The Health Foundation s Quality Improvement Initiatives & Evaluation. Dr. Dale Webb Assistant Director, Evaluation & Research

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1 The Health Foundation s Quality Improvement Initiatives & Evaluation Dr. Dale Webb Assistant Director, Evaluation & Research

2 The Health Foundation is an independent charitable foundation working to improve the quality of healthcare across the UK. Our endowment enables us to spend up to 20 million annually to develop leaders in healthcare; test new ways of improving the quality of health services; and disseminate evidence for changing health policy and practice.

3 Our Strategic Aims Building and Making Public the Knowledge Base for Quality and Performance Improvement Developing leaders to improve health and healthcare services Supporting Healthcare Organisations to Improve Quality and Performance Engaging Clinicians in Quality Improvement Engaging Patients for Better Health and Healthcare Outcomes

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5 Quality Enhancing Interventions Patientfocused interventions Regulatory interventions Incentives Data-driven & IT based interventions Organisation al interventions Clinical care delivery models

6 Our Strategic Aims Building and Making Public the Knowledge Base for Quality and Performance Improvement Developing leaders to improve health and healthcare services Supporting Healthcare Organisations to Improve Quality and Performance Engaging Clinicians in Quality Improvement Engaging Patients for Better Health and Healthcare Outcomes

7 Our Strategic Aims Building and Making Public the Knowledge Base for Quality and Performance Improvement Developing leaders to improve health and healthcare services Supporting Healthcare Organisations to Improve Quality and Performance Engaging Clinicians in Quality Improvement Engaging Patients for Better Health and Healthcare Outcomes

8 Our Strategic Aims Building and Making Public the Knowledge Base for Quality and Performance Improvement Developing leaders to improve health and healthcare services Supporting Healthcare Organisations to Improve Quality and Performance Engaging Clinicians in Quality Improvement Engaging Patients for Better Health and Healthcare Outcomes

9 Our Strategic Aims Building and Making Public the Knowledge Base for Quality and Performance Improvement Developing leaders to improve health and healthcare services Supporting Healthcare Organisations to Improve Quality and Performance Engaging Clinicians in Quality Improvement Engaging Patients for Better Health and Healthcare Outcomes

10 How does evaluation and research contribute to our mission? To support the strategic direction of the Foundation To inform programme development To support mid-course corrections in scheme design and implementation To provide evidence to persuade policy-makers, decisionmakers and practitioners To strengthen our accountability

11 Our approach to evaluation Our approach can take researchers (and quality improvement practitioners) out of their comfort zone The paradox of quality improvement research Pronovost s critique of the IHI s 100,000 lives campaign Occupy a middle ground on key methodological debates Data for improvement v. data for judgement Test-beds v. prototypes Randomisation is seldom feasible other considerations are important Combination of process, outcome and theory-driven evaluation Data analysis support to interventions Self-evaluation

12 Some examples Safer Patients Initiative IHI collaborative with four (now twenty) hospitals Controlled trial led by Prof. Richard Lilford Camcorders and snapshots Statistical process control v. traditional statistics Treat different ways of knowing collaboratively Malawi Timescale differences for improvement and research Randomisation Contamination v. diffusion

13 Next steps An organisational theory of change Takes as its starting point Amalberti s work on how healthcare systems become safer A model of organisational impact assessment Have we reduced the gaps between actual and best practice? What have we contributed to public knowledge about quality improvement methods?