Emma Rowley

Research into practice: Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Nottinghamshire, Derbyshire, Lincolnshire (NDL)

BackgroundTo address the problem of translation from research-based evidence to routine healthcare practice, the Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire, and Lincolnshire (CLAHRC-NDL) was funded by the National Institute for Health Research as one of nine CLAHRCs across England. This paper outlines the underlying theory and its application that CLAHRC-NDL has adopted, as a case example that might be generalised to practice outside the CLAHRC, in comparison to alternative models of implementation.DiscussionConventional approaches to health research frequently generate evidence in isolation from the environment in which it is intended for use. The premise of the CLAHRC-NDL model is that barriers to implementation can be overcome if knowledge is co-produced by academic and clinical service staff, taking account of the organisational context in which it is to be applied. This approach is founded on organisational learning theory, recognising that change is a social and political phenomenon. Evidence is produced in real time, taking full account of the environment in which it is to be implemented. To support this process, senior health service staff are seconded to the CLAHRC as ‘diffusion fellows’ (DFs) to actively bridge the research to practice gap by being a full member of both the research team and their area of clinical practice. To facilitate innovation and embed change in the local health community, existing communities of practice are enhanced and new ones are fostered around specific themes. Our approach has been adopted by 16 clinical research studies in the areas of mental health, children and young people, primary care, and stroke rehabilitation.SummaryThe CLAHRC-NDL model of implementation applies organisational learning theory by addressing the social and situational barriers and enablers to implementation, and adopting a philosophy of co-production. Two key mechanisms for translation of innovation have been utilised: DFs, to actively bridge the research to practice gap, and communities of practice, to underpin and sustain improvements in healthcare. The model shows promising results in putting research into practice, which may be transferable to other healthcare contexts.

What Does the Use of a Computerized Checklist Mean for Patient-Centered Care? The Example of a Routine Diabetes Review

The authors examine the interaction between nurses and patients with type 2 diabetes during routine consultations in primary care settings in the United Kingdom. Through preconsultation interviews, the authors identified the patients’ expectations. The article draws on videotaped consultations with 25 patients with type 2 diabetes. Using conversation analysis, the authors examine the use of a rigid agenda, imposed via a computerized checklist, and consider how far this is able to suppress the patients agenda. They consider the potential impact for the patient and the factors that might encourage the clinician, and the nurse specifically, to adopt a narrowly task-based approach to the consultation. They identify two potentially conflicting strands within contemporary diabetes care, patient-centered practice and an emphasis on biomedical audit, and suggest that achievement of the former might be compromised by the demands of the latter.

Industry perceptions of barriers to commercialization of regenerative medicine products in the UK

AIMS Regenerative medicine is an emerging field with the potential to provide widespread improvement in healthcare and patient wellbeing via the delivery of therapies that can restore, regenerate or repair damaged tissue. As an industry, it could significantly contribute to economic growth if products are successfully commercialized. However, to date, relatively few products have reached the market owing to a variety of barriers, including a lack of funding and regulatory hurdles. The present study analyzes industry perceptions of the barriers to commercialization that currently impede the success of the regenerative medicine industry in the UK. MATERIALS & METHODS The analysis is based on 20 interviews with leading industrialists in the field. RESULTS The study revealed that scientific research in regenerative medicine is thriving in the UK. Unfortunately, lack of access to capital, regulatory hurdles, lack of clinical evidence leading to problems with reimbursement, as well as the culture of the NHS do not provide a good environment for the commercialization of regenerative medicine products. CONCLUSION Policy interventions, including increased translational government funding, a change in NHS and NICE organization and policies, and regulatory clarity, would likely improve the general outcomes for the regenerative medicine industry in the UK.

Narratives of professional regulation and patient safety: The case of medical devices in anaesthetics

Government prescription for the management of clinical risk and patient safety relies upon the development of a shared perspective between stakeholders engaged in the delivery of healthcare about what constitutes clinical risk and what mechanisms are suitable to manage such risk to ensure patient safety. However, there are tensions arising from notions of clinical risk and its management, specifically between healthcare professionals and those managers given responsibility for implementation of policy. Central to these tensions are issues of legitimacy, power and identity in claims about how risk should be managed. Aligned with an emerging body of literature that takes a narrative approach to change in healthcare systems (e.g. Currie and Brown 2003), including patient safety (e.g. McDonald et al. 2005, 2006), our paper examines how healthcare professionals make sense of the regulation of single use medical devices (SUDs) in anaesthesia. Our study indicates that there is considerable resistance to detailed surveillance of SUDs. It appears that doctors author a narrative that privileges clinical judgement over managerial control in the use of SUDs, and this has come to be adopted by other healthcare professionals and managers. This may undermine future policy aspirations for the tighter regulation of clinical autonomy.

