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Venugopal R, Shafqat N, Venugopal I, Tillbury BMJ, Stafford HD, Bourazeri A. Privacy preserving Generative Adversarial Networks to model Electronic Health Records. Neural Netw 2022; 153:339-348. [DOI: 10.1016/j.neunet.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/13/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
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Currie G, Spyridonidis D, Oborn E. The influence of HR practices upon knowledge brokering in professional organizations for service improvement: Addressing professional legitimacy and identity in health care. HUMAN RESOURCE MANAGEMENT 2019. [DOI: 10.1002/hrm.22001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Graeme Currie
- Warwick Business SchoolUniversity of Warwick Coventry UK
| | | | - Eivor Oborn
- Warwick Business SchoolUniversity of Warwick Coventry UK
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McAteer J, Di Ruggiero E, Fraser A, Frank JW. Bridging the academic and practice/policy gap in public health: perspectives from Scotland and Canada. J Public Health (Oxf) 2019; 41:632-637. [PMID: 30053047 PMCID: PMC6785667 DOI: 10.1093/pubmed/fdy127] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/06/2018] [Indexed: 11/14/2022] Open
Abstract
This article presents a critical commentary of specific organizational models and practices for bridging 'the gap' between public health research and policy and practice. The authors draw on personal experiences of such models in addition to the wider knowledge translation and exchange literature to reflect on their strengths and weaknesses as implemented in Scotland and Canada since the early 1990s.
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Affiliation(s)
- J McAteer
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, UK
| | - E Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Suite 408 Toronto, Ontario, Canada
| | - A Fraser
- Public Health Science, NHS Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburghx, UK
| | - J W Frank
- The Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, UK
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Mervyn K, Amoo N, Malby R. Challenges and insights in inter-organizational collaborative healthcare networks. INTERNATIONAL JOURNAL OF ORGANIZATIONAL ANALYSIS 2019. [DOI: 10.1108/ijoa-05-2018-1415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Public sectors have responded to grand societal challenges by establishing collaboratives – new inter-organizational partnerships to secure better quality health services. In the UK, a proliferation of collaboration-based healthcare networks exists that could help to enhance the value of investments in quality improvement programs. The nature and organizational form of such improvements is still a subject of debate within the public-sector literature. Place-based collaboration has been proposed as a possible solution. In response, the purpose of this study is to present the results and findings of a place-based collaborative network, highlighting challenges and insights.
Design/methodology/approach
This study adopted a social constructionist epistemological approach, using a qualitative methodology. A single case study was used and data collected in three different stages over a two-year period.
Findings
The study finds that leadership, data-enabled learning through system-wide training and development, and the provision of an enabling environment that is facilitated by an academic partner, can go a long way in the managing of healthcare networks for improving quality.
Research limitations/implications
Regardless of the tensions and challenges with place-based networks, they could still be a solution in maximizing the public value required by government investments in the healthcare sector, as they offer a more innovative structure that can help to address complex issues beyond the remit of hierarchical structures. This study is limited by the use of a single case study.
Practical implications
Across countries health systems are moving away from markets to collaborative models for healthcare delivery and from individual services to population-based approaches. This study provides insights to inform leaders of collaborative health models in the design and delivery of these new collaborations.
Social implications
As demand rises (as a result of increasing complexity and demographics) in the western world, health systems are seeking to redefine the boundaries between health service provision and community self-reliance and resilience. This study provides insights into the new partnership between health institutions and communities, providing opportunities for more social- and solidarity-based healthcare models which place patients and the public at the heart of change.
Originality/value
The city place-based network is the first of such organizational form in healthcare collaboration in the UK.
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Abstract
PURPOSE Many nations are focussing on health care's Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes have been based on a taught curriculum, but the purpose of this paper is to demonstrate more modern approaches through procedures and tools. DESIGN/METHODOLOGY/APPROACH This study evolved from grounded and activity theory foundations (using semi-structured interviews with ten senior healthcare executives and qualitative analysis) which describe obstructions to progress. The study began with the premise that quality and affordable health care are dependent upon collaborative innovation. The growth of new leaders goes from skills to procedures and tools, and from training to development. FINDINGS This paper makes "frugal innovation" recommendations which while not costly in a financial sense, do have practical and social implications relating to the Triple Aim. The research also revealed largely externally driven health care systems under duress suffering from leadership shortages. RESEARCH LIMITATIONS/IMPLICATIONS The study centred primarily on one Canadian community health care services' organisation. Since healthcare provision is place-based (contextual), the findings may not be universally applicable, maybe not even to an adjacent community. PRACTICAL IMPLICATIONS The paper dismisses outdated views of the synonymity of leadership and management, while encouraging clinicians to assume leadership roles. ORIGINALITY/VALUE This paper demonstrates how health care leadership can be developed and sustained.
