Sarah McNicol

Ten challenges in improving quality in healthcare: lessons from the Health Foundation's programme evaluations and relevant literature

Background Formal evaluations of programmes are an important source of learning about the challenges faced in improving quality in healthcare and how they can be addressed. The authors aimed to integrate lessons from evaluations of the Health Foundations improvement programmes with relevant literature. Methods The authors analysed evaluation reports relating to five Health Foundation improvement programmes using a form of ‘best fit’ synthesis, where a pre-existing framework was used for initial coding and then updated in response to the emerging analysis. A rapid narrative review of relevant literature was also undertaken. Results The authors identified ten key challenges: convincing people that there is a problem that is relevant to them; convincing them that the solution chosen is the right one; getting data collection and monitoring systems right; excess ambitions and ‘projectness’; organisational cultures, capacities and contexts; tribalism and lack of staff engagement; leadership; incentivising participation and ‘hard edges’; securing sustainability; and risk of unintended consequences. The authors identified a range of tactics that may be used to respond to these challenges. Discussion Securing improvement may be hard and slow and faces many challenges. Formal evaluations assist in recognising the nature of these challenges and help in addressing them.

The challenges of strategic planning in academic libraries

Purpose – This paper reports on the findings of the HEFCE‐funded outcomes project which aimed to investigate strategic planning in UK academic libraries.Design/methodology/approach – The research consisted of a literature and documentation review, followed by interviews with academic library directors and senior institutional managers. There was also a survey of all UK HE libraries.Findings – The key issues which need to be addressed by academic libraries in terms of strategic planning are: the involvement of library staff; communication of library aims and plans externally; level of active involvement in institutional and departmental planning; evaluation and target setting; and involvement in more “difficult” institutional aims such as income generation and widening participation.Research limitation/implications – The response to the various activities of this research project indicate the lack of interest in outcomes assessment within the academic library sector. There is little rigorous evidence in th...

How collaborative are quality improvement collaboratives: a qualitative study in stroke care

BackgroundQuality improvement collaboratives (QICs) continue to be widely used, yet evidence for their effectiveness is equivocal. We sought to explain what happened in Stroke 90:10, a QIC designed to improve stroke care in 24 hospitals in the North West of England. Our study drew in part on the literature on collective action and inter-organizational collaboration. This literature has been relatively neglected in evaluations of QICs, even though they are founded on principles of co-operation and sharing.MethodsWe interviewed 32 professionals in hospitals that participated in Stroke 90:10, conducted a focus group with the QIC faculty team, and reviewed purposively sampled documents including reports and newsletters. Analysis was based on a modified form of Framework Analysis, combining sensitizing constructs derived from the literature and new, empirically derived thematic categories.ResultsImprovements in stroke care were attributed to QIC participation by many professionals. They described how the QIC fostered a sense of community and increased attention to stroke care within their organizations. However, participants’ experiences of the QIC varied. Starting positions were different; some organizations were achieving higher levels of performance than others before the QIC began, and some had more pre-existing experience of quality improvement methods. Some participants had more to learn, others more to teach. Some evidence of free-riding was found. Benchmarking improvement was variously experienced as friendly rivalry or as time-consuming and stressful. Participants’ competitive desire to demonstrate success sometimes conflicted with collaborative aims; some experienced competing organizational pressures or saw the QIC as duplication of effort. Experiences of inter-organizational collaboration were influenced by variations in intra-organizational support.ConclusionsCollaboration is not the only mode of behavior likely to occur within a QIC. Our study revealed a mixed picture of collaboration, free-riding and competition. QICs should learn from work on the challenges of collective action; set realistic goals; account for context; ensure sufficient time and resources are made available; and carefully manage the collaborative to mitigate the risks of collaborative inertia and unhelpful competitive or anti-cooperative behaviors. Individual organizations should assess the costs and benefits of collaboration as a means of attaining quality improvement.

LIS the interdisciplinary research landscape

Researchers from different disciplines may choose to work together for a variety of reasons. Their complementary skills may enable problems to be solved more quickly; they may be better placed to tackle a multi-faceted problem; or they may wish to learn new skills and expand their methodological range. In other cases, research funders may require such an approach. Alternatively, the complexity or high cost of the research may mean that working together is the only viable option if the research is to be carried out at all. Interdisciplinary research was just one of a number of topics to be investigated as part of a short research project, ‘The LIS Research Landscape: a review and prognosis’, conducted by the Centre for Information Research (CIRT) at the University of Central England in Birmingham (UCE) in 2001. To address new problems facing the library and information world, researchers need to develop new skills. This project reported that there was a need for a stronger, closer interface between various disciplines; it acknowledged that, currently, researchers from different subject backgrounds tended to work independently. There is a need for more cooperation between researchers in different fields and for explicitly interdisciplinary research to address the problems currently facing the LIS community. However, more needs to be done to encourage interdisciplinary research, for example funders and professional organizations should promote research opportunities which bring together researchers from different disciplines.Researchers from different disciplines may choose to work together for a variety of reasons. Their complementary skills may enable problems to be solved more quickly; they may be better placed to tackle a multi-faceted problem; or they may wish to learn new skills and expand their methodological range. In other cases, research funders may require such an approach. Alternatively, the complexity or high cost of the research may mean that working together is the only viable option if the research is to be carried out at all. Interdisciplinary research was just one of a number of topics to be investigated as part of a short research project, ‘The LIS Research Landscape: a review and prognosis’, conducted by the Centre for Information Research (CIRT) at the University of Central England in Birmingham (UCE) in 2001. To address new problems facing the library and information world, researchers need to develop new skills. This project reported that there was a need for a stronger, closer interface between various...

Is Research an Untapped Resource in the Library and Information Profession

Traditionally, the library and information profession has not been strongly research led in the way in which other professions, such as medicine and education for example, might be considered to be. However, it may be that the extent of practitioner involvement in research and the extent to which research informs practice have been underestimated. The article reports on a survey designed to scope present and planned involvement in research within a variety of library sectors and to identify the priorities for future research as seen by practitioners. It also investigated the main barriers which prevent practitioners having greater involvement in research. It concludes that there is scope for much more effective communication between all types of library and information researchers and practitioners and also for greater recognition of practitioner research.

Humanising illness: presenting health information in educational comics.

Research into the effectiveness of comic books as health education tools overwhelmingly consists of studies evaluating the information learnt as a result of reading the comic, for example using preintervention and postintervention questionnaires. In essence, these studies evaluate comics in the same way in which a patient information leaflet might be evaluated, but they fail to evaluate the narrative element of comics. Health information comics have the potential to do much more than simply convey facts about an illness; they can also support patients in dealing with the social and psychological aspects of a condition. This article discusses how some common elements of educational comics are handled in a selection of comics about diabetes, focusing on the more personal or social aspects of the condition as well as the presentation of factual information. The elements examined include: fears and anxieties; reactions of friends and family; interactions with medical professionals; self-management; and prevention. In conclusion, the article argues that comics, potentially, have many advantages over patient information leaflets, particularly in the way in which they can offer ‘companionship’, helping patients to address fears and negative feelings. However, empirical studies are required to evaluate educational comics in a way which takes account of their potential role in supporting patients in coming to terms with their condition, as well as becoming better informed.

What Makes a Joint Use Library a Community Library

Although the majority of joint use libraries in educational establishments provide at least an adequate level of service for their school, college, or university users, the standard of service they provide for members of the public is more questionable in many cases. This article considers the benefits and problems of joint use libraries from the perspective of their public users, providing examples from the UK and elsewhere to demonstrate how these occur in practice. A number of success factors are identified that need to be considered if a joint use library is to be successful as a community library, perhaps the most important of these being the need to involve the local community in the development of the library from its earliest stage. Gaining the support and active involvement of the local community is crucial; only then can the true benefits of joint use libraries, as locations for intergenerational activity and lifelong learning, be realized.

The eVALUEd toolkit: a framework for the qualitative evaluation of electronic information services

Purpose. To provide an overview of the approach to EIS evaluation taken by the eVALUEd toolkit and relate this to other work in this area. Design/methodology/approach. The eVALUEd toolkit was designed to fill a gap in EIS evaluation in relation to qualitative techniques, user‐focused evaluation and the utilisation of evaluation findings. Findings. The eVALUEd toolkit makes a distinct contribution to EIS evaluation through its focus on people rather than resources or technology, emphasis on qualitative methods and promotion of all aspects of the evaluation cycle. Research limitations/implications. Further work is required in relation to mixed methods of EIS evaluation and case studies would provide greater insight into the ways in which such data can be used in practice. Practical implications. There should be greater consideration given to the use of qualitative methods of EIS evaluation as statistical data alone are rarely sufficient for investigating complex problems and planning and managing services. However, there is a need for further guidance and training in this area. Originality/value. Aimed at library practitioners and researchers and others who provide support with evaluation. Reports on a practical tool and offers a balance to work focused on quantitative evaluation methods.

The potential of educational comics as a health information medium

Abstract Objectives To investigate ways in which educational comics might provide support in dealing with feelings and attitudes towards health conditions, as well as improving understanding of factual information and to identify potential weakness of comics as a medium for health information. Methods Semi‐structured interviewees with eleven university students who either had a mental or physical health condition themselves or had a family member with a health condition. Results The result highlighted the potential value of comics as a format for health information. In addition to conveying factual information, comics offer opportunities for self‐awareness, reassurance, empathy, companionship and a means to explore the impact of illness on family relationships. However, there are notable barriers to the greater use of comics to provide health information, namely, a lack of awareness of, and easy access to, educational comics, along with the perception that comics are exclusively light‐hearted and for children. Conclusions Currently, the full potential of comics in health settings is not being realised. Health information professionals may be in a position to address this issue through identifying, cataloguing, indexing and promoting comics as a legitimate format for health information.

Striking a balance: priorities for research in LIS

This paper examines current research activities, and future priorities for research, in the library and information community and describes some of the areas of convergence and divergence between research driven by UK government policy and that driven by practitioners themselves. Information gathered through two fact‐finding research projects, the Research Landscape Project and the Library Practitioner Research project provides the basis of the discussion outlined. The many benefits that library and information science (LIS) research, in particular collaboration between researchers and practitioners, provides are highlighted. The paper concludes that in the diverse LIS community there are various reasons for undertaking research and that the needs of practitioners should be balanced against those of other sections of the research community, such as funders and politicians.