The latest in the CaHRU and Lincoln Institute for Health Improvement Science and Research Methods seminar series was given by Professor Siriwardena on ‘Quality Improvement Collaboratives (QICs): theory design and effects on 28 February 2018. The CaHRU team have led three large scale collaboratives over the past 12 years, including Resources for Effective Sleep Treatment (REST), the Ambulance Services Cardiovascular Quality Initiative (ASCQI) and most recently Scaling up PINCER (a pharmacist and information technology intervention to reduce potential clinically important prescribing errors in general practice.
QICs are an organised, multifaceted approach to quality improvement involving five essential features: a specified topic; clinical experts and experts in quality improvement provide ideas and support for improvement; multi-professional teams from multiple sites participate; using a model for improvement (measurement, change, feedback); and a collaborative process involves series of structured activities. The talk described how QICs have been used to implement healthcare interventions at scale and referred to a recent systematic review suggesting that over 4 out of 5 reported improvement in one or more outcomes although the quality of studies was variably poor.
QICs were described in terms of their common features: a logic model and theory of change; the complex (pragmatic) contexts of the intervention, setting and participants; and the variation in effects and changes that the intervention can or will undergo during the process of the collaborative. It was proposed that there were different types of collaborative based on their purpose which could be for intervention development, increasing reliability of evidence based processes, or scaling up evidence based complex interventions. It was argued that reviews of QICs should consider these different purposes when describing the outcomes and effects of QICs.
By Professor Niro Siriwardena[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/03/QICs_Siriwardena.pdf” width=”660″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]
Despina Laparidou, Research Assistant at CaHRU, together with Antony Chuter, a patient representative for Scaling Up PINCER (pharmacist-led information technology intervention for reducing clinically important errors) recently attended the International Society for Quality in Health Care (ISQua) Conference at the Queen Elizabeth II Conference Centre in London (1st – 4th October 2017) and presented the preliminary findings of the Scaling Up PINCER project, funded by the Health Foundation.
The Main Conference offered a combination of exciting plenaries, short oral presentations and longer themed sessions, while poster and e-poster presentations were also presented throughout the duration of the conference. One of the most interesting sessions was the “A Mile in My Shoes”. A Mile in My Shoes is an interactive shoe shop that invited delegates to “(literally) step into someone else’s shoes and embark on a mile-long physical, emotional and imaginative journey to see the world through their eyes”. The session involved listening to, while wearing their shoes at the same time, unique audio stories from people working within health and social care, sharing their experiences and showing the remarkable contribution and challenges faced by those working in, and using, our health and social care system.
Despina and Antony gave their presentation on the morning of Tuesday 3rd October during a session on “Health Foundation Improving Quality in Community Health Services” and was very well received by the audience. PINCER is a pharmacist-led information technology intervention for reducing clinically important errors in medication management in general practices and the study’s preliminary results show early indications of improvement in most of the study’s safety indicators for gastrointestinal bleed, stroke, heart failure and acute kidney injury, but not for the two asthma indicators. The session, chaired by Will Warburton from The Health Foundation, also showcased studies, such as the “Ophelia Project” on improving health literacy for vulnerable people in the community, and “Making Waves” on Promoting a positive experience for people with COPD.
The Conference came to an end with Wednesday’s plenary and the promise to meet again in 2018 for an even more exciting ISQua Conference in Malaysia!
Members of the Scaling up PINCER project team (PINCER is a pharmacist-led information technology intervention for reducing clinically important errors in medication management in general practice), Prof Niro Siriwardena, Janice Wiseman, Dr Sarah Rodgers, Chris Rye and Despina Laparidou, recently attended (on June 29th) the Scaling-Up Improvement Programme Mid-point Event in London. The event was organised by the Health Foundation, the main funder for the six participating projects. The focus of the meeting was on evaluation and sustainability of improvement.
The day was designed to be as interactive as possible and teams were asked to bring materials with them, such as information, pictures, posters, leaflets, data, etc., to put up on a pin board, with the purpose of giving a visual story of their project for other teams to view during and between sessions. This created a wonderful opportunity for teams to learn about each other’s projects and discuss issues (such as successes and challenges) around their progress.
A number of interesting talks were presented around evaluating and sustaining scaling-up improvements, such as the sessions facilitated by Tom Ling/Bryn Garrod (RAND Europe) and Kathy Elliott (NCAT) respectively. One of the most stimulating and thought-provoking sessions, “Influencing for sustainability”, asked delegates to split into two large groups and have one person from each project team ‘make a case’ for their project, facilitated by Carl Smith (Frontline) and Jamie Ripman (Practive). At the end of each brief presentation, the rest of the delegates provided feedback on their performance and suggestions on how to improve their style and adjust the context of the presentation to better fit the target audience’s agenda.
At the end of the day, Sally Williams (Frontline) and Valentina Karas (the Health Foundation) brought the event to its close by reflecting on the day and discussing future actions.