Tag Archives: quality improvement

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Joseph Akanuwe receives PhD for work on communicating cancer risk

Joseph Akanuwe, doctoral student at CaHRU was recently confirmed by the College of Social Science Research Degrees Board that he be awarded his PhD for his thesis ‘Exploring service user and practitioner perspectives of using cancer risk assessment tools in primary care consultations. Cancer risk prediction tools are novel tools that combine risk factors and symptoms to predict an individual’s risk of developing cancer.

WP_20160208_16_16_01_RichThe work included a systematic scoping review followed by interviews of 19 service users and 17 primary care practitioners, the latter before and after they had used the tools in patient consultations. Participants suggested ways to best communicate cancer risk to patients in primary care consultations, emphasising the importance of: tailoring visual representation of risk; being open and honest; informing and involving patients in use of cancer risk prediction tools and providing time for listening, explaining and reassuring in the context of a professional approach.

He also found barriers to the uptake of cancer risk prediction tools including: the additional time required; worry and anxiety generated by referral for investigations; potential for over-referral; practitioner scepticism about using the new tool; and the need for evidence of effectiveness before introducing cancer risk prediction tools in general practice consultations. These barriers were perceived before the use of the tools. The findings add to the knowledge and understanding of how best to communicate cancer risk information to patients when using cancer risk prediction tools. Joseph was supervised by Profs Niro Siriwardena and Sara Owen, together with Dr Sharon Black.

By Prof Niro Siriwardena

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CaHRU team at Imperial College London for international partnership to improve primary care with South Asia

icl_cahruMembers of the Community and Health Research Unit, Dr Stephanie Armstrong, Dr Murray Smith, Professor Graham Law and Professor Niro Siriwardena attended a week long meeting with colleagues from Imperial College London (Professor Azeem Majeed, Dr Matthew Harris, Dr Yasser Bhatti, Dr Mala Rao, Professor Peter Childs and Professor James Barlow), Sri Lanka (Drs Rivaiz Haniffa and Dr Sajeeva Ranaweera, University of Colombo), Pakistan (Dr Asim Mahmood of Integrated Health Services) and Bangladesh (Dr Foysol Chowdhury of BRAC) to develop a collaboration exploring frugal innovation and quality improvement in primary care in middle income countries in South Asia.

The meeting consisted of seminars, presentations and discussions on the current systems of primary care in Sri Lanka, Pakistan, Bangladesh, other countries such as Brazil, and the United Kingdom, those systems being developed to improve care, how we could introduce frugal low cost innovations to enhance care in low and middle income countries and how these innovations could be introduced into the UK through ‘reverse innovation’. There were also presentations on research ethics and intellectual property.

taj2During the week’s meeting professor Siriwardena was invited to give a presentation on his work on quality improvement, specifically on ‘Quality Improvement Collaboratives: theory, design and effects’. This summarised work on three large scale QICs, Resources for Effective Sleep Treatment (REST), the Ambulance Services Cardiovascular Quality Initiative (ASCQI) and Scaling up PINCER, a pharmacist intervention to reduce clinically important prescribing errors in primary care, all funded by the Health Foundation and the last also co-funded by East Midlands Academic Health Science network. The talk developed the idea that collaboratives had different purposes and that syntheses should take this into account.

The meeting finished with partners agreeing to work together in future, support each other on the need to develop primary care and to implement frugal innovations as part of quality improvement initiatives in the countries involved.

By Professor Niro Siriwardena

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/03/QICs_ICSiriwardena.pdf” width=”660″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

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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.

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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]

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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]