Nottingham University Business School

Centre for Health Innovation, Leadership and Learning (CHILL)

The Use of Improvement Methodologies in Clinical Practices

The delivery of healthcare services within the National Health Service is frequently perceived to be in context of ‘crisis’, be it due to increasing public expectation, budgetary constraint or widely reported failings in care.

Although there is some encouraging evidence of improvement in quality and safety, large and inexplicable variations in quality of care are evident across multiple domains and sectors of healthcare. Variations are therefore very difficult to address despite good intentions, policy focus, ambitious improvement programmes and investment of resources. Successful implementation of quality improvement methods requires national policy makers, healthcare managers and frontline staff to know why and how they work.

Care bundles and checklists have become a widely used solution for a range of patient safety and quality issues in healthcare. Their apparent simplicity suggests that their adoption can be used to effectively address complex system issues. However, the evidence for their use is mixed, implementation teams are faced with complex sociological and cultural challenges that continue to dominant regardless of the evidence-base and implementation methodology applied. Therefore, understanding the complex and multiple processes involved in the implementation of care bundles and checklists in order to determine how and why they work will help to define the best implementation strategies.

Project aims

The overall aim is to understand how, amongst the competing pressures of their daily work, frontline clinical teams engage with and integrate care bundles and checklists, aimed at standardising care into their daily work.

  • To understand how clinicians’ interaction with structured clinical improvement methods changes their professional practice.
  • To explore the way in which professionals use such interactions in order to help meet the requirements of their daily work.  

Project highlights

This PhD will study two Trusts that represent a range of acute care services responsible for delivering structured clinical improvement methods in line with local and national requirements. The sepsis care bundles and intentional rounding have been chosen as examples of structured clinical improvement methods because they involve the engagement of more than one healthcare professional. Both doctors and nurses use the sepsis care bundle and nurses and unqualified healthcare assistants utilise intentional rounding in their daily work.

Project team

Student: Charlotte Overton

Supervised by: Professor Justin Waring, Dr Stephen Timmons and Dr Emma Rowley

Funder: The Health Foundation

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Nottingham University Business School

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