Saba Hinrichs

CLAHRCs in practice: combined knowledge transfer and exchange strategies, cultural change, and experimentation

Objectives The nine NIHR CLAHRCs are collaborations between universities and local NHS organizations that seek to improve patient outcomes through the conduct and application of applied health research. The theoretical and practical context within which the CLAHRCs were set up was characterized by a considerable degree of uncertainty, and the CLAHRCs were established as a natural experiment. Methods We adopted a formative and emergent evaluation approach. Drawing on in-depth, multi-method case studies of two CLAHRCs we explored how they pursued their remit by supporting efforts to increase the relevance and use of health research, and building relationships. Results Both CLAHRCs: strengthened local networks and relationships; built capacity in their local academic and NHS communities to undertake and use research that meets the needs of the service; developed research and implementation methodologies; and added to understanding of the complex relation between research and implementation. There was evidence of impact of CLAHRC projects on health and social care services. Informed by the literature on implementing collaborative research initiatives, knowledge transfer and exchange and cultural change, some key lessons can be drawn. Conclusion The CLAHRCs pursued a strategy that can be categorized as one of flexible comprehensiveness; i.e. their programmes have been flexible and responsive and they have used a range of approaches that seek to match the diverse aspects of the complex issues they face. Key features include their work on combining a range of knowledge transfer and exchange strategies, their efforts to promote cultural change, and the freedom to experiment, learn and adapt. Although the CLAHRCs do not, by themselves, have the remit or resources to bring about wholesale service improvement in health care, they do have features that would allow them to play a key role in some of the wider initiatives that encourage innovation.

Evidence on global medical travel

Abstract The potential benefits of travelling across national borders to obtain medical treatment include improved care, decreased costs and reduced waiting times. However, medical travel involves additional risks, compared to obtaining treatment domestically. We review the publicly-available evidence on medical travel. We suggest that medical travel needs to be understood in terms of its potential risks and benefits so that it can be evaluated against alternatives by patients who are seeking care. We propose three domains –quality standards, informed decision-making, economic and legal protection – in which better evidence could support the development of medical travel policies.

A new resource for identifying and assessing the impacts of research

Abstract/SummaryThe impact case studies submitted by UK Higher Education Institutions to the Research Excellence Framework (REF) in 2014 provide a rich resource of text describing impact beyond academia and across all disciplines. Using text mining techniques and qualitative assessment, the 6,679 non-redacted case studies submitted were analysed and the impact described was found to be multidisciplinary, multi-impactful, and multinational. By digging deeper into the data, the health gains from health research in terms of Quality Adjusted Life Years was also estimated. Similar analyses are possible using these case studies, but will require the data to be ‘re-purposed’ from the original intention (i.e., for assessment purposes) for robust analysis.

Evaluating chronic disease management in real-world settings in six European countries: Lessons from the collaborative DISMEVAL project

Objective To describe the interventions, research methods and main findings of the international DISMEVAL project, in which the “real-world” impact of exemplary European disease management approaches was investigated in six countries using advanced analytic techniques. Design Across countries, the project captured a wide range of disease management strategies and settings; approaches to evaluation varied per country, but included, among others, difference-in-differences analysis and regression discontinuity analysis. Setting Austria, Denmark, France, Germany, The Netherlands, and Spain. Participants Health care providers and/or statutory insurance funds providing routine data from their disease management interventions, mostly retrospectively. Intervention(s) This study did not carry out an intervention but evaluated the impact of existing disease management interventions implemented in European care settings. Main outcome measure(s) Outcome measures were largely dependent on available routine data, but could concern health care structures, processes, and outcomes. Results Data covering 10 to 36 months were gathered concerning more than 154,000 patients with three conditions. The analyses demonstrated considerable positive effects of disease management on process quality (Austria, Germany), but no more than moderate improvements in intermediate health outcomes (Austria, France, Netherlands, Spain) or disease progression (Denmark) in intervention patients, where possible compared with a matched control group. Conclusions Assessing the “real-world” impact of chronic disease management remains a challenge. In settings where randomization is not possible and/or desirable, routine health care performance data can provide a valuable resource for practice-based evaluations using advanced analytic techniques.

An Approach to Establishing International Quality Standards for Medical Travel.

The number of individuals traveling abroad is increasing annually. The rising popularity of medical travel and the absence of clear minimum quality requirements in this area urgently call for the development of international standards to ensure good practice and patient safety. The aim of this study is to identify the key domains in medical travel where quality standards should be established. Drawing from the evidence-based OECD framework and an extensive literature review, this study proposes three critical areas for consideration: minimum standards of health-care facilities and third-party agencies, financial responsibility, and patient centeredness. Several cultural challenges have been introduced that may pose a barrier to development of the guidelines and should be taken into consideration. Establishing international quality standards in medical travel enhances benefits to patients and providers, which is an urgent necessity given the rapid growth in this industry.

Stakeholder challenges in purchasing medical devices for patient safety.

Objective This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. Methods Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. Results The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of “clinical engineering” is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. Conclusions The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

A Case Study of Design Methods Applied to Researching Medical Device Purchasing Processes

Design and engineering concepts are increasingly welcomed by healthcare communities for developing products and environments. With the recognition of healthcare as a safetycritical industry, design processes can also be used to develop services, organisations, and management systems in healthcare. The case study reported on here forms part of a wider research study of medical device purchasing practice, and provides an example of applying systemic design methods to one healthcare context. Collaboration between the researchers and a hospital provided an opportunity to explore design approaches as part of the research process, in terms of data collection, analysis, synthesis, as well as in the implementation of new practices. The paper firstly gives justification for using design and systems approaches, and specifies the particular aspects of design approaches used, including a discussion on their applicability to the purchasing of medical devices. Design approaches used included diagramming methods, participatory design, and risk analyses techniques, which were used in conjunction with qualitative methods. A description of the techniques used with the collaborating hospital then follows, including some of the methodological challenges encountered. The case study shows a practical example of how design methods and tools can be used to research within a healthcare context, and is

Evaluation of the UCLH-Macmillan Partnership to deliver improvements in the care, treatment, support, and information to patients with cancer throughout their individual journeys

The authors would like to thank those individuals across the two partnership organisations for their support throughout this study, in particular, Nikki Cannon, Tatyana Guveli, Nick Kirby, Hilary Plant, Amanda Quincey, David Salisbury and Jo Swiecicka. As part of the study we engaged with a wide range of stakeholders involved in the partnership and delivery of cancer care at UCLH. We would like to thank them all for generously donating their time to participate in our study. Dr Ellen Nolte provided insight and inspiration at the start of this evaluation before taking up her current position at the European Observatory on Health Systems and Policies. Finally, we gratefully acknowledge the helpful, and insightful, comments provided by Professor Martin Roland and Dr Stephen Barclay, who acted as the quality assurance reviewers for this report.