Background

NHS organisations and clinical services vary significantly in the quality and safety of care they provide to patients. National NHS bodies and regulators have at their disposal a range of interventions to address performance problems in NHS organisations, including concerns relating to quality of care. However, many commonly-applied strategies suffer from an uncertain evidence base regarding their use in NHS settings that may be underperforming, and may not be implemented for the primary purpose of improving quality.

Quality improvement programmes are an important example of interventions designed to improve quality at scale in healthcare, including in challenged organisations. Improvement programmes in the NHS, however, have demonstrated variable impacts on quality and evaluations have tended not to focus on generating learning specifically to support challenged organisations to improve. How interventions such as quality improvement programmes can be optimised to improve quality in challenged NHS organisations is thus an important research need.

Approach

NHS maternity services in England are characterised by persistent variations in quality and thus represent an important focus for producing evidence about how quality improvement interventions can be optimised to improve quality in challenged services. The aim of the PhD project will be to add to the evidence base for supporting challenged healthcare organisations to improve, through a detailed examination of the implementation of a national maternity safety improvement programme.

The project will use qualitative methods to develop in-depth understanding of the distinctive needs of challenged NHS maternity settings in relation to accessing the benefits of the improvement programme, and how the programme might best be adapted to address these. A key task will be to capture the range of relevant contextual influences, and to characterise how the interplay between structure, processes, systems and organisational culture will affect programme delivery and implementation at both service and national level.

James gave a lightning talk about his research project at our 2022 annual event, THIS Space.

James is working on the Avoiding Brain Injury (ABC) collaboration. You can find out more here.