The use of single-use devices in anaesthesia: balancing the risks to patient safety*

Single‐use devices are designed, manufactured and sold to be used once and then discarded. This paper addresses growing concerns about the quality of some devices. Single‐use devices, manufactured at a lower cost to justify their disposal, are perceived to have a lesser efficacy, which may threaten patient safety through iatrogenic harm. There is, in addition, growing scepticism about the actual risk of contracting variant Creutzfeldt‐Jakob disease and other blood‐borne diseases from reused surgical instruments. Interview data suggests that when choosing to use a single‐use device, clinicians balance concerns about the risk of infection against those about the risk of injury. However, despite reservations about induced harm and the unknown risk of an iatrogenic disease, most clinicians would want single‐use devices used on themselves and their family if they were patients.

Group interviews with people taking long‐term medication: comparing the perspectives of people with arthritis, respiratory disease and mental health problems

Objective — To examine experiences of medicine use, advice and support from the perspectives of people taking medicines long term for arthritis, respiratory disease and mental health problems.

Electronic Medical Records in Diabetes Consultations: Participants' Gaze as an Interactional Resource

Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurses gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

Narrative review of the UK Patient Safety Research Portfolio.

Objectives The UK Patient Safety Research Portfolio (PSRP) commissioned 38 studies investigating the threats to patient safety in various clinical settings and evaluating safety-related service interventions. This paper reviews 27 of these studies, drawing out emergent and cross-cutting themes in terms of theory, research methods and thematic findings. Methods Given the diversity of PSRP studies, the paper takes a narrative approach that allows for qualitative description, interpretation and synthesis of the studies and their findings. Results The theoretical review shows the majority of PSRP studies draw upon a patient safety ‘orthodoxy’, developed from the concepts and models associated with the human factors approach. The methodological review shows that a diverse range of research designs and techniques have been utilized. Although many follow in the ‘scientific’ tradition, interpretative, mixed and innovative methods have been integral to research. The thematic review of findings highlights significant contributions to knowledge in the areas of ‘people’, ‘organizations’, and ‘technology’. As well as identifying the various sources of risk in the organization and delivery of patient care, the studies also evaluate and make recommendations about service change and improvement. Conclusions The PSRP has provided the foundations for significant theoretical, methodological and empirical advances in the area of patient safety. The findings and recommendations make important contributions to policy formulation and implementation as well as professional and managerial practice. Through this body of research the PSRP has supported the formation and growth of a thriving research community across academic, policy and professional communities.

The impact of injuries study. multicentre study assessing physical, psychological, social and occupational functioning post injury - a protocol

BackgroundLarge numbers of people are killed or severely injured following injuries each year and these injuries place a large burden on health care resources. The majority of the severely injured are not fully recovered 12-18 months later. Psychological disorders are common post injury and are associated with poorer functional and occupational outcomes. Much of this evidence comes from countries other than the UK, with differing health care and compensation systems. Early interventions can be effective in treating psychological morbidity, hence the scale and nature of the problem and its impact of functioning in the UK must be known before services can be designed to identify and manage psychological morbidity post injury.Methods/DesignA longitudinal multi-centre study of 680 injured patients admitted to hospital in four areas across the UK: Nottingham, Leicester/Loughborough, Bristol and Surrey. A stratified sample of injuries will ensure a range of common and less common injuries will be included. Participants will complete a baseline questionnaire about their injury and pre-injury quality of life, and follow-up questionnaires 1, 2, 4, and 12 months post injury. Measures will include health and social care utilisation, perceptions of recovery, physical, psychological, social and occupational functioning and health-related quality of life. A nested qualitative study will explore the experiences of a sample of participants, their carers and service providers to inform service design.DiscussionThis study will quantify physical, psychological, social and occupational functioning and health and social care utilisation following a range of different types of injury and will assess the impact of psychological disorders on function and health service use. The findings will be used to guide the development of interventions to maximise recovery post injury.

On doing 'being ordinary': women's accounts of BRCA testing and maternal responsibility

Abstract In recent months, genetic testing for the breast and ovarian cancer genes, BRCA1 and BRCA2, has again hit the headlines in the UK press. Four women, all from families with a strong breast cancer pedigree, have asked the Human Fertility and Embryology Authority for permission to screen their embryos for BRCA1/2 mutations. Although this may be a dramatic example of parental responsibility, other studies have shown that women at risk of BRCA-related cancers frequently cite responsibility to others as an important influence on their testing and treatment decision making. In this paper, I explore the decision-making explanations that women at risk of BRCA-related breast and ovarian cancer provide when accounting for their decision to undergo genetic testing. In doing so, I treat womens accounts critically, and examine how and why the women verbalize their explanations in the manner that they do.