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Affiliation(s)
- Terry J Boyle
- School of Health and Social Care, London South Bank University , London, UK
| | - Kieran Mervyn
- School of Health and Social Care, London South Bank University , London, UK
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Heaton J, Day J, Britten N. Collaborative research and the co-production of knowledge for practice: an illustrative case study. Implement Sci 2016; 11:20. [PMID: 26897169 PMCID: PMC4761144 DOI: 10.1186/s13012-016-0383-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2008, the National Institute for Health Research (NIHR) began funding a major 5-year pilot research programme of translational research in England, establishing nine 'Collaborations for Leadership in Applied Health Research and Care' (CLAHRCs). A number of evaluations were carried out to examine whether or not the various collaborations worked as intended and why. In this paper, we examine what the theory of co-production adds to understanding of processes of knowledge creation and translation we observed in one of the CLAHRCs. METHODS A case study of a successful knowledge translation project was identified from our wider realist evaluation of the mechanisms of closer collaboration at play in the CLAHRC. In the project, a computer simulation model of an emergency pathway for acute ischaemic stroke was built to explore if and how the time between the onset and treatment of the condition could be minimised by redesigning the pathway. The aim of the case study was to improve our understanding of the nature and workings of the mechanisms of closer collaboration that were associated with the more successful projects by examining the relevance of the theory of co-production. Qualitative methods of analysis were used to explore the fit between the mechanisms of closer collaboration we observed in the realist evaluation and the principles of co-production we identified from the literature. RESULTS We found a close fit between the nine mechanisms of closer collaboration at work in the project and the principles of co-production (active agents; equality of partners; reciprocity and mutuality; transformative; and facilitated). The successful style of collaborative working exemplified by the project was consistent with a strong form of co-production. CONCLUSIONS In our view, the theory of co-production provides useful insights into what it is about the qualities of collaborative working that inspire the requisite mechanisms for generating knowledge that is translated into practice. The theory provides a potentially useful basis for future knowledge translation programmes and projects in applied health research in a range of contexts.
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Affiliation(s)
- Janet Heaton
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, Devon, EX1 2SL, UK.
| | - Jo Day
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, Devon, EX1 2SL, UK.
| | - Nicky Britten
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, Devon, EX1 2SL, UK.
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Soper B, Hinrichs S, Drabble S, Yaqub O, Marjanovic S, Hanney S, Nolte E. Delivering the aims of the Collaborations for Leadership in Applied Health Research and Care: understanding their strategies and contributions. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2008, the National Institute for Health Research (NIHR) in England established nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) to develop partnerships between universities and local NHS organisations focused on improving patient outcomes through the conduct and application of applied health research.ObjectivesThe study explored how effectively the CLAHRCs supported the ‘translation’ of research into patient benefit, and developed ways of doing applied research that maximised its chances of being useful to the service and the capacity of the NHS to respond. It focused on three issues: (1) how the NHS influenced the CLAHRCs, and vice versa; (2) how effective multistakeholder and multidisciplinary research and implementation teams were built in the CLAHRCs; (3) how the CLAHRCs supported the use of research knowledge to change commissioning and clinical behaviour for patient benefit.MethodsThe study adopted an adaptive and emergent approach and incorporated a formative evaluation. An initial phase mapped the landscape of all nine CLAHRCs and the context within which they were established, using document analysis, workshops and interviews, and a literature review. This mapping exercise identified the three research questions that were explored in phase 2 through a stakeholder survey of six CLAHRCs, in-depth case studies of two CLAHRCs, validation interviews with all nine CLAHRCs and the NIHR, and document review.Results(1) The local remit and the requirement for matched NHS funding enhanced NHS influence on the CLAHRCs. The CLAHRCs achieved positive change among those most directly involved, but the larger issue of whether or not the CLAHRCs can influence others in and across the NHS remains unresolved. (2) The CLAHRCs succeeded in engaging different stakeholder groups, and explored what encouraged specific groups to become involved. Being responsive to people’s concerns and demonstrating ‘quick wins’ were both important. (3) There was some evidence that academics were becoming more interested in needs-driven research, and that commissioners were seeing the CLAHRCs as a useful source of support. A growing number of completed projects had demonstrated an impact on clinical practice.ConclusionsThe CLAHRCs have included NHS decision-makers in research and researchers in service decision-making, and encouraged research-informed practice. All the CLAHRCs (as collaborations) adopted relationship models. However, as the complexities of the challenges they faced became clearer, it became obvious that a focus on multidisciplinary relationships was necessary, but not sufficient on its own. Attention also has to be paid to the systems within and through which these relationships operate.Recommendations for researchFuture research should compare areas with an Academic Health Science Network (AHSN) and a CLAHRC with areas with just an AHSN, to understand the difference CLAHRCs make. There should be work on understanding implementation, such as the balancing of rigour and relevance in intervention studies; systemic barriers to and facilitators of implementation; and tailoring improvement interventions. There is also a need to better understand the factors that support the explicit use of research evidence across the NHS, and the processes and mechanisms that support the sustainability and scale-up of implementation projects. Research should place emphasis on examining the role of patient and public involvement in CLAHRCs and of the relation between CLAHRCs and NHS commissioners.FundingThe NIHR Health Services and Delivery Research programme.
