Building a solid evidence base

Danielle Doyle of THIS Institute, co-created by the University of Cambridge and the Health Foundation, says the new organisation will dare to try radical new approaches to solving complex health problems – and invites everyone to join them.

Every year, hundreds of babies are born with brain injury because of preventable incidents during labour. Some need lifelong care, resulting in trauma for families and malpractice claims costing the NHS millions of pounds each year. For decades, procedures have been in place to prevent this from happening, such as fetal monitoring, which involves checking babies’ heart rates, interpreting the data and escalating cases. But all too often, they fail to prevent brain injury. So what is going wrong?

This is one of the research questions being tackled by THIS Institute (The Healthcare Improvement Studies Institute) – a new organisation dedicated to developing an evidence base about the best ways to solve complex healthcare problems. Funded by a grant from the Health Foundation, THIS will shed light on sustainable and replicable improvements that work across organisations and systems, creating widescale change.

Quality improvement is increasingly widespread – so what is different about the THIS approach? “The growing interest in quality improvement marks an important cultural shift in healthcare,” said Dr Jenni Burt, senior social scientist at THIS, “but much of it is piecemeal and localised. Sometimes quality improvements in one area can unwittingly create further strain in another. The evidence base for many improvement tools, approaches and techniques is weak, and evaluation is not always rigorous. At THIS Institute, we want to build a solid evidence base so that organisations can confidently apply improvements.”

Another difference is its genuinely multidisciplinary approach – looking at technology, systems, social and cultural factors to get a really nuanced view of a problem. Returning to the fetal monitoring example, Burt explained: “We plan to have ethnographers and system engineers carrying out observations in maternity units. These two disciplines have different ways of working and analysing data. Bring them together and you end up with a completely different, very innovative way of looking at a problem.”

A similar approach is planned for the other research projects in the pipeline, including one looking at the kit carried by ambulance crews, and another looking at operational failures in general practice.

As part of its commitment to working in partnership with staff and patients, THIS will be breaking new ground by asking NHS staff and patients to contribute to systematic reviews, to ensure as wide a reach as possible. It’s launching its own citizen science platform later this year and encouraging everyone, from consultants to porters to carers, to register on the site and get involved in the research. THIS will provide the infrastructure to bring frontline staff and patients together, and is sharing its funding with partners including universities, patient organisations and royal colleges, supporting them to conduct large-scale research.

So clearly, THIS is not your usual academic institute. “I’m sure there will be some scepticism,” accepted Burt. “We won’t be the first academics who’ve suggested ways of doing things differently. But we aren’t about simply studying healthcare and then writing our findings up in journals. It’s unprecedented to have this level of resource and expertise for healthcare improvement, so we can be bold and try some radical approaches that no one else has the resource to do.”

When it comes to maternity care, this new approach could finally shift the stalemate. “People generally don’t go into a situation wanting to make mistakes or do badly: usually, these things happen because of the systems,” she said. “THIS Institute gives us the space to really unpick individual healthcare situations, working with the people on the coal face, solving problems together, and sharing the learning to help produce real change.”




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