What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Tackling health inequalities can often seem ‘too big’ for individual leaders and clinicians to own and tangibly improve, as responsibility and solutions to social determinants of health are perceived to cross system boundaries, including acute, community and mental health care, education, housing and local government. While patient safety is often not seen as the priority to focus on before harm has occurred (see podcast linked below and https://www.rcpch.ac.uk/news-events/news/patient-safety-podcast-5).

Considering health inequalities through a patient safety lens may provide both tangible focus and measurable frameworks for tracking improvements. Taking a health inequality approach to patient safety may enable improvements to reach the most vulnerable in society, which in turn improves outcomes for all. This is an under-tested area within paediatrics.

This project will explore how this approach can enable partnership across system boundaries, reduce health inequality and improve patient safety outcomes.

What does your project aim to achieve?

This project aims to cover four aspects:

1. Developing initial illustrations of examples of ‘safety – health inequality’ improvement projects alongside a proof of concept that articulates the value of this approach.
2. Co-produced engagement and quasi-Delphi process with experts with experience across system boundaries (e.g. children and young people, improvers, child health practitioners, educators) that develops a view on the viability and potential options for this approach.
3. Production of a range of communication outputs (podcasts, improvement reports, academic articles, webinars, etc.) that illustrate tangible examples of ‘safety – health inequality’ improvement projects alongside a proof of concept of the approach.
4. Production of a design of improvement programme for delivery in a potential stage two to pilot this approach across health boundaries.

How will the project be delivered?

The funding will enable the delivery of the project as described to meet the stated aims. A part-time improvement lead will organise and deliver the project, including interviews, delivery of the adapted Delphi sessions, and production of communications outputs.

The project team will input into the detailed design and delivery of the project.

The first five months will focus on Aim One, building on the current evidence and qualitative interviews (including research and ethics approval if needed).

The next five months will be spent setting up and delivering Aim Two – adapted-Delphi sessions with children and young people and other experts with experience. We will take a trauma informed approach to these sessions, working with a youth specialist clinical psychotherapist and the RCPCH&US team, who are expert in running co-produced sessions in these areas.

The final four months will focus on Aim Three.

How is your project going to share learning?

We will actively ask for and collate input and feedback throughout the project and beyond through our QI Central sharing platform, the Q Community,  and RCPCH communications mechanisms.

We will develop an initial programme theory at the start of the project, which will be adapted and developed throughout the project in response to participant feedback, Q Community and broader feedback.

We will develop outcome and impact measures linked to the programme theory, with data captured during the project – where relevant – and captured after the project, where outcomes and impact are expected after the first year. This is likely to include metrics on understanding of the concept, development and testing in practice and improvements in outcomes from projects tested in this topic.

Part three of the project focuses on developing outputs for shared learning, linked to Aim Three.