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Affiliation(s)
- Bryony Soper
- Health Economics Research Group, Brunel University London, Uxbridge, UK
| | | | | | | | | | - Stephen Hanney
- Health Economics Research Group, Brunel University London, Uxbridge, UK
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Lea S, Callaghan L, Eick S, Heslin M, Morgan J, Bolt M, Healey A, Barrett B, Rose D, Patel A, Thornicroft G. The management of individuals with enduring moderate to severe mental health needs: a participatory evaluation of client journeys and the interface of mental health services with the criminal justice system in Cornwall. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundExisting research identified substantial gaps between NHS mental health services and the criminal justice system for individuals with enduring moderate to severe mental health needs (EMHN). A pilot study in Cornwall echoed these findings, identifying deficiencies in provision at the interface of police and mental health services.AimTo explore the interagency management of individuals with EMHN as they come into contact with the police.DesignA mixed-methods approach within a community psychology framework to enhance the implementation of findings. Stage 1: policy review and clinical audit to identify a sample of mental health service users who were in contact with the police. Stage 2: case-linkage study of 80 service user journeys through services at the time of three types of police contact (Section 136 detention; arrest for criminal offence and contact that did not result in detention); and a health economics component including analysis of the actual cost of 55 service user journeys and enhanced service scenarios. Stage 3: local stakeholder consultation to validate and contextualise case-linkage findings, including a national event.SettingThe research site was the county of Cornwall within the organisational contexts of Cornwall Partnership NHS Foundation Trust and Devon & Cornwall Police.SampleProportionate stratified random sampling identified a sample of 80 cases examined in the case-linkage study from the 538 linked cases identified by the clinical audit.Data sourcesCase-linkage and health economics data involved individuals’ police and mental health records; stakeholder consultation data involved focus groups and interviews.ResultsOf the sample of 80 cases examined, 23 individuals had been detained under Section 136 of the Mental Health Act (1983: Great Britain.Mental Health Act 1983.Chapter 20. London: The Stationery Office; 1983) (accounting for 32 detentions), 52 had been detained in custody on suspicion of an offence (accounting for 126 arrests) and 15 had non-detention contact with the police. Findings showed that where police were aware of mental health needs and individuals were on caseload of a Mental Health Team, there was increased interaction and enhanced outcomes for service users and organisations. The health economics scenario modelling suggests that enhancing services has minimal effects on individual level costs compared with current practice.ConclusionsThe research revealed discrepancy in police and mental health professionals’ assessment of risk and interpretation of protocol and highlighted the need for joint interagency protocols and training to improve information sharing between agencies to enhance the management of individuals with enduring moderate to severe mental health needs.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Susan Lea
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lynne Callaghan
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, Devon, UK
| | - Susan Eick
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, Devon, UK
| | - Margaret Heslin
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - John Morgan
- Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin, Cornwall, UK
| | - Mark Bolt
- Devon & Cornwall Police, Exeter, Devon, UK
| | - Andrew Healey
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Barbara Barrett
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Diana Rose
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anita Patel
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Supplee LH, Metz A. Opportunities and Challenges in Evidence-based Social Policy and commentaries. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/j.2379-3988.2015.tb00081.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Allison Metz
- University of North Carolina at Chapel Hill; National Implementation Research Network
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Coventry P, Lovell K, Dickens C, Bower P, Chew-Graham C, McElvenny D, Hann M, Cherrington A, Garrett C, Gibbons CJ, Baguley C, Roughley K, Adeyemi I, Reeves D, Waheed W, Gask L. Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ 2015; 350:h638. [PMID: 25687344 PMCID: PMC4353275 DOI: 10.1136/bmj.h638] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions. DESIGN Cluster randomised controlled trial. SETTING 36 general practices in the north west of England. PARTICIPANTS 387 patients with a record of diabetes or heart disease, or both, who had depressive symptoms (≥ 10 on patient health questionaire-9 (PHQ-9)) for at least two weeks. Mean age was 58.5 (SD 11.7). Participants reported a mean of 6.2 (SD 3.0) long term conditions other than diabetes or heart disease; 240 (62%) were men; 360 (90%) completed the trial. INTERVENTIONS Collaborative care included patient preference for behavioural activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse. Usual care was standard clinical practice provided by general practitioners and practice nurses. MAIN OUTCOME MEASURES The primary outcome was reduction in symptoms of depression on the self reported symptom checklist-13 depression scale (SCL-D13) at four months after baseline assessment. Secondary outcomes included anxiety symptoms (generalised anxiety disorder 7), self management (health education impact questionnaire), disability (Sheehan disability scale), and global quality of life (WHOQOL-BREF). RESULTS 19 general practices were randomised to collaborative care and 20 to usual care; three practices withdrew from the trial before patients were recruited. 191 patients were recruited from practices allocated to collaborative care, and 196 from practices allocated to usual care. After adjustment for baseline depression score, mean depressive scores were 0.23 SCL-D13 points lower (95% confidence interval -0.41 to -0.05) in the collaborative care arm, equal to an adjusted standardised effect size of 0.30. Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care. There were no significant differences between groups in quality of life, disease specific quality of life, self efficacy, disability, and social support. CONCLUSIONS Collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity. The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity. TRIAL REGISTRATION ISRCTN80309252.
