Health Quality Improvement Research

    I want to welcome you to my Chair's Homepage. My Research Chair in Health Quality Improvement Science is the first of its kind in Canada[1]. Governments face ever-increasing demands on health care systems. In Saskatchewan, more than 40 per cent of the provincial budget goes to health care, and there is constant pressure to spend more. Quality Improvement Science could help to reduce this pressure to provide better health, better value, better care, and better teams.

    What is Quality Improvement Science?

    Quality improvement in health care is an approach to achieving and sustaining changes that lead to better care and a sustainable health care system. It refers to the application of Quality Improvement (QI) science, which provides tools and concepts to implement, test, improve, and scale-up effective QI practices[1]. There are many QI approaches, not only Lean, but Lean is very progressive with a very broad focus. “Health care quality improvement science really took hold in North America after the publication of the Institute of Medicine’s (IOM) report in 2000: To Err is Human”[1]. This study revealed that between 44,000 and 98,000 patients in the US die each year as a result of medical errors and called for a national initiative to provide better care, and to improve patient safety. In Canada, the Adverse Events study reported that of the 2.5 million annual hospital admissions about 185,000 (7.5%) patients experience one or more adverse events. Nearly 70,000 (36.9%) of these incidents are preventable and a small but significant proportion of these patients (20%) die[2].. In Saskatchewan, the government found through a variety of reviews, reports and patient experience surveys that its health system was not fully addressing the needs of the province’s citizens. As a result, the government committed to a system-wide transformation based on the Lean methodology. This transformation has been referred to in the media as “probably the largest lean transformation in the world” [3].

    My Research Program

    Current approaches to develop, implement, and evaluate concepts and/or interventions to improve the quality of care in healthcare are inadequate. There is only fragmented and very limited evidence published on the application and implementation of effective healthcare interventions to provide the best available care. The majority of the primary studies investigating quality improvement interventions are often lacking explicitly stated concepts, research designs, appropriate analysis, and outcome measures. Furthermore, little has been documented about the failed attempts or barriers to implementation, adoption and sustainability of interventions such as ‘Continuous Quality Improvement’ approaches, Lean, clinical pathways, guidelines, and protocols. Patient outcomes can be improved by translating the available evidence into practice. However, the translation of research findings into daily practice is a slow process. According to the literature, it takes an average of 17 years for new evidence-based findings to reach clinical practice, and even then the application is highly uneven. Meanwhile, the slow uptake of research-based innovations places a costly burden on the health care system and can harm the patient.

    Concurrently, potentially effective interventions/ concepts such as clinical pathways, or Lean management are under-researched and we know very little about the contexts and mechanisms which have to be in place to generate a desired outcome.

    In 2012, I was awarded a Saskatchewan Research Chair in Health Quality Improvement Science at the University of Saskatchewan. Other research awards include: (1) the 2013 Saskatchewan Research Foundation (SHRF) Establishment Grant, (2) the 2009 Group of Eight (Go8) German Exchange Service (DAAD) research cooperation grant for the research alliance established with Monash University, Australia, and (3) two very competitive and prestigious scholarships from the German Friedrich-Ebert-Foundation in 2004, and in 2007 for my clinical pathway research program.

    Program Objectives

    The overall goal of my research program is to advance the science of knowledge synthesis (KS) and translation (KT) with a strong focus on effective implementation strategies and rigorous large-scale program evaluation as well as clinical research. Specific objectives for the research program are as follows:

    • To synthesis, catalog, and update the internationally available evidence on integrated care models to improve the quality of care, such as clinical pathways, protocols, and checklists.
    • To rigorously investigate the most frequently used quality improvement concepts such as Lean Management or Continuous Quality Improvement approaches to improve our knowledge and understanding of effective and evidence-based QI interventions
    • To advance the science of KS and KT to improve the evidence-base and to close the evidence-practice-gap in health care
    • To enhance my experience and expertise with “Realist’ systematic reviews and ‘theory building’ for decision makers as well as to conduct more ‘real world’ evaluations (Realist Evaluation) such as the Lean investigation in Saskatchewan, to better understand for whom, in which circumstances, and why or why not health care interventions work.
    • To provide state-of-the-art undergraduate and graduate supervision and to develop innovative academic programs and resources (capacity building).

    References:

    1. Health_Quality_Ontario: Quality Improvement Science. http://wwwhqontarioca/Portals/0/Documents/qi/qi-science-primer-enpdf 2014:(accessed on August 1, 2014).

    2. Baker GR, Norton P, Flintoft V: Knowledge Translation and Patient Safety: The Canadian Adverse Events Study. Health Policy 2006, 1(3):45-50.

    3. J F: Lean Machine. In: Star Phoenix. Saskatchewan; 2014.



    [1] The Chair in Quality Improvement Science is jointly funded by the Saskatchewan Ministry of Health, University of Saskatchewan, Saskatchewan Health Quality Council, and Saskatchewan Heath Research Foundation

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