Improving perioperative care on a national scale
A fellowship improving perioperative care on a national scale
A holistic assessment of an older person’s medical, physiological and physical condition before surgery can offer potential patient benefits through targeting interventions that reduce the risk of complication and improve recovery. Justin’s fellowship project studied the POPS model which was developed to provide a holistic assessment of an older person’s condition prior to surgery. The model brought together various teams in the surgical and recovery process to benefit the patient, and Justin examined the role out of the model. But scaling innovation nationally is complex and not always successful.
Justin said, “This was an innovation in the surgical care of older people that was in a sense ‘bottom-up’ and being led by clinicians (rather than being forced upon clinicians, top-down). And yet at the same time, POPS had the potential to transform the working relationships between geriatricians, surgeons and anaesthetists.” Focusing on six NHS hospital sites, Justin interviewed geriatricians, surgeons, anaesthetists, and nurses to trace how the POPS model had been spread, adapted, and adopted in practice. The evidence generated showed the model being implemented across more sites (and along with the support of NHS Elect), Justin worked to understand how the POPS team managed to avoid many of the pitfalls that hinder the take up of innovations, and he looked closely at the tactics used by clinical leaders and advocates.
Key findings from his research showed that success depended on several factors. These included piloting within defined pathways to generate local evidence, actively engaging potentially sceptical clinicians by demonstrating how the innovation could be undertaken with minimal disruption, strong leadership, and sustained effort to build legitimacy working within existing professional practice.
Continuing to build on the fellowship project findings
Something that stood out to Justin during the research process was the incredible leadership support that rallied behind POPS, not only introducing and sustaining a new model of working at their own hospital, but in spreading this across the country and even internationally. “They have been very entrepreneurial and used a range of strategies to secure buy-in from a range of professional and managerial groups and when I attended the British Geriatrics Society conference, the leadership team behind the implementation were superstars – they have had such a massive influence on their professional community.”
With more progress to achieve in this area, Justin’s fellowship study helped by providing foundational research for the implementation component of a follow up project which received funding from National Institute for Health and Care Research (NIHR). By using his fellowship’s preliminary framework to understand the implementation processes, the ‘POPS-SUp’ (POPS Scale-Up) study will look at the way POPS can work and how it can be introduced at scale. The POPS-SUp study will include a trial and large-scale implementation study.
“The POPS study had rekindled my interest in the study of inter-professional working and how the relationships between professional specialities evolves over time. This includes attention to not only the competition or tensions between groups, but also how they can coordinate their activities in more complementary ways.”
Multidisciplinary research to improve healthcare
Justin has a longstanding interest in how innovations and improvements in health and care systems become implemented and embedded in everyday practice (and in some cases, how they don’t become embedded or how they’re adapted through the processes of implementation). Prior to his fellowship, he conducted a series of studies on patient safety reporting and analysis, lean healthcare, public-private partnerships.
In addition to his fellowship project and as Director of BRACE the Birmingham, RAND, and Cambridge Rapid Service Evaluation, Justin helped secure £3 million in funding from the NIHR for five years of research. In partnership with THIS Institute, the BRACE Centre is made up of a team of multidisciplinary researchers conducting rapid evaluations of promising new services and innovations in health and social care.
Justin and the team continue to research what works, how and why things work (or don’t) and in what context in close collaboration with NHS staff, patients, the public, and other stakeholders. The centre’s outputs will provide decision makers with high quality evidence about the potential benefits of promising new service innovations. Prior to Justin joining BRACE, the team worked on rapid evaluations of issues such as the early implementation of primary care networks, virtual wards during COVID-19, the children and young people’s mental health trailblazer programme, and women’s health hubs. They also explored evaluations of patient referral pathways to the NHS Digital Weight Management Programmes, and the NHS General Practice Improvement Programme.