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Affiliation(s)
- Peter Coventry
- NIHR Collaboration for Leadership in Applied Health Research and Care, Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Chris Dickens
- Institute of Health Service Research, University of Exeter Medical School, Exeter EX1 2LU, UK
| | - Peter Bower
- NIHR School for Primary Care Research and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, and NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, University of Keele, Keele ST5 5BG, UK
| | - Damien McElvenny
- NIHR Collaboration for Leadership in Applied Health Research and Care, Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Mark Hann
- Centre for Biostatistics and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Andrea Cherrington
- Research Institute, Primary Care and Health Sciences, University of Keele, Keele ST5 5BG, UK
| | - Charlotte Garrett
- Centre for Primary Care and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Chris J Gibbons
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK
| | - Clare Baguley
- NHS Health Education North West, Manchester M1 3BN, UK
| | - Kate Roughley
- Division of Clinical Psychology, University of Liverpool, Liverpool L69 3GB, UK
| | - Isabel Adeyemi
- NIHR Collaboration for Leadership in Applied Health Research and Care, Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - David Reeves
- NIHR School for Primary Care Research and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Waquas Waheed
- Lancashire Care NHS Foundation Trust, Preston PR5 6AW, UK
| | - Linda Gask
- Centre for Primary Care and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
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Kislov R, Waterman H, Harvey G, Boaden R. Rethinking capacity building for knowledge mobilisation: developing multilevel capabilities in healthcare organisations. Implement Sci 2014; 9:166. [PMID: 25398428 PMCID: PMC4234886 DOI: 10.1186/s13012-014-0166-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/19/2014] [Indexed: 11/29/2022] Open
Abstract
Background Knowledge mobilisation in healthcare organisations is often carried out through relatively short-term projects dependent on limited funding, which raises concerns about the long-term sustainability of implementation and improvement. It is becoming increasingly recognised that the translation of research evidence into practice has to be supported by developing the internal capacity of healthcare organisations to engage with and apply research. This process can be supported by external knowledge mobilisation initiatives represented, for instance, by professional associations, collaborative research partnerships and implementation networks. This conceptual paper uses empirical and theoretical literature on organisational learning and dynamic capabilities to enhance our understanding of intentional capacity building for knowledge mobilisation in healthcare organisations. Discussion The discussion is structured around the following three themes: (1) defining and classifying capacity building for knowledge mobilisation; (2) mechanisms of capability development in organisational context; and (3) individual, group and organisational levels of capability development. Capacity building is presented as a practice-based process of developing multiple skills, or capabilities, belonging to different knowledge domains and levels of complexity. It requires an integration of acquisitive learning, through which healthcare organisations acquire knowledge and skills from knowledge mobilisation experts, and experience-based learning, through which healthcare organisations adapt, absorb and modify their knowledge and capabilities through repeated practice. Although the starting point for capability development may be individual-, team- or organisation-centred, facilitation of the transitions between individual, group and organisational levels of learning within healthcare organisations will be needed. Summary Any initiative designed to build capacity for knowledge mobilisation should consider the subsequent trajectory of newly developed knowledge and skills within the recipient healthcare organisations. The analysis leads to four principles underpinning a practice-based approach to developing multilevel knowledge mobilisation capabilities: (1) moving from ‘building’ capacity from scratch towards ‘developing’ capacity of healthcare organisations; (2) moving from passive involvement in formal education and training towards active, continuous participation in knowledge mobilisation practices; (3) moving from lower-order, project-specific capabilities towards higher-order, generic capabilities allowing healthcare organisations to adapt to change, absorb new knowledge and innovate; and (4) moving from single-level to multilevel capability development involving transitions between individual, group and organisational learning.
