The PRU’s work will be framed by five interrelated themes.
- Appropriate measures of quality and outcomes for whole health and care systems
This theme concerns the identification and development of quality and outcome measures that are best used to assess the progress of whole health and care systems, recognising the range of health and care needs of the population and the multiple service areas that operate to meet those needs. There is a need to develop a consensus around core indicator sets. Our initial focus will be on development and consensus of indicators that both measure quality and outcomes for integrated care, social care and public health needs, and can contribute to our assessment of whole health and care systems.
- Learning from specific (adverse) incidents
Under this theme we will assess the effectiveness of mechanisms for learning from specific incidents of poor quality (especially safety incidents).
We propose to determine how patient safety programmes are working to promote learning from incidents by focusing on the impact of the Learning from Deathspolicy in acute hospitals and its relationship with other safety programmes. In particular, we wish to understand how such programmes will be implemented in integrated health and social care settings to promote system wide learning.
- Understanding and addressing system and population level variation in quality
We propose to analyse how quality is affected and varies between providers, systems and populations. The intention is to gain insight for the improvement of the quality of care. We aim to use the range of available quality indicators to draw out the patterns that characterise and inform us about the underlying quality of the care provided in the population. We then propose to explore the variation in (underlying) quality, assessing how far it is explained by factors that are more in the control of the care system – particularly leadership – and those which the system is less able to control.
- Resolution after harmful events
Errors and harmful events will occur in even the best-designed health and care systems. In this theme we intend to explore how the consequences are addressed – for example which can be through complaints mechanisms, consensual no-blame resolution approaches, as well as adversarial approaches such as litigation. We will begin with a focus on complaints, aiming to identify the factors motivating patients to complain, and the system and service factors that may shape how complaints progress.
- Identifying effective approaches to implementation of systems to promote quality
Care systems and processes can be planned and designed to produce good quality care, assuming the components are fully implemented; for example, hygiene protocols in hospital or personal care in care homes. In practice, we know that processes are not always implemented or undertaken in line with their intended operation, often due to human error or infrastructure failure. This theme is about bringing together research on how implementation can be improved, that is, about how systems can be designed to improve execution and operation.
We are currently working on five projects that fall into the first four themes above.