This was the team’s fifth team award over the past 6 years and the fourth time the team have received the team award for achievement in research. Members of the team include Prof Niro Siriwardena (director), Prof Graham Law, Dr Murray Smith, Dr Zahid Asghar, Dr Coral Sirdifield, Dr Stephanie Armstrong, Dr Julie Pattinson, Dr Rebecca Marples, Viet-Hai Phung, Despina Laparidou, Michael Toze, Laura Simmons, Joseph Akanuwe, Dr Nadeeka Chandraratne, Dr Ravindra Pathirathna and Sue Bowler (administrator).

ResearchTeamAward2017CertificateThe CaHRU team are striving to conduct research which will make a difference to patients and healthcare delivery. The group conducts basic and translational interdisciplinary research in collaboration with health service and academic partners.  It currently has over 30 active projects in progress across a range of research methods from systematic reviews (e.g. role of community first responders, ethics of ambulance trials), major clinical trials (investigating conditions such as hyper-acute care of stroke, prehospital pain management, ambulance hypoglycaemia pathways and primary care for insomnia), observational studies (investigating prehospital pain and seizure management), qualitative designs (community first responders, dementia carers, ethics of ambulance trials, fairness of medical licensing exams), consensus methods (ambulance indicators), and surveys (healthcare for offenders on community sentences) to quality improvement programmes (prescribing safety) and international research networks (ethics of ambulance trials). Details of current studies are available on the CaHRU website (http://cahru.org.uk/research/).

CaHRU_logotypeThis has led to over 20 publications in the past year covering research on development of new pathways and indicators for ambulance services, assessment and treatment for insomnia and use of health technology innovations, in major journals such as Resuscitation, Annals of Emergency medicine, Health Technology Assessment, Health Expectations and Lancet Psychiatry. The team have  received several major grants over the past year, particularly from the National Institute for Health Research, as well as continuing to work on studies funded by the Wellcome Trust, Health Foundation and Falck Foundation. This year we have also welcomed international fellows from the University of Colombo to the team for the first time.