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Affiliation(s)
- Roman Kislov
- Manchester Business School, The University of Manchester, Room D38 MBS East, Booth Street West, Manchester, M15 6PB, UK.
| | - Heather Waterman
- School of Nursing, Midwifery and Social Work, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Gill Harvey
- Manchester Business School, The University of Manchester, Room D38 MBS East, Booth Street West, Manchester, M15 6PB, UK. .,School of Nursing, The University of Adelaide, Level 3, Eleanor Harrald Building, Adelaide, 5005, SA, Australia.
| | - Ruth Boaden
- Manchester Business School, The University of Manchester, Room D38 MBS East, Booth Street West, Manchester, M15 6PB, UK.
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Bentley CL, Mountain GA, Thompson J, Fitzsimmons DA, Lowrie K, Parker SG, Hawley MS. A pilot randomised controlled trial of a Telehealth intervention in patients with chronic obstructive pulmonary disease: challenges of clinician-led data collection. Trials 2014; 15:313. [PMID: 25100550 PMCID: PMC4131041 DOI: 10.1186/1745-6215-15-313] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients' vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a pilot randomised controlled trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. METHODS A two-arm pragmatic pilot RCT was conducted comparing the standard service with a Telehealth-supported service and assessed the potential for progressing into a full RCT. The co-primary outcome measures were the proportion of COPD patients readmitted to hospital and changes in patients' self-reported quality of life. The objectives were to assess the suitability of the methodology, produce a sample size calculation for a full RCT, and to give an indication of cost-effectiveness for both pathways. RESULTS Sixty three participants were recruited (n = 31 Standard; n = 32 Telehealth); 15 participants were excluded from analysis due to inadequate data completion or withdrawal from the Telehealth arm. Recruitment was slow with significant gaps in data collection, due predominantly to an unanticipated 60% reduction of staff capacity within the clinical team. The sample size calculation was guided by estimates of clinically important effects and COPD readmission rates derived from the literature. Descriptive analyses showed that the standard service group had a lower proportion of patients with hospital readmissions and a greater increase in self-reported quality of life compared to the Telehealth-supported group. Telehealth was cost-effective only if hospital admissions data were excluded. CONCLUSIONS Slow recruitment rates and service reconfigurations prevented progression to a full RCT. Although there are advantages to conducting an RCT with data collection conducted by a frontline clinical team, in this case, challenges arose when resources within the team were reduced by external events. Gaps in data collection were resolved by recruiting a research nurse. This study reinforces previous findings regarding the difficulty of undertaking evaluation of complex interventions, and provides recommendations for the introduction and evaluation of complex interventions within clinical settings, such as prioritisation of research within the clinical remit. TRIAL REGISTRATION Current Controlled Trials ISRCTN68856013, registered Nov 2010.
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Affiliation(s)
- Claire L Bentley
- />School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA England
| | - Gail A Mountain
- />School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA England
| | - Jill Thompson
- />School of Nursing and Midwifery, The University of Sheffield, Barber House Annexe, 3a Clarkehouse Road, Sheffield, S10 2LA England
| | | | - Kinga Lowrie
- />School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA England
| | - Stuart G Parker
- />Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon, Tyne NE4 5PL UK
| | - Mark S Hawley
- />School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA England
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Ovretveit J, Hempel S, Magnabosco JL, Mittman BS, Rubenstein LV, Ganz DA. Guidance for research-practice partnerships (R-PPs) and collaborative research. J Health Organ Manag 2014; 28:115-26. [PMID: 24783669 DOI: 10.1108/jhom-08-2013-0164] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to provide evidence based guidance to researchers and practice personnel about forming and carrying out effective research partnerships. DESIGN/METHODOLOGY/APPROACH A review of the literature, interviews and discussions with colleagues in both research and practice roles, and a review of the authors' personal experiences as researchers in partnership research. FINDINGS Partnership research is, in some respects, a distinct "approach" to research, but there are many different versions. An analysis of research publications and of their research experience led the authors to develop a framework for planning and assessing the partnership research process, which includes defining expected outcomes for the partners, their roles, and steps in the research process. PRACTICAL IMPLICATIONS This review and analysis provides guidance that may reduce commonly-reported misunderstandings and help to plan more successful partnerships and projects. It also identifies future research which is needed to define more precisely the questions and purposes for which partnership research is most appropriate, and methods and designs for specific types of partnership research. ORIGINALITY/VALUE As more research moves towards increased participation of practitioners and patients in the research process, more precise and differentiated understanding of the different partnership approaches is required, and when each is most suitable. This article describes research approaches that have the potential to reduce "the research-practice gap". It gives evidence- and experience-based guidance for choosing and establishing a partnership research process, so as to improve partnership relationship-building and more actionable research.
