Writing up improvement work for impact and implementation Helen Crisp Assistant Director Research and Evaluation

Writing up improvement work for impact and implementationHelen CrispAssistant DirectorResearch and Evaluation

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Reporting for impact and implementation

Aim:

To encourage better reporting of improvement work to encourage spread of successful approaches


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Why don’t we learn from improvement projects?

Around the world 1,000s of improvement projects in healthcare:• Some make a difference• Others don’t work

- but what do we learn from them?


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We could learn, if . . . Reports on improvement work told us not only the results but also:• how the initiative was designed• what were the core components• what measures and data were used to

measure the change• what challenges were overcome along the

way• how they were overcome• what the team would do differently in the

future


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Part of the problem Many improvement reports amount to

“See we did X!”

versus

“Here’s what we had to do to achieve X”

Only your team (and possibly your parents) are interested in the first

More people will care about the second


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Writing up for implementation

Improvement reports need to provide enough detail:

• to convey credibly that something worked

• to give others insight on what they would

have to do replicate in their clinical setting

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Common problemsReporting for impact and implementation

• Reports lack important details about key

ingredients of intervention and institutional

context

− readers cannot know if it’s even worth pursuing

• No barriers to implementation described

− No improvement effort works immediately, this

absence decreases credibility

− Readers will ask “How did you get clinicians to

do such and such?” Or “Did this newly

designed tool really work right away?”

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Typical QI reportReporting for impact and implementation

Introduction

Hospital infections affect thousands each year

Hospital staff do not wash their hands consistently

We implemented a multi-faceted strategy:

• Staff education

• Clinical champions

• Empowering patients to ask staff if they have washed their hands

Methods

Briefly stated design, data collection strategy and main outcomes, plus some mention of PDSA

Results

We improved hand hygiene by 50%

Discussion

Patient empowerment can be effective

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What is lacking here?Reporting for impact and implementation

Introduction

Hospital infections affect thousands each year

Hospital staff do not wash their hands consistently

We implemented a multifaceted strategy:

• Staff education

• Clinical champions

• Empowering patients to ask staff if they have washed their hands

No connection between the introduction material and specific features of the intervention

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A better approach?Reporting for impact and implementation

IntroductionCommonly identified barriers to hand hygiene compliance include A, B, and C

Staff education, clinical champions, and empowering patients address A, B, and C by doing X, Y, and Z

• This introduction makes clear what factors explain poor hand hygiene

• And, it makes explicit why the intervention includes these ingredients

• This “theory for the intervention” will pay off in writing the report and interpreting the results

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But what did you do???Reporting for impact and implementation

Methods

Briefly stated design, data collection strategy and main outcomes, plus some mention of PDSA

Results

We improved hand hygiene by 50%

Discussion

Patient empowerment can be effective

‘PDSA’ is not fairy dust!

Simply saying; ‘we carried out three PDSA cycles’ is not informative. What did the ‘study’ of what you had ‘done’ reveal and how did you ‘act’ as a result?

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A better approach?Reporting for impact and implementation

MethodAfter the first round of staff education we reviewed the delivery mechanism and feedback from participants, using PDSA methodology. It was reported that timing of training sessions was an issue in getting staff attendance, so the next sessions were planned with ward managers.Participants wanted more visual material to illustrate key points - these were designed with staff and used in subsequent sessions.

• This provides more detail which makes the report credible

• Others are likely to have the same issues and could avoid making the same mistakes


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Points to consider • When do you start ‘writing up?

• How to capture the key ingredients of your improvement initiative?

• How do you set appropriate measures?

• When barriers arise - how do you record these- and the action to overcome

them?


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Some tips for writing up• Report writing always takes longer than you

think – guard against leaving it to the last minute

• Robust data collection and reporting from the outset is vital

• Keeping an ‘improvement diary’ of the work helps to capture information at the time

• Include different perspectives - not just the team leader, not just the clinical team

• Patients, service users, commissioners, other departments/service providers will all have a view


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More tips for writing up• Consider the audience• While the core information is the same

presentation differs for:• Accountability to the funder• A record for the team and organisation• Academic publication for researchers• Practitioners looking to adapt your ideas for

local implementation• Beyond text:

• Photos, videos, animation all bring the work to life more than text ever will


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A tool to help:SQUIRE Guidelines Standards for Quality Improvement Reporting Excellence

Checklist of points to consider when writing up improvement work

BUT

Don’t leave it until you’ve completed the work

Use guidelines to consider what data to capture as you go along

Developed in 2008 and currently being revised

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Disseminating and promoting your work


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Publication and beyond• Using SQUIRE or other guidelines will help to

produce a coherent account• This improves chances of external publication• Approach a range of publications to target

different audiences• Try to publish in the places professionals look

to get ideas (not just high-impact peer reviewed journals)

• Other approaches:

• Web-sites and resource centres

• National awards and competitions


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Awards – what the judges look for:

• Clear results

• Tangible benefits for patients (and staff)

• Something a bit different – originality

• Understanding what was done and how


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Spreading the wordProfessionals listen to their peers!

Think of a range of approaches - and use every opportunity:• Blogs• Twitter• E-mail bulletins

and:• Professional seminars• National and international conferences

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Challenge:When you hear presentations on improvement projects - if it’s not clear how you would reproduce the work, ask:

• More detail on the components?

• What were the challenges along the way?

• What sort of training for staff?

• How did you engage the patients?

• How did you use PDSA – what did change as a result?

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For more information on Health Foundation funded improvement programmes see:

w w w . h e a l t h . o r g . u k

SQUIRE Guidelines can be downloaded from:

http://squire-statement.org/guidelines

Documents

Writing up improvement work for impact and implementation Helen Crisp Assistant Director Research and Evaluation