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  1. Article ; Online: Push, pull or co-produce?

    Boaden, Ruth

    Journal of health services research & policy

    2020  Volume 25, Issue 2, Page(s) 67–69

    MeSH term(s) Health Services Research ; Humans ; Interdisciplinary Communication
    Language English
    Publishing date 2020-04-22
    Publishing country England
    Document type Editorial
    ZDB-ID 1330668-6
    ISSN 1758-1060 ; 1355-8196
    ISSN (online) 1758-1060
    ISSN 1355-8196
    DOI 10.1177/1355819620907352
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    Zs.A 4529: Show issues Location:
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  2. Article ; Online: Does the process of developing products for knowledge mobilisation from healthcare research influence their uptake? A comparative case study.

    Sharp, Charlotte A / Boaden, Ruth J / Dixon, William G / Sanders, Caroline

    Implementation science communications

    2022  Volume 3, Issue 1, Page(s) 132

    Abstract: Background: Getting knowledge from healthcare research into practice (knowledge mobilisation) remains a global challenge. One way in which researchers may attempt to do this is to develop products (such as toolkits, actionable tools, dashboards, ... ...

    Abstract Background: Getting knowledge from healthcare research into practice (knowledge mobilisation) remains a global challenge. One way in which researchers may attempt to do this is to develop products (such as toolkits, actionable tools, dashboards, guidance, audit tools, protocols and clinical decision aids) in addition to journal papers. Despite their increasing ubiquity, the development of such products remains under-explored in the academic literature. This study aimed to further this understanding by exploring the development of products from healthcare research and how the process of their development might influence their potential application.
    Methods: This study compared the data generated from a prospective, longitudinal, comparative case study of four research projects which aimed to develop products from healthcare research. Qualitative methods included thematic analysis of data generated from semi-structured interviews (38), meeting observations (83 h) and project documents (300+). Cases were studied for an average of 11.5 months (range 8-19 months).
    Results: Case comparison resulted in the identification of three main themes with the potential to affect the use of products in practice. First, aspects of the product, including the perceived need for the specific product being identified, the clarity of product aim and clarity and range of end-users. Second, aspects of development, whereby different types of stakeholder engagement appear to influence potential product application, which either needs to be 'meaningful', or delivered through the implicit understanding of users' needs by the developing team. The third, overarching theme, relates to the academic context in which products are developed, highlighting how the academic context perpetuates the development of products, which may not always be useful in practice.
    Conclusions: This study showed that aspects of products from healthcare research (need/aim/end-user) and aspects of their development (stakeholder engagement/implicit understanding of end-users) influence their potential application. It explored the motivation for product development and identifies the influence of the current academic context on product development. It shows that there is a tension between ideal 'systems approaches' to knowledge mobilisation and 'linear approaches', which appear to be more pervasive in practice currently. The development of fewer, high-quality products which fulfil the needs of specified end-users might act to counter the current cynicism felt by many stakeholders in regard to products from healthcare research.
    Language English
    Publishing date 2022-12-14
    Publishing country England
    Document type Journal Article
    ISSN 2662-2211
    ISSN (online) 2662-2211
    DOI 10.1186/s43058-022-00360-9
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  3. Article ; Online: Contributors are representative, as long as they agree: How confirmation logic overrides effort to achieve synthesis in applied health research.

    Knowles, Sarah E / Walkington, Pat / Flynn, Jackie / Darley, Sarah / Boaden, Ruth / Kislov, Roman

    Health expectations : an international journal of public participation in health care and health policy

    2022  Volume 25, Issue 5, Page(s) 2405–2415

    Abstract: Introduction: The paradox of representation in public involvement in research is well recognized, whereby public contributors are seen as either too naïve to meaningfully contribute or too knowledgeable to represent 'the average patient'. Given the ... ...

    Abstract Introduction: The paradox of representation in public involvement in research is well recognized, whereby public contributors are seen as either too naïve to meaningfully contribute or too knowledgeable to represent 'the average patient'. Given the underlying assumption that expertise undermines contributions made, more expert contributors who have significant experience in research can be a primary target of criticism. We conducted a secondary analysis of a case of expert involvement and a case of lived experience, to examine how representation was discussed in each.
    Methods: We analysed a case of a Lived Experience Advisory Panel (LEAP) chosen for direct personal experience of a topic and a case of an expert Patient and Public Involvement (PPI) panel. Secondary analysis was of multiple qualitative data sources, including interviews with the LEAP contributors and researchers, Panel evaluation data and documentary analysis of researcher reports of Panel impacts. Analysis was undertaken collaboratively by the author team of contributors and researchers.
    Results: Data both from interviews with researchers and reported observations by the Panel indicated that representation was a concern for researchers in both cases. Consistent with previous research, this challenge was deployed in response to contributors requesting changes to researcher plans. However, we also observed that when contributor input could be used to support research activity, it was described unequivocally as representative of 'the patient view'. We describe this as researchers holding a confirmation logic. By contrast, contributor accounts enacted a synthesis logic, which emphasized multiplicity of viewpoints and active dialogue. These logics are incompatible in practice, with the confirmation logic constraining the potential for the synthesis logic to be achieved.
    Conclusion: Researchers tend to enact a confirmation logic that seeks a monophonic patient voice to legitimize decisions. Contributors are therefore limited in their ability to realize a synthesis logic that would actively blend different types of knowledge. These different logics hold different implications regarding representation, with the synthesis logic emphasizing diversity and negotiation, as opposed to the current system in which 'being representative' is a quality attributed to contributors by researchers.
    Patient or public contribution: Patient contributors are study coauthors, partners in analysis and reporting.
    MeSH term(s) Humans ; Qualitative Research ; Research Personnel ; Patient Participation ; Surveys and Questionnaires ; Logic
    Language English
    Publishing date 2022-08-11
    Publishing country England
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2119434-8
    ISSN 1369-7625 ; 1369-6513
    ISSN (online) 1369-7625
    ISSN 1369-6513
    DOI 10.1111/hex.13555
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    Zs.A 5896: Show issues Location:
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  4. Article: Understanding performance management in primary care.

    Rogan, Lisa / Boaden, Ruth

    International journal of health care quality assurance

    2017  Volume 30, Issue 1, Page(s) 4–15

    Abstract: Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is ...

    Abstract Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.
    MeSH term(s) Cooperative Behavior ; England ; Humans ; Organizational Objectives ; Outcome and Process Assessment (Health Care) ; Primary Health Care/organization & administration ; Quality Indicators, Health Care ; State Medicine/organization & administration
    Language English
    Publishing date 2017-02-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 645125-1
    ISSN 0952-6862 ; 1366-0756
    ISSN 0952-6862 ; 1366-0756
    DOI 10.1108/IJHCQA-10-2015-0128
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  5. Article ; Online: Assessing improvement capability in healthcare organisations: a qualitative study of healthcare regulatory agencies in the UK.

    Furnival, Joy / Boaden, Ruth / Walshe, Kieran

    International journal for quality in health care : journal of the International Society for Quality in Health Care

    2018  Volume 30, Issue 9, Page(s) 715–723

    Abstract: Objectives: Healthcare regulatory agencies are increasingly concerned not just with assessing the current performance of the organisations they regulate, but with assessing their improvement capability to predict their future performance trajectory. ... ...

    Abstract Objectives: Healthcare regulatory agencies are increasingly concerned not just with assessing the current performance of the organisations they regulate, but with assessing their improvement capability to predict their future performance trajectory. This study examines how improvement capability is conceptualised and assessed by healthcare UK regulatory agencies.
    Design: Qualitative analysis of data from six UK healthcare regulatory agencies was conducted. Three data sources were analysed using an a priori framework of eight dimensions of improvement capability identified from an extensive literature review.
    Setting: The focus of the research study was the regulation of hospital-based care, which accounts for the majority of UK healthcare expenditure. Six UK regulatory agencies that review hospital care participated.
    Participants: Data sources included interviews with regulatory staff (n = 48), policy documents (n = 90) and assessment reports (n = 30).
    Intervention: None-this was a qualitative, observational study.
    Results: This research study finds that of eight dimensions of improvement capability, process improvement and learning, and strategy and governance, dominate regulatory assessment practices. The dimension of service-user focus receives the least frequency of use. It may be that dimensions which are relatively easy to 'measure', such as documents for strategy and governance, dominate assessment processes, or there may be gaps in regulatory agencies' assessment instruments, deficits of expertise in improvement capability, or practical difficulties in operationalising regulatory agency intentions to reliably assess improvement capability.
    Conclusions: The UK regulatory agencies seek to assess improvement capability to predict performance trajectories, but out of eight dimensions of improvement capability, two dominate assessment. Furthermore, the definition and meaning of assessment instruments requires development. This would strengthen the validity and reliability of agencies' assessment, diagnosis and prediction of performance trajectories, and support development of more appropriate regulatory performance interventions.
    MeSH term(s) Federal Government ; Humans ; Legislation, Hospital ; Qualitative Research ; Quality Improvement/legislation & jurisprudence ; Quality Improvement/organization & administration ; Quality Improvement/standards ; Quality of Health Care/legislation & jurisprudence ; Quality of Health Care/organization & administration ; Quality of Health Care/standards ; United Kingdom
    Language English
    Publishing date 2018-04-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 1194150-9
    ISSN 1464-3677 ; 1353-4505
    ISSN (online) 1464-3677
    ISSN 1353-4505
    DOI 10.1093/intqhc/mzy085
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  6. Article ; Online: Pre-hospital stroke recognition in a UK centralised stroke system: a qualitative evaluation of current practice.

    Brunton, Lisa / Boaden, Ruth / Knowles, Sarah / Ashton, Christopher / Parry-Jones, Adrian R

    British paramedic journal

    2020  Volume 4, Issue 1, Page(s) 31–39

    Abstract: Background: A significant number of patients conveyed via ambulance to hyper acute stroke units (HASU) with suspected stroke have other diagnoses. This may delay treatment for non-stroke patients and cause burden to stroke teams. The Greater Manchester ( ...

    Abstract Background: A significant number of patients conveyed via ambulance to hyper acute stroke units (HASU) with suspected stroke have other diagnoses. This may delay treatment for non-stroke patients and cause burden to stroke teams. The Greater Manchester (GM) Connected Health Cities (CHC) stroke project links historical North West Ambulance Service NHS Trust (NWAS) data with Salford Royal Hospital electronic data to study stroke pathway compliance and accuracy of paramedic diagnosis and aims to use these data to improve pre-hospital clinicians' accurate recognition of stroke through development of service improvement innovations. We report on supplementary qualitative work required to understand stroke recognition from the pre-hospital clinician's perspective.
    Methods: Focus groups and semi-structured interviews were conducted with pre-hospital clinicians of various grades, working in the GM area of NWAS. Focus groups and interviews were audio recorded and transcribed verbatim. We used thematic analysis informed by normalisation process theory (NPT) to analyse the data. This theory helps us to understand how innovations are developed, implemented and sustained into healthcare practice.
    Results: Sixteen pre-hospital clinicians took part in two focus groups, one dyad interview and five one-to-one interviews. Analysis identified that respondents were unaware of false positive stroke rates entering onto the stroke pathway. Pre-hospital clinicians receive limited feedback from jobs and this impedes their ability to learn from their experiences. Respondents reported difficulty in ruling out stroke in certain patient cohorts and difficulty in recognising differential diagnoses. They expressed a lack of confidence to rule out stroke in the pre-hospital setting. They also expressed greater concern for 'missed strokes'.
    Conclusion: The qualitative findings support the development of innovations to improve accurate recognition of stroke in the pre-hospital setting.An enhanced FAST tool, better relations with HASU clinicians, feedback and education on the stroke pathway and differential diagnoses were all considered useful to improve accurate stroke recognition.
    Language English
    Publishing date 2020-12-02
    Publishing country England
    Document type Journal Article
    ISSN 1478-4726
    ISSN (online) 1478-4726
    DOI 10.29045/14784726.2019.06.4.1.31
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  7. Article ; Online: Emerging hybridity: comparing UK healthcare regulatory arrangements.

    Furnival, Joy / Walshe, Kieran / Boaden, Ruth

    Journal of health organization and management

    2017  Volume 31, Issue 4, Page(s) 517–528

    Abstract: Purpose Healthcare regulation is one means to address quality challenges in healthcare systems and is carried out using compliance, deterrence and/or improvement approaches. The four countries of the UK provide an opportunity to explore and compare ... ...

    Abstract Purpose Healthcare regulation is one means to address quality challenges in healthcare systems and is carried out using compliance, deterrence and/or improvement approaches. The four countries of the UK provide an opportunity to explore and compare different regulatory architecture and models. The purpose of this paper is to understand emerging regulatory models and associated tensions. Design/methodology/approach This paper uses qualitative methods to compare the regulatory architecture and models. Data were collected from documents, including board papers, inspection guidelines and from 48 interviewees representing a cross-section of roles from six organisational regulatory agencies. The data were analysed thematically using an a priori coding framework developed from the literature. Findings The findings show that regulatory agencies in the four countries of the UK have different approaches and methods of delivering their missions. This study finds that new hybrid regulatory models are developing which use improvement support interventions in parallel with deterrence and compliance approaches. The analysis highlights that effective regulatory oversight of quality is contingent on the ability of regulatory agencies to balance their requirements to assure and improve care. Nevertheless, they face common tensions in sustaining the balance in their requirements connected to their roles, relationships and resources. Originality/value The paper shows through its comparison of UK regulatory agencies that the development and implementation of hybrid models is complex. The paper contributes to research by identifying three tensions related to hybrid regulatory models; roles, resources and relationships which need to be managed to sustain hybrid regulatory models.
    Language English
    Publishing date 2017-06-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 2109532-2
    ISSN 1758-7247 ; 1477-7266
    ISSN (online) 1758-7247
    ISSN 1477-7266
    DOI 10.1108/JHOM-06-2016-0109
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  8. Article ; Online: Conceptualizing and assessing improvement capability: a review.

    Furnival, Joy / Boaden, Ruth / Walshe, Kieran

    International journal for quality in health care : journal of the International Society for Quality in Health Care

    2017  Volume 29, Issue 5, Page(s) 604–611

    Abstract: Purpose: The literature is reviewed to examine how 'improvement capability' is conceptualized and assessed and to identify future areas for research.: Data sources: An iterative and systematic search of the literature was carried out across all ... ...

    Abstract Purpose: The literature is reviewed to examine how 'improvement capability' is conceptualized and assessed and to identify future areas for research.
    Data sources: An iterative and systematic search of the literature was carried out across all sectors including healthcare. The search was limited to literature written in English.
    Data extraction: The study identifies and analyses 70 instruments and frameworks for assessing or measuring improvement capability. Information about the source of the instruments, the sectors in which they were developed or used, the measurement constructs or domains they employ, and how they were tested was extracted.
    Results of data synthesis: The instruments and framework constructs are very heterogeneous, demonstrating the ambiguity of improvement capability as a concept, and the difficulties involved in its operationalisation. Two-thirds of the instruments and frameworks have been subject to tests of reliability and half to tests of validity. Many instruments have little apparent theoretical basis and do not seem to have been used widely.
    Conclusion: The assessment and development of improvement capability needs clearer and more consistent conceptual and terminological definition, used consistently across disciplines and sectors. There is scope to learn from existing instruments and frameworks, and this study proposes a synthetic framework of eight dimensions of improvement capability. Future instruments need robust testing for reliability and validity. This study contributes to practice and research by presenting the first review of the literature on improvement capability across all sectors including healthcare.
    MeSH term(s) Efficiency, Organizational ; Humans ; Quality Improvement/organization & administration ; Quality Improvement/standards ; Quality of Health Care/organization & administration ; Quality of Health Care/standards ; Reproducibility of Results ; Staff Development
    Language English
    Publishing date 2017-10-09
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1194150-9
    ISSN 1464-3677 ; 1353-4505
    ISSN (online) 1464-3677
    ISSN 1353-4505
    DOI 10.1093/intqhc/mzx088
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  9. Article ; Online: Learning from the emergence of NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs): a systematic review of evaluations.

    Kislov, Roman / Wilson, Paul M / Knowles, Sarah / Boaden, Ruth

    Implementation science : IS

    2018  Volume 13, Issue 1, Page(s) 111

    Abstract: Background: Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were funded by NIHR in England in 2008 and 2014 as partnerships between universities and surrounding health service organisations, focused on improving the quality ... ...

    Abstract Background: Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were funded by NIHR in England in 2008 and 2014 as partnerships between universities and surrounding health service organisations, focused on improving the quality of healthcare through the conduct and application of applied health research. The aim of this review is to synthesise learning from evaluations of the CLAHRCs.
    Methods: Fifteen databases including CINAHL, MEDLINE, EMBASE and PsycINFO were searched to identify any evaluations of CLAHRCs. Current and archived CLAHRC websites and the reference lists of retrieved articles were scanned to identify any additional evaluations. Searches were restricted to English language only. Any publications from evaluations of the CLAHRCs were eligible for inclusion if they fulfilled at least one of three pre-specified inclusion criteria. A narrative synthesis was undertaken.
    Results: Twenty-six evaluations (reported in 37 papers) were deemed eligible for inclusion. Evaluations focused on describing and exploring the formative partnerships, vision, values, structures and processes of CLAHRCs; the nature and role of boundaries; the deployment of knowledge brokers and hybrid roles to support knowledge mobilisation; patient and public involvement; and capacity building. The relative lack of data about the early impact of CLAHRCs on health care provision or outcomes is notable.
    Conclusions: Much of the evaluative focus on CLAHRCs has been on how they have been organised and on the development of theory around their emergent properties. Evidence is lacking on the impact of CLAHRCs particularly in relation to the knowledge mobilisation processes and practices adopted. Further evaluation of CLAHRCs and other similar research and practice partnerships is warranted and should focus on which knowledge mobilisation approaches work where, how and why.
    Trial registration: PROSPERO (Registration number: CRD42016042945 ).
    MeSH term(s) Cooperative Behavior ; Diffusion of Innovation ; England ; Evidence-Based Practice ; Health Services Research ; Humans ; Leadership ; Quality of Health Care
    Language English
    Publishing date 2018-08-15
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ISSN 1748-5908
    ISSN (online) 1748-5908
    DOI 10.1186/s13012-018-0805-y
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  10. Article ; Online: Improvement capability and performance: a qualitative study of maternity services providers in the UK.

    Darley, Sarah / Walshe, Kieran / Boaden, Ruth / Proudlove, Nathan / Goff, Mhorag

    International journal for quality in health care : journal of the International Society for Quality in Health Care

    2018  Volume 30, Issue 9, Page(s) 692–700

    Abstract: Objective: We explore variations in service performance and quality improvement across healthcare organisations using the concept of improvement capability. We draw upon a theoretically informed framework comprising eight dimensions of improvement ... ...

    Abstract Objective: We explore variations in service performance and quality improvement across healthcare organisations using the concept of improvement capability. We draw upon a theoretically informed framework comprising eight dimensions of improvement capability, firstly to describe and compare quality improvement within healthcare organisations and, secondly to investigate the interactions between organisational performance and improvement capability.
    Design: A multiple qualitative case study using semi-structured interviews guided by the improvement capability framework.
    Setting: Five National Health Service maternity services sites across the UK. We focused on maternity services due to high levels of variation in quality and the availability of performance metrics which enabled us to select organisations from across the performance spectrum.
    Participants: About 52 hospital staff members across the five case studies in positions relevant to the research questions, including midwives, obstetricians and clinical managers/leaders.
    Main outcome measure: A qualitative analysis of narratives of quality improvement and performance in the five case studies, using the improvement capability framework as an analytic device to compare and contrast cases.
    Results: The improvement capability framework has utility in analysing quality improvement within and across organisations. Qualitative differences in the configurations of improvement capability were identified across all providers but were particularly striking between higher and lower performing organisations.
    Conclusions: The improvement capability framework is a useful tool for healthcare organisations to assess, manage and develop their own improvement capabilities. We identified an interaction between performance and improvement capability; higher performing organisations appeared to have more developed improvement capabilities, though the meaning of this relationship requires further research.
    MeSH term(s) Female ; Hospital Administration/methods ; Humans ; Maternal Health Services/standards ; Personnel, Hospital ; Pregnancy ; Qualitative Research ; Quality Improvement/organization & administration ; Quality of Health Care/organization & administration ; Quality of Health Care/standards ; United Kingdom
    Language English
    Publishing date 2018-05-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 1194150-9
    ISSN 1464-3677 ; 1353-4505
    ISSN (online) 1464-3677
    ISSN 1353-4505
    DOI 10.1093/intqhc/mzy081
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