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Hinchcliff R, Greenfield D, Braithwaite J. Is it worth engaging in multi-stakeholder health services research collaborations? Reflections on key benefits, challenges and enabling mechanisms. Int J Qual Health Care 2014; 26:124-8. [DOI: 10.1093/intqhc/mzu009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oborn E, Barrett M, Prince K, Racko G. Balancing exploration and exploitation in transferring research into practice: a comparison of five knowledge translation entity archetypes. Implement Sci 2013; 8:104. [PMID: 24007259 PMCID: PMC3847109 DOI: 10.1186/1748-5908-8-104] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/22/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Translating knowledge from research into clinical practice has emerged as a practice of increasing importance. This has led to the creation of new organizational entities designed to bridge knowledge between research and practice. Within the UK, the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) have been introduced to ensure that emphasis is placed in ensuring research is more effectively translated and implemented in clinical practice. Knowledge translation (KT) can be accomplished in various ways and is affected by the structures, activities, and coordination practices of organizations. We draw on concepts in the innovation literature--namely exploration, exploitation, and ambidexterity--to examine these structures and activities as well as the ensuing tensions between research and implementation. METHODS Using a qualitative research approach, the study was based on 106 semi-structured, in-depth interviews with the directors, theme leads and managers, key professionals involved in research and implementation in nine CLAHRCs. Data was also collected from intensive focus group workshops. RESULTS In this article we develop five archetypes for organizing KT. The results show how the various CLAHRC entities work through partnerships to create explorative research and deliver exploitative implementation. The different archetypes highlight a range of structures that can achieve ambidextrous balance as they organize activity and coordinate practice on a continuum of exploration and exploitation. CONCLUSION This work suggests that KT entities aim to reach their goals through a balance between exploration and exploitation in the support of generating new research and ensuring knowledge implementation. We highlight different organizational archetypes that support various ways to maintain ambidexterity, where both exploration and exploitation are supported in an attempt to narrow the knowledge gaps. The KT entity archetypes offer insights on strategies in structuring collaboration to facilitate an effective balance of exploration and exploitation learning in the KT process.
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Affiliation(s)
- Eivor Oborn
- Warwick Business School, The University of Warwick, Coventry CV4 7AL, UK
| | - Michael Barrett
- Judge Business School, University of Cambridge, Cambridge CB2 1AG, UK
| | - Karl Prince
- Judge Business School, University of Cambridge, Cambridge CB2 1AG, UK
| | - Girts Racko
- Warwick Business School, The University of Warwick, Coventry CV4 7AL, UK
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Martin GP, McNicol S, Chew S. Towards a new paradigm in health research and practice? Collaborations for Leadership in Applied Health Research and Care. J Health Organ Manag 2013; 27:193-208. [PMID: 23802398 DOI: 10.1108/14777261311321770] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are a new UK initiative to promote collaboration between universities and healthcare organisations in carrying out and applying the findings of applied health research. But they face significant, institutionalised barriers to their success. This paper seeks to analyse these challenges and discuss prospects for overcoming them. DESIGN/METHODOLOGY/APPROACH The paper draws on in-depth qualitative interview data from the first round of an ongoing evaluation of one CLAHRC to understand the views of different stakeholders on its progress so far, challenges faced, and emergent solutions. FINDINGS The breadth of CLAHRCs' missions seems crucial to mobilise the diverse stakeholders needed to succeed, but also produces disagreement about what the prime goal of the Collaborations should be. A process of consensus building is necessary to instil a common vision among CLAHRC members, but deep-seated institutional divisions continue to orient them in divergent directions, which may need to be overcome through other means. ORIGINALITY/VALUE This analysis suggests some of the key means by which those involved in joint enterprises such as CLAHRCs can achieve consensus and action towards a current goal, and offers recommendations for those involved in their design, commissioning and performance management.
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Affiliation(s)
- Graham P Martin
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, Leicester, UK.
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Developing communities of practice to support the implementation of research into clinical practice. Leadersh Health Serv (Bradf Engl) 2013. [DOI: 10.1108/17511871311291705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kothari A, Wathen CN. A critical second look at integrated knowledge translation. Health Policy 2012; 109:187-91. [PMID: 23228520 DOI: 10.1016/j.healthpol.2012.11.004] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 09/10/2012] [Accepted: 11/08/2012] [Indexed: 11/29/2022]
Abstract
Integrated knowledge translation (IKT) requires active collaboration between researchers and the ultimate users of knowledge throughout a research process, and is being aggressively positioned as an essential strategy to address the problem of underutilization of research-derived knowledge. The purpose of this commentary is to assist potential "knowledge users", particularly those working in policy or service settings, by highlighting some of the more nuanced benefits of the IKT model, as well as some of its potential costs. Actionable outcomes may not be immediately (or ever) forthcoming, but the process of collaboration can result in group-level identity transformation that permits access to different professional perspectives as well as, we suggest, added organizational and social value. As well, the IKT approach provides space for the re-balancing of what is considered "expertise". We offer this paper to help practitioners, administrators and policymakers more realistically assess the potential benefits and costs of engaging in IKT-oriented research.
