Search results

The purpose of this paper is to describe how clinical registers were designed and used to serve multiple purposes in three health systems, in order to contribute practical experience for building learning healthcare systems.

Case description and comparison of the development and use of clinical registries, drawing on participants’ experience and published and unpublished research.

Clinical registers and new software systems enable fact-based decisions by patients, clinicians, and managers about better care, as well as new and more economical research. Designing systems to present the data for users’ daily work appears to be the key to effective use of the potential afforded by digital data.

The case descriptions draw on the experience of the authors who were involved in the development of the registers, as well as on published and unpublished research. There is limited data about outcomes for patients or cost-effectiveness.

The cases show the significant investments which are needed to make effective use of clinical register data. There are limited skills to design and apply the digital systems to make the best use of the systems and to reduce their disadvantages. More use can be made of digital data for quality improvement, patient empowerment and support, and for research.

Patients can use their data combined with other data to self-manage their chronic conditions. There are challenges in designing and using systems so that those with lower health and computer literacy and incomes also benefit from these systems, otherwise the digital revolution may increase health inequalities.

The paper shows three real examples of clinical registers which have been developed as part of their host health systems’ strategies to develop learning healthcare systems. The paper gives a simple non-technical introduction and overview for clinicians, managers, policy-advisors and improvers of what is possible and the challenges, and highlights the need to shape the design and implementation of digital infrastructures in healthcare services to serve users.

Scientific description of the organization and management of a temporary large scale healthcare (T-LSHc) vaccination clinic and evidence-based guidance for future temporary healthcare (T-Hc) services.

Mixed-methods rapid feedback case study, using interviews, document analysis and quantitative data, with both data collection and analysis guided by a research-informed systems program theory of the clinic.

Private contractors were not willing to bid for contracts to set up and close a T-LSHc vaccination clinic in 2022, although they had done so earlier in the year. The public health system was able successfully to set up and run the clinic itself for 2 months, serving 3,000 people a day at its peak. Part of the success was because a dedicated unit to set up and run T-Hc services had been created in 2020. The Stockholm organization model differed from the Milan model by using information technology to reduce the need for a large number of on-site doctors.

There may be recall bias in interview data as interviews were carried out four months after the closing of the clinic. The conclusions apply to clinically simple but managerially complex T-Hc services but are limited to public healthcare systems operating in a similar context to that of the case study service. The study contributes to the new science of healthcare crisis organization and management and fills gaps in knowledge in disaster medicine for enduring and fluctuating health crises. The findings show the importance of a capacity to establish and manage T-Hc, and of the specialist management and HIT competence that health systems will need to build to meet the crises that threaten our health, both now and in the future.

Public healthcare systems can provide clinically simple and managerially complex T-Hc services quickly and successfully if they have experience and capacity to plan and set up such services, skilled operational managers respected by staff, staff who can be redeployed, and suitable health information technology.

The need for healthcare services to respond to crises is likely to increase in the future. Information for creating the service may be limited at first and changing. The exact nature of the health threat may be uncertain, as may the demand and needs of subpopulations and individuals. The study findings can help to respond quickly to reduce morbidity illness and death through creating and organizing temporary large-scale public healthcare services when existing services cannot be reorganized to meet the scale of the need.

This article is the first detailed empirical description and analysis of a large-scale temporary healthcare service operated by the primary care division of an integrated public healthcare system, with research informed guidance for future services of this type in similar contexts. This article compares two organization models of T-LSHc services, and contributes to an emerging subdiscipline of the organization and management of disaster and crisis healthcare.

The purpose of this paper is to explore a non-technical overview for leaders and researchers about how to use a communications perspective to better assess, design and use digital health technologies (DHTs) to improve healthcare performance and to encourage more research into implementation and use of these technologies.

Narrative overview, showing through examples the issues and benefits of introducing DHTs for healthcare performance and the insights that communications science brings to their design and use.

Communications research has revealed the many ways in which people communicate in non-verbal ways, and how this can be lost or degraded in digitally mediated forms. These losses are often not recognized, can increase risks to patients and reduce staff satisfaction. Yet digital technologies also contribute to improving healthcare performance and staff morale if skillfully designed and implemented.

Researchers are provided with an introduction to the limitations of the research and to how communications science can contribute to a multidisciplinary research approach to evaluating and assisting the implementation of these technologies to improve healthcare performance.

Using this overview, managers are more able to ask questions about how the new DHTs will affect healthcare and take a stronger role in implementing these technologies to improve performance.

New insights into the use and understanding of DHTs from applying the new multidiscipline of communications science. A situated communications perspective helps to assess how a new technology can complement rather than degrade professional relationships and how safer implementation and use of these technologies can be devised.

The purpose of this paper is to enable improvers to use recent knowledge from implementation science to carry out improvement changes more effectively. It also highlights the importance of converting research findings into practical tools and guidance for improvers so as to make research easier to apply in practice.

This study provides an illustration of how a quality improvement (QI) team project can make use of recent findings from implementation research so as to make their improvement changes more effective and sustainable. The guidance is based on a review and synthesis of improvement and implementation methods.

The paper illustrates how research can help a quality project team in the phases of problem definition and preparation, in design and planning, in implementation, and in sustaining and spreading a QI. Examples of the use of different ideas and methods are cited where they exist.

The example is illustrative and there is little limited experimental evidence of whether using all the steps and tools in the one approach proposed do enable a quality team to be more effective. Evidence supporting individual guidance proposals is cited where it exists.

If the steps proposed and illustrated in the paper were followed, it is possible that quality projects could avoid waste by ensuring the conditions they need for success are in place, and sustain and spread improvement changes more effectively.

More patients could benefit more quickly from more effective implementation of proven interventions.

The paper is the first to describe how improvement and implementation science can be combined in a tangible way that practical improvers can use in their projects. It shows how QI project teams can take advantage of recent advances in improvement and implementation science to make their work more effective and sustainable.

High or low quality is as much a result of how care systems are organised as it is a result of individual clinicians’ performance. Failure to introduce new care organisation or quality methods which research shows to be effective is as serious an omission as failing to act on poor clinical performance. Managers make many decisions about policies and organisation which affect the quality of care, but they rarely use evaluation research in making these decisions. Such research is difficult to find, produced using many different types of methods which are difficult for non‐experts to assess, often of poor quality, and difficult to translate to the local setting. However, managers can develop an evaluation informed practice, and make greater use of evaluation research in decisions with high cost or risk implications. The paper explains why the model of evidence‐based medicine is not appropriate, proposes instead a practical four‐step approach, and shows how managers can use evaluation in everyday practice.

Can we speed the testing, implementation and spread of management innovations in a systematic way to also contribute to scientific knowledge? Researchers and implementers have developed an approach to test and revise a local version of an innovation during its implementation. The chapter starts with a case example of an application of this combination of implementation and quality improvement sciences and practices (improve-mentation). It then summarizes four examples of this approach so as to help understand what improve-mentation is and how it is different from traditional quality improvement and traditional implementation of evidence-based practices. It considers gaps in knowledge that are hindering both more use of improve-mentation to generate scientific knowledge about spread and implementation, as well as more use of improve-mentation by health care service organizations and researchers. It closes by proposing fruitful research and development that can address these knowledge gaps to speed the implementation, sustainment and spread of care and management innovations.

Seeks to provide answers to the questions: How can institutional purchasers of services be sure that the quality of a service will be acceptable over the period of the contract? Can they predict the future quality of a service? How should they monitor service quality? Reviews audit methods and awards and assesses their uses and limitations for purchasers and providers of services. Observes that many audit frameworks for services are adapted from product quality experience and not from systematic research into factors critical to service quality. Contrasts these frameworks with research into what practising service managers found to be important for service quality. Proposes that, in most cases, purchasers should adapt auditing frameworks for their particular purposes drawing on such research and their own and providers′ experience. Concludes that the validity of existing audit frameworks as predictors of service quality is questionable, especially for wide‐scope, long‐term service contracts with a high professional component. Points out that there are advantages to the provider and purchaser agreeing and developing an audit framework in partnership and that, if purchasers and providers select a framework with caution, they may reduce the risks inherent in contracting for services and develop more refined monitoring methods.

The purpose of this paper is to explore factors influencing early implementation and intermediate outcomes of a healthcare-academia partnership in a primary healthcare setting.

The Academic Primary Healthcare Network (APHN) initiative was launched in 2011 in Stockholm County, Sweden and included 201 primary healthcare centres. Semi-structured interviews were conducted in 2013-2014 with all coordinating managers (n=8) and coordinators (n=4). A strategic change model framework was used to collect and analyse data.

Several factors were identified to aid early implementation: assignment and guidelines that allowed flexibility; supportive management; dedicated staff; facilities that enabled APHN actions to be integrated into healthcare practice; and positive experiences from research and educational activities. Implementation was hindered by: discrepancies between objectives and resources; underspecified guidelines that trigger passivity; limited research and educational activities; a conflicting non-supportive reimbursement system; limited planning; and organisational fragmentation. Intermediate outcomes revealed that various actions, informed by the APHN assignment, were launched in all APHNs.

The findings can be rendered applicable by preparing stakeholders in healthcare services to optimise early implementation of healthcare-academia partnerships.

This study increases understanding of interactions between factors that influence early stage partnerships between healthcare services and academia in primary healthcare settings.

Discusses, on the basis of existing quality initiatives, a systematic and integrated approach to mental health care in Northern Ireland. Utilizes two approaches: the Brunel Quality Management System and the FACE‐IQMS model.

The purpose of this paper is to provide evidence based guidance to researchers and practice personnel about forming and carrying out effective research partnerships.

A review of the literature, interviews and discussions with colleagues in both research and practice roles, and a review of the authors' personal experiences as researchers in partnership research.

Partnership research is, in some respects, a distinct “approach” to research, but there are many different versions. An analysis of research publications and of their research experience led the authors to develop a framework for planning and assessing the partnership research process, which includes defining expected outcomes for the partners, their roles, and steps in the research process.

This review and analysis provides guidance that may reduce commonly-reported misunderstandings and help to plan more successful partnerships and projects. It also identifies future research which is needed to define more precisely the questions and purposes for which partnership research is most appropriate, and methods and designs for specific types of partnership research.

As more research moves towards increased participation of practitioners and patients in the research process, more precise and differentiated understanding of the different partnership approaches is required, and when each is most suitable. This article describes research approaches that have the potential to reduce “the research-practice gap”. It gives evidence- and experience-based guidance for choosing and establishing a partnership research process, so as to improve partnership relationship-building and more actionable research.