Improvement, Sustainability, Spread and Scale

Quality Improvement (QI) projects have been established as important for delivering innovations in healthcare, however, many of these initiatives fail to be effectively implemented, maintained, or spread positive results. In this project area we support the development of theoretical frameworks, tools, and evidence-based guidance on the use in practice of QI methods and on strategies to support the sustainability, spread and scale up of QI interventions.

Research Stream 1: Process mapping in healthcare

Objective: To understand and promote the role of process mapping techniques as an improvement strategy in healthcare services.

Over the last 20 years many healthcare systems have implemented initiatives to improve quality and safety using tools drawn from industrial engineering. Process Mapping (PM), either as a stand-alone methodology, or as part of other QI techniques (e.g. Lean, Six Sigma) is an important tool to identify areas for QI or to understand the settings of interventions.

The use of PM within healthcare improvement projects helps to support understanding of complex healthcare systems and adaptation of improvement interventions to their local context. Studies have highlighted that PM is particularly useful for mapping complex healthcare processes as it provides improvement teams with insight into ‘work as is’ rather than ‘work as imagined’. PM plays a unique role within change processes in providing a shared understanding of complex systems in a way which is readily understandable by a wide range of stakeholders.

It can be seen as a communication tool supporting engagement and collaboration of healthcare professionals within improvement projects, thus supporting their design, implementation and evaluation. Although the informed and systematic use of PM in healthcare is advocated by researchers and practitioners, it is not routinely used in improvement approaches within healthcare organizations. Improved understanding of the use of PM in the healthcare setting is therefore required to ensure that people working in the healthcare environment are aware of the opportunities and benefits offered by the adoption of this versatile and simple technique. Such research can raise awareness on the value of PM as QI method and inform its practical implementation.

In this area we have conducted:

  • A systematic review on PM to increase understanding of its use in healthcare. We developed a conceptual framework to guide effective implementation, assessment, and reporting of PM in healthcare. We assessed adherence of 105 empirical studies (based on knowledge from real-world experience and observations) to quality criteria outlined in a newly created conceptual framework. We identifed common features characterising the use of PM across the selected studies, reported context of use and benefits of using PM in improvement work. Our research has been published in the journal BMC Health Services Research.

  • An empirical study exploring the use of PM in a sample of QI projects conducted by improvement teams in the UK’s National Health Service (NHS) to understand the main benefits achieved by the use of PM in healthcare practice as well as the main success factors of PM within QI projects. Our research has been published in the journal Health Services Management Research.

Research Stream 2: Sustainability, spread and scale

Objective: To explore the sustainability and spread challenges encountered through the implementation of health improvement projects.

With most of the available research focusing on the implementation of QI projects, there is little insight into how to sustain and spread healthcare improvements. This research areas aims to explore the sustainability and spread challenges encountered throughout implementation of QI projects in practice. We explore how sustainability and spread challenges are addressed through specific actions to enhance long term success and scale.

We investigate how models, tools and frameworks can support this process, this includes four active research projects:

  • A study which follows four improvement case studies over a 3-year period to investigate actions and strategies to sustain.

  • A systematic review of published spread and scale models, tools and frameworks to consider how to best guide improvement teams to share their initiatives.

  • A qualitative study of how digital health technologies are used for heart failure care at Chelsea and Westminster hospital and how this learning can be sustained and spread to other NHS sites.

  • A systematic review of reviews exploring the reported benefits, barriers and challenges associated with the implementation, sustainability, scale up and spread of telemedicine during the COVID-19 pandemic.

Our research about sustainability has been published in the journals Health Research Policy and Systems, Journal of Acquired Immune Deficiency Syndromes and Implementation Science.

Our research on the spread of healthcare interventions has been published in BMJ Quality & Safety.

Our research on QI methods has been published in BMJ Quality & Safety.