How to improve healthcare improvement—an essay by Mary Dixon-Woods

Abstract

As improvement practice and research begin to come of age, Mary Dixon-Woods considers the key areas that need attention if we are to reap their benefits

A qualitative study of design stakeholders’ views of developing and implementing a registry-based learning health system

“…The way that I see the basics of this, is that you know we are putting patient-reported data, […] and some of the clinically collected data, on the same playing field. (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) In the follow-up (phase 2) interviews, participants suggested thinking of the clinical encounter as involving two experts: the clinician, an expert in biomedical knowledge, and the patient, an expert in their own experience of living with a life-limiting illness. It was proposed that this reconfigured relationship would result in new forms of partnership.…”

“…I think of it as the lead team […] we have involved interdisciplinary clinical teams, including patients and family members in each of those five settings, they are the lead teams that are looking at this model that we are looking at, and coming to understand it, and helping to decide what those dashboards look like, what the information technology solution approach will be and the CF Foundation is at the table as well. (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) Participants consistently identified the key stakeholders in the project as the patients and their families, the care team, and the Cystic Fibrosis Foundation, as well as senior executives in individual organizations. Others included electronic health record vendors, specialist pharmacies, researchers, and regulators and payers.…”

“…To help make decisions about how well the treatment plans are working, to help inform the conversation about the best next steps in the treatment plan, based on patient preference and evidence base. (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) Participants identified that for these goals to be achieved, the technical infrastructure would need to meet several key requirements. In particular, it would need to be technically capable of supporting clinical care, research, and improvement; create an easy, non-frustrating way for patients to record data and make direct inputs to their own health records; help clinicians to record and view key clinical measures without irritating them or slowing them down; and enable both sets of data (patient-generated and cliniciangenerated) to be displayed visually for easy use by patients, families, and clinicians as part of routine visits.…”

“…Despite enthusiasm for the principles of a learning health system, few real-life examples exist [9,10] such that "a learning health system remains an aspiration rather than an achievement" [3]. The risk is that, unless early models are studied [11], learning health systems may not mature to the point where their ambitions can be delivered. In this article, we report a study of the views of design stakeholders of a program known as "Enabling Uptake of a Registry-Supported Care and Learning System in the US" (RCLS) for people with cystic fibrosis (CF).…”

Beyond barriers and facilitators: the central role of practical knowledge and informal networks in implementing infection prevention interventions

“…The three meta-themes related to implementation success identified through Clack et al ’s analysis—implementation agendas, resources and boundary spanners—highlight the key role that practical knowledge and informal networks play in impacting how interventions are ‘metabolised’ by hospitals 9. Practical knowledge involves skills and intelligence that people acquire based on their ‘insider’ or local experience.…”