Publications
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Yusuf S, Ali A, Khasati A, et al., 2023, Benefits and challenges of video consulting for mental health diagnosis and follow-up: a qualitative study in community care, International Journal of Environmental Research and Public Health, Vol: 20, Pages: 1-12, ISSN: 1660-4601
Mental health services continue to experience rising demand that exceeds capacity. The COVID-19 pandemic exacerbated this crisis, with access to services being reduced. Although video consultations (VCs) are a solution, usage in UK community mental healthcare settings remains limited. This study aims to investigate psychiatrists’ and general practitioners’ (GPs) perceptions of the benefits and challenges of VC for the diagnosis and follow-up of general adult mental health patients in the community during the COVID-19 pandemic. Semi-structured interviews in NHS community mental healthcare settings were conducted. Psychiatrists (n = 11) and GPs (n = 12) were recruited through purposive sampling. An explorative qualitative approach was employed. Data were analysed using thematic analysis. Four key themes were identified: (1) patient access to VC, (2) suitability of VC for mental health consultations, (3) information gathering with VC and (4) clinician satisfaction with VC. This study provides valuable insights into the experiences of psychiatrists and GPs working in the UK during the COVID-19 pandemic. To facilitate a digital-first future for the NHS, greater investment in remote technologies is required, particularly in the context of growing mental healthcare demand. Though face-to-face consultations remain the gold standard, VC provides an efficient way of communicating with patients, particularly those with less severe forms of mental illness.
Hidefjall P, Laurell H, Johansson J, et al., 2023, Institutional logics and the adoption and implementation of remote patient monitoring, INNOVATION-ORGANIZATION & MANAGEMENT, ISSN: 1447-9338
Mindell JS, Parag Y, Bartington SE, et al., 2022, The Middle-Out Perspective: an approach to formalise 'normal practice' in public health advocacy, PERSPECTIVES IN PUBLIC HEALTH, ISSN: 1757-9139
Bolous NS, Graetz DE, Ashrafian H, et al., 2022, Harnessing a clinician-led governance model to overcome healthcare tribalism and drive innovation: a case study of Northumbria NHS Foundation Trust, Journal of Health, Organization and Management, Vol: 37, Pages: 1-16, ISSN: 0268-9235
PurposeHealthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.Design/methodology/approachThis was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.FindingsThe trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.Practical implicationsThis study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.Originality/valuePrevious studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.
Hofer M, Criscuolo P, Shah N, et al., 2022, Regulatory policy and pharmaceutical innovation in the United Kingdom after Brexit: initial insights, Frontiers in Medicine, Vol: 9, ISSN: 2296-858X
Brexit was presented as an opportunity to promote innovation by breaking free from the European Union regulatory framework. Since the beginning of 2021 the Medicines and Healthcare products Regulatory Agency (MHRA) has operated as the independent regulatory agency for the United Kingdom. The MHRA's regulatory activity in 2021 was analyzed and compared to that of other international regulatory bodies. The MHRA remained reliant on EU regulatory decision-making for novel medicines and there were significant regulatory delays for a small number of novel medicines in the UK, the reasons being so far unclear. In addition, the MHRA introduced innovation initiatives, which show early promise for quicker authorization of innovative medicines for cancer and other areas of unmet need. Longer-term observation and analysis is needed to show the full impact of post-Brexit pharmaceutical regulatory policy.
Nilsen P, Reed J, Nair M, et al., 2022, Realizing the potential of artificial intelligence in healthcare: Learning from intervention, innovation, implementation and improvement sciences, Frontiers in Health Services, Vol: 2, Pages: 1-8, ISSN: 2813-0146
Introduction: Artificial intelligence (AI) is widely seen as critical for tackling fundamental challenges faced by health systems. However, research is scant on the factors that influence the implementation and routine use of AI in healthcare, how AI may interact with the context in which it is implemented, and how it can contribute to wider health system goals. We propose that AI development can benefit from knowledge generated in four scientific fields: intervention, innovation, implementation and improvement sciences.Aim: The aim of this paper is to briefly describe the four fields and to identify potentially relevant knowledge from these fields that can be utilized for understanding and/or facilitating the use of AI in healthcare. The paper is based on the authors' experience and expertise in intervention, innovation, implementation, and improvement sciences, and a selective literature review.Utilizing knowledge from the four fields: The four fields have generated a wealth of often-overlapping knowledge, some of which we propose has considerable relevance for understanding and/or facilitating the use of AI in healthcare.Conclusion: Knowledge derived from intervention, innovation, implementation, and improvement sciences provides a head start for research on the use of AI in healthcare, yet the extent to which this knowledge can be repurposed in AI studies cannot be taken for granted. Thus, when taking advantage of insights in the four fields, it is important to also be explorative and use inductive research approaches to generate knowledge that can contribute toward realizing the potential of AI in healthcare.
Dallera G, Skopec M, Barlow J, et al., 2022, Review of a frugal cooling mattress to induce therapeutic hypothermia for treatment of hypoxic-ischaemic encephalopathy in the UK NHS, Globalization and Health, Vol: 18, ISSN: 1744-8603
Hypoxic ischaemic encephalopathy (HIE) is a major cause of neonatal mortality and disability in the United Kingdom (UK) and has significant human and financial costs. Therapeutic hypothermia (TH), which consists of cooling down the newborn’s body temperature, is the current standard of treatment for moderate or severe cases of HIE. Timely initiation of treatment is critical to reduce risk of mortality and