Making Health and Social Care Better How can Education & Training Help? Professor Jane Sandall PhD

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1 Making Health and Social Care Better How can Education & Training Help? Professor Jane Sandall PhD Professor of Social Science and Women s Health Capacity building lead NIHR CLAHRC South London and King s Improvement Science Jane.sandall@kcl.ac.uk

2 What we will cover today 1. Results of mapping work to help us build capacity for Implementation and Improvement Science and practical know how for service improvement 2. Current education and training initiatives Health Innovation Network (HIN) and CLAHRC South London 3. What next?

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4 The NHS needs a considered resourced and driven agenda of capability building in order to deliver continuous improvement Berwick Report 2013 Attempts to improve health care, translate new knowledge into frontline care, or scale up promising interventions and models of care cannot later demonstrate whether improvements were actually made.

5 The implementation challenge Affordable, life-saving interventions exist to confront many of the health challenges we face, but there is little understanding of how best to deliver those interventions across the full range of existing health systems and in the wide diversity of possible settings. Too often interventions that work in small-scale pilot studies fail to live up to expectations when rolled out in national strategies, or fail to transfer from one country to another as a result of contextual differences. Implementation issues often arise as a result of contextual factors that policy-makers and health system managers may not even have considered.

6 How might education and training help?

7 Aims 1. Understand the range of courses, programmes and fellowships available to the south London health and social care workforce (including non clinicians) that support the development of improvement/implementation science skills. 2. Promote these courses, programmes and fellowships to the south London workforce. A downloadable document containing a snapshot of courses, programmes and fellowships relating to implementation science, improvement science and service improvement is available on the CLAHRC South London website. 3. Describe the enablers and barriers associated with staff accessing and engaging with development opportunities in improvement/implementation science. 4. Use the findings from 1 and 2 above to inform the development of the NIHR CLAHRC South London s implementation/improvement science education and training and MSc. and

8 Mapping work Jointly commissioned by HIN and NIHR CLAHRC South London What we did May-September 2014: A. Mapped views - What stops you/staff developing knowledge and skills for improvement. What would help you/staff develop knowledge and skills for improvement? B. Mapped current education and training supporting improvement.

9 Mapping Work What we found (A) - Views Clinicians, managers, commissioners, patients and service users and early career scientists were interested in developing their knowledge and skills for improvement and implementation of research People find it hard to get protected time and funding for learning about improvement and implementation and developing research skills to assess impact People want to broaden their horizons and learn from those outside their professional/organisational field and from executive teams People want practical learning delivered by genuine experts, supported through skilled mentorship and peer learning There is recognition of the need for leadership skills alongside technical research skills, tools and techniques Ward and service managers and commissioning managers struggle to deliver real improvement in context of national, local, organisational initiatives and staff views at the coalface

10 Mapping Work What we found (B) Current education and training availability A range of courses and fellowships of relevance to Improvement Science and Service Improvement. Need PSRB registration for most Masters level courses Gaps relating to Implementation Science Research Hard for students to identify courses not helped by terminology!

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12 What s happened since?

13 Developing short courses based on findings from the mapping work. Fellows network led by HIN. Implementation Science Masterclass Fee bursaries for health and social care and 3rd sector staff working in South London for Improvement Science Masterclasses and MSc. Development of MSc Implementation and Improvement Science led by King s College London in collaboration with KSGUL. Implementation-and-Improvement-Science.aspx

14 What do we need to know?

15 MSc Implementation and Improvement Science OVERVIEW Aimed at those who need to design, evaluate and research robust implementation and improvement science programmes. Course aims to prepare participants to understand, critique and design improvement and implementation evaluation and research. Students will have a greater critical understanding of theory and conceptual frameworks can guide and inform research and evaluation. How to understand and analyse the role of context when developing interventions and implementation projects, a range of qualitative and quantitative review methods, and a practical understanding and critique of specific methodologies used in improvement research. Created jointly by researchers at King s College and St George s, University of London who are part of the CLAHRC South London. Starting September KEY POINTS Interdisciplinary programme, taught by researchers and specialists in the field. A wide range of specialist options. Flexibility: modules can be taken either as stand-alone units or towards the MSc qualification. Opportunities to engage with worlds of policy-making, non-governmental agencies, and health research. Summer masterclass run by international experts. Participants from health, policy, NGO and government sector, including health and social science researchers both in the UK and an international context. Many assessments are practical prepare a poster, produce a presentation about implementation of a quality improvement intervention for a non-expert audience, compile an application for ethical approval for research, dissertation in partnership with external organisations.

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17 Measurement risks

18 Patients and carers play an essential role in safety monitoring, by listening, perceiving and anticipating risk. However, all too often they are an underused defence in preventing patient harm

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21 References and resources Ajzen, Icek. "The theory of planned behavior." Organizational behavior and human decision processes 50.2 (1991): Clar, C., Campbell, S., Davidson, L. and Graham, W. What are the effects of interventions to improve the uptake of evidence from health research into policy in low and middle-income countries? Report to the Department for International Development, Available at Craig, Peter, et al. "Developing and evaluating complex interventions: the new Medical Research Council guidance." Bmj 337 (2008). PDF available at Durlak, Joseph A., and Emily P. DuPre. "Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation." American journal of community psychology (2008): Hoffmann, Tammy C., et al. "Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide." BMJ: British Medical Journal 348 (2014). doi: Lang, Eddy S., Peter C. Wyer, and R. Brian Haynes. "Knowledge translation: closing the evidence-topractice gap." Annals of emergency medicine 49.3 (2007): Lavis JN, Davies H, Oxman A, Denis JL, Golden-Biddle K and Ferlie E. Towards systematic reviews that inform health care management and policy-making. J Health Serv Res Policy (2005): 10(Suppl 1): Michie et al. Making psychological theory useful for implementing evidence based practice. Quality & Safety in Health Care (2005): 14: David H. Peters, Nhan T. Tran, Taghreed Adam. Implementation research in health: a practical guide. Alliance for Health Policy and Systems Research, World Health Organization, US Dept of Health and Human Services. NIH program announcement on dissemination and implementation research. Program announcement number PAR Available at:

22 Questions 1. How can we link student research/projects with strategic improvement and implementation priorities in service? 2. What type of learning and development would help ward/service and service commissioning managers to support trainees and collaborate and host