Does improving the quality of care from health organisations need research? This was the question asked at the Annual Network Event of the Clinical Research Network for the North East and Cumbria. The network has been successful over the last four years in bringing together a wide range of clinical staff across the region and promoting and supporting high quality health research, which was celebrated at the event, but the organisers didn’t shy away from asking some tough questions.
Q (John de Lancie) pictured behind Captain Jean-Luc Picard (Patrick Stewart)
While the network has put a strong focus on numbers, particularly related to regional recruitment targets for patients in trials, its clinical Director, Professor Stephen Robson, acknowledged that this was only part of the story and that it also ignored what happened later in the research process. For instance, how do we ensure that the research findings get adopted by practice organisations? Brilliant studies are useless if they don’t result in changing clinical practice. But how to change this practice?
The event therefore put a renewed focus on quality improvement. How can we help health professionals to improve their practice? One of the network’s partners, the Academic Health Science Network for the North East and Cumbria (AHSN NENC), joined forces last year with NHS Improvement and the Health Foundation to play a leading role in the national roll out of the Q community.
Unfortunately for us ‘Trekkies’, this is not a new Star Trek episode about the famous Q tormenting various Starfleet Captains; instead, the Q community is a force for good that connects health professionals across the UK to improve health and care quality. The community supports members in their existing improvement work and tries to enhance their skills, helps members to share ideas and enable them to make changes in their organisations that benefit patients.
For this episode, Q came out of the 2013 Berwick report, which followed the publication of the Francis Report into the breakdown of care at the infamous Mid Staffordshire Hospital. The report urged health organisations to make better use of members of staff with improvement expertise and made a case for a system devoted to continual learning and improvement. In response, NHS Improvement (with support from the Health Foundation) developed the Q community in 2015, which now has 236 members in the North East (5000+ nationally) and is expected to grow considerably over the next few years.
I unashamedly applied to become a member of this network last year and they were crazy enough to accept me, so I was looking forward to the Q workshop at the annual event, led by Suzy Cook. The workshop looked at the link between research and quality improvement but, to my surprise, focused on the differences and argued that they should be viewed as separate activities with distinct aims, following different processes and timescales. Research was described as a linear and long-term process that is mostly concerned with the effectiveness of existing and new services, while quality improvement was pictured as a more cyclic and shorter term process with linked PDSA cycles (Plan-Do-Study-Act) that focus on the sustainability of services.
This distinction does not do justice to both activities and feels like a rather odd separation: why can’t research inform what practice needs to improve and how? And what about evaluating quality improvement; isn’t research a key component of the PDSA cycle? Luckily, participants in the workshop raised the same objections and an alternative view was provided in the next workshop by Seamus O’Neill, Chief Executive of AHSN NENC.
He argued instead that there was a clear link between research and quality improvement by looking at the adoption of research in the NHS. Quality improvement needs evidence to select the right intervention in the right context. Just sinking money into an innovation because we think it is going to make a difference will not impress funding and commissioning bodies. At the same time, he warned that many quality improving and cost-saving interventions are not used by health care organisations. They are either not aware of them (clinicians do not read journal articles) or they do not know how to adopt them (how can we make it work here?). According to Seamus, this is where quality improvement can come in: using dedicated health professionals, such as the Q community, and their skills to study, plan, do and act on the research evidence.
Researchers and quality improvement professionals need each other, not to put more clear blue water between them, but to make both activities more useful and effective. Even Q in Star Trek perhaps saw the wisdom of this when he remarked: “I look at the universe in an entirely different way now. I mean, I can’t go around causing temporal anomalies or subspace inversions without considering the impact it’ll have”. (Star Trek: Voyager: The Q and the Grey #3.11, 1996).