15 October 2020

This is #ELFTQuality & Innovation Awareness Week. Today, ELFT's Chief Quality Officer Dr Amar Shah describes the relationship between research and quality improvement at the Trust. Click here for all the articles in this week's series on R&I.

How would you describe the relationship between research and quality improvement at ELFT? 
There is a strong relationship here between research, innovation and quality improvement.

We have world-leading expertise in research, that has enabled us to develop pioneering treatments and interventions, such as Dialog+. 

More recently we have begun developing our quality improvement expertise at ELFT, with thousands of people, including staff, service users, commissioners and partners, all learning how to apply the systematic method of quality improvement to solve complex quality and safety issues. 

Our early work on violence reduction in inpatient settings began with a literature review to identify the evidence-based interventions that we could test here. 

Our learning from applying quality improvement to develop the safety culture changed bundle that has led to a reduction of 30% in physical violence across the Trust, has now fed into a formal research study to understand the efficacy of these individual interventions. 

Many of the problems we are applying quality improvement to help solve are complex issues to which there is no known proven solution. 

We are therefore bringing creativity and innovation to develop change ideas that can help us discover better ways of providing care, supporting people in improving outcomes.
Are there ever times staff come to QI with ideas for change or improvement they would like to collaborate on, and it has felt more appropriate to approach the problem from a research point of view instead?

Research and quality improvement answer different questions, so for me the key starting point has to be clear about the question we are asking ourselves. 

If we want to understand the efficacy of the particular intervention, then we need a research study to help us understand cause-and-effect more robustly.

However, if we want to test ideas in the real world to see which ones might influence the outcome of interest, and we are happy to accept all of the messiness and complexity that comes with experimenting in the real world, then quality improvement gives us a structured and systematic approach to help us navigate and learn how to improve the system. 

So it is entirely natural that we would need to harness the best of both research and quality improvement in order to build knowledge about which interventions have demonstrable efficacy and to learn which of these might work, and whether they need any adaptation, in our particular context.
Which collaborative projects between R&I and QI have been important markers in terms of the ELFT journey towards continuous improvement & innovation in recent times? 
There are so many examples of work that have relied on research, innovation and quality improvement. 

When we were working across our community teams to improve flow and reduce waiting times from referral to assessment, we looked at the evidence base to understand what interventions might help us reduce the 25% non-attendance at first appointment that we were seeing. 

We drew from the controlled trial of SMS messaging with different wording, to develop tests of change that scale up, as part of our theory of change within the quality improvement work.

How do you see the relationship between quality improvement and research evolving? 
I think we have a great opportunity to bring together our research and improvement knowledge, to accelerate progress towards our mission, which is to improve the quality of life for all we serve. 

I would like to see us find more structured ways to integrate research more firmly into the way that we identify improvement opportunities, and then tackle these. 

We also have a good opportunity, now that our quality improvement approach is relatively well established, to develop a separate innovation process.

Although our quality improvement work relies on creativity and innovation to develop and test change ideas, many organisations have a separate process to identify specific ideas that may have merit, and to test and scale these rapidly. 

This is different from our quality improvement work, which starts by identifying complex challenges to which we often do not know the answer, and where a single idea is unlikely to be the solution.
What advice would you have, for staff who would like to know more about the intersection between R&I and QI?

We have great opportunities here at ELFT for everyone to learn about research and quality improvement, and to get involved in both. 

If you are involved in quality improvement work, I would ask you to think about how you can leverage the learning from research to help inform the ideas that you will be testing. 

And if you are involved in research, I would ask you to think about how your knowledge may be translated into practice through quality improvement to take the ideas, enable teams to own these locally, and adapt them to our context.

To find out more about how to get involved in research at ELFT visit the webpage Getting Involved in Research.

You can contact ELFT’s R&I team for more informationelft.researchoffice@nhs.net