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Affiliation(s)
- Anita Kothari
- School of Health Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.
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Suleman J, Anwar MS, Weston C, Baker R. Use of outcomes in monitoring healthcare - how many outcome measures are needed in monitoring diabetes in primary care? J R Soc Med 2011; 104:413-20. [PMID: 21969479 DOI: 10.1258/jrsm.2011.110064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the relationship between patient experience assessed through surveys of random samples of practice populations and intermediate outcome targets in those patients with diabetes, collected in the Quality and Outcomes Framework pay-for-performance scheme. DESIGN Cross-sectional study. SETTING The East Midlands region of England. PARTICIPANTS Six hundred and twenty-nine general practices. MAIN OUTCOME MEASURES Logistic regression models were used to assess whether practice-level reports of patient experience of access and consultations were associated with achievement of treatment targets (HbA1c of 7.5% and 10% or lower, BP 145/85 mmHg or lower, and cholesterol 5 mmol/L or lower) in people with diabetes. Survey respondent characteristics (ethnicity, age, sex) and practice size, deprivation, and prevalence of diabetes and obesity were also assessed within the models. RESULTS Patient experience of practice populations explained little of the variation in diabetes treatment targets. In the practice survey, the proportion of respondents who had seen a nurse in the last 6 months was associated with increased likelihood of achieving HbA1c of 7.5%, and being involved in decision-making or having tests and treatment explained were associated with achievement of HbA1c of 10% or less, cholesterol of 5 mmol/L or less, and BP of 145/85 or less. CONCLUSIONS Although patient experience at practice level should be included in monitoring outcomes, it should not replace monitoring clinical outcomes in diabetes. A mix of clinical and patient experience measures will have to be used to monitor outcomes in general practice.
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Affiliation(s)
- Javid Suleman
- Department of Health Sciences, University of Leicester, Leicester, UK
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Harvey G, Fitzgerald L, Fielden S, McBride A, Waterman H, Bamford D, Kislov R, Boaden R. The NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy. Implement Sci 2011; 6:96. [PMID: 21861886 PMCID: PMC3170237 DOI: 10.1186/1748-5908-6-96] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 08/23/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In response to policy recommendations, nine National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were established in England in 2008, aiming to create closer working between the health service and higher education and narrow the gap between research and its implementation in practice. The Greater Manchester (GM) CLAHRC is a partnership between the University of Manchester and twenty National Health Service (NHS) trusts, with a five-year mission to improve healthcare and reduce health inequalities for people with cardiovascular conditions. This paper outlines the GM CLAHRC approach to designing and evaluating a large-scale, evidence- and theory-informed, context-sensitive implementation programme. DISCUSSION The paper makes a case for embedding evaluation within the design of the implementation strategy. Empirical, theoretical, and experiential evidence relating to implementation science and methods has been synthesised to formulate eight core principles of the GM CLAHRC implementation strategy, recognising the multi-faceted nature of evidence, the complexity of the implementation process, and the corresponding need to apply approaches that are situationally relevant, responsive, flexible, and collaborative. In turn, these core principles inform the selection of four interrelated building blocks upon which the GM CLAHRC approach to implementation is founded. These determine the organizational processes, structures, and roles utilised by specific GM CLAHRC implementation projects, as well as the approach to researching implementation, and comprise: the Promoting Action on Research Implementation in Health Services (PARIHS) framework; a modified version of the Model for Improvement; multiprofessional teams with designated roles to lead, facilitate, and support the implementation process; and embedded evaluation and learning. SUMMARY Designing and evaluating a large-scale implementation strategy that can cope with and respond to the local complexities of implementing research evidence into practice is itself complex and challenging. We present an argument for adopting an integrative, co-production approach to planning and evaluating the implementation of research into practice, drawing on an eclectic range of evidence sources.
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Affiliation(s)
- Gill Harvey
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Louise Fitzgerald
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Sandra Fielden
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Anne McBride
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Heather Waterman
- School of Nursing, Midwifery and Social Work, University of Manchester
| | - David Bamford
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Roman Kislov
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Ruth Boaden
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
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Rycroft-Malone J, Wilkinson JE, Burton CR, Andrews G, Ariss S, Baker R, Dopson S, Graham I, Harvey G, Martin G, McCormack BG, Staniszewska S, Thompson C. Implementing health research through academic and clinical partnerships: a realistic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC). Implement Sci 2011; 6:74. [PMID: 21771329 PMCID: PMC3168414 DOI: 10.1186/1748-5908-6-74] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 07/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The English National Health Service has made a major investment in nine partnerships between higher education institutions and local health services called Collaborations for Leadership in Applied Health Research and Care (CLAHRC). They have been funded to increase capacity and capability to produce and implement research through sustained interactions between academics and health services. CLAHRCs provide a natural 'test bed' for exploring questions about research implementation within a partnership model of delivery. This protocol describes an externally funded evaluation that focuses on implementation mechanisms and processes within three CLAHRCs. It seeks to uncover what works, for whom, how, and in what circumstances. DESIGN AND METHODS This study is a longitudinal three-phase, multi-method realistic evaluation, which deliberately aims to explore the boundaries around knowledge use in context. The evaluation funder wishes to see it conducted for the process of learning, not for judging performance. The study is underpinned by a conceptual framework that combines the Promoting Action on Research Implementation in Health Services and Knowledge to Action frameworks to reflect the complexities of implementation. Three participating CLARHCS will provide in-depth comparative case studies of research implementation using multiple data collection methods including interviews, observation, documents, and publicly available data to test and refine hypotheses over four rounds of data collection. We will test the wider applicability of emerging findings with a wider community using an interpretative forum. DISCUSSION The idea that collaboration between academics and services might lead to more applicable health research that is actually used in practice is theoretically and intuitively appealing; however the evidence for it is limited. Our evaluation is designed to capture the processes and impacts of collaborative approaches for implementing research, and therefore should contribute to the evidence base about an increasingly popular (e.g., Mode two, integrated knowledge transfer, interactive research), but poorly understood approach to knowledge translation. Additionally we hope to develop approaches for evaluating implementation processes and impacts particularly with respect to integrated stakeholder involvement.
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Affiliation(s)
- Jo Rycroft-Malone
- Centre for Health-Related Research, School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Joyce E Wilkinson
- Centre for Health-Related Research, School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Christopher R Burton
- Centre for Health-Related Research, School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Gavin Andrews
- Faculty of Social Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Steven Ariss
- ICOSS, School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Richard Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sue Dopson
- Said Business School, University of Oxford, Oxford, UK
| | - Ian Graham
- Canadian Institutes of Health Research, Elgin Street, Ottawa, Ontario, Canada
| | - Gill Harvey
- Manchester Business School, University of Manchester, Manchester, UK
| | - Graham Martin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Brendan G McCormack
- Institute of Nursing Research, University of Ulster, Coleraine, Co. Londonderry, N. Ireland
| | | | - Carl Thompson
- Department of Health Sciences, University of York, Heslington, York, UK
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Baker R, Tang MY. The role of research in helping general practice commission efficient healthcare. LONDON JOURNAL OF PRIMARY CARE 2011; 4:27-32. [PMID: 25949644 DOI: 10.1080/17571472.2011.11493324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/31/2011] [Indexed: 10/23/2022]
Abstract
The new commissioning consortia face a major challenge in improving the efficiency of the NHS. They are new organisations, and at the same time as establishing themselves they need to overcome significant obstacles to reforming services. Research evidence about the value of care can help consortia achieve efficiencies, but there are often delays between the provision of evidence and its routine use in policy and practice. The National Institute for Health Research (NIHR) has invested substantial funding in providing evidence for the NHS, and in this article we discuss how consortia can make sure they obtain and apply relevant evidence as quickly as possible, and also generate evidence on practical questions such as the impact of redesigned services. Partnership with NIHR research organizations, particularly the Collaborations for Leadership in Applied Research and Care (CLAHRCs), offer one approach to helping consortia commission efficient health care.
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Affiliation(s)
| | - Mei Yee Tang
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR)
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Rogers A, Vassilev I, Sanders C, Kirk S, Chew-Graham C, Kennedy A, Protheroe J, Bower P, Blickem C, Reeves D, Kapadia D, Brooks H, Fullwood C, Richardson G. Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support. Implement Sci 2011; 6:56. [PMID: 21619695 PMCID: PMC3120720 DOI: 10.1186/1748-5908-6-56] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 05/29/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support. METHODS Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support. DISCUSSION The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.
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Affiliation(s)
- Anne Rogers
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Ivaylo Vassilev
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Caroline Sanders
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Susan Kirk
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Anne Kennedy
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Joanne Protheroe
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Peter Bower
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Christian Blickem
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - David Reeves
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Dharmi Kapadia
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Helen Brooks
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Catherine Fullwood
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
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