Thread by @DBadenoch

Starting soon at #Quality2021

@QualityForum presents a conversation with @MaryDixonWoods:

How can we improve #improvement in health and health care?

After all, improvement begins at home.

internationalforum.bmj.com/europe/2021/04…

Some significant challenges raised by @MaryDixonWoods

Not least amongst this is the reliance on unvalidated measures.

#Quality2021

This is a substantial task.

Measures need to be co-produced and good enough for evidence-building.

@MaryDixonWoods #Quality2021

It follows therefore that research and evaluation are an important obligation of #improvement programmes.

Well-intentioned efforts can have unforeseen and/or harmful effects

Not all babies are lovely!

@MaryDixonWoods #Quality2021

Good examples of intubation boxes for preventing #COVID transmission.

Seems like a great idea, didn't stack up in practice.

@MaryDixonWoods at #Quality2021; we have learned a new German word: Verschlimmbesserung

"Doing harm whilst trying to do things right"

"The work as imagined is not the same as the work that is done"

Process evaluations are an invaluable tool for untangling these issues.

@MaryDixonWoods #Quality2021

So how do we evaluate #improvement efforts?

We need to be aware of fidelity/loyalty issues, the practical limitations on conventional trial designs and, crucially, the relationship between the stakeholders, esp researchers and practitioners.

#Quality2021 with @MaryDixonWoods

That was a thrilling ride, many thanks to @MaryDixonWoods

Now onto questions.

#Quality2021

As you'd expect, there's lots to choose from.

Q - How can we better use high quality research in QI?

A - We need better channels for QI research, curated by collaborators, for sharing this information.

Idea to @MaryDixonWoods please ;-) #Quality2021

Q - What do we keep a check on our biases?

A - Be aware of the limitations of your evidence; improvement at larger scales allows comparisons to be made within the system.

We need better infrastructure for #improvement research, like we have for clinical research.

#Quality2021

Ultimately, we need to be "democratising what 'good' looks like" into our evaluations.

Many thanks to @MaryDixonWoods for a fascinating session.

Find out more about her work here: thisinstitute.cam.ac.uk/about/people/m…

#Quality2021

Breakout chat was about involving everyone, doing proper evaluation, and scaling up from the "projectised" model.

What are we taking home? Perhaps it's converging around #engagement, avoiding "lovely baby syndrome" and doing rigorous research/evaluation.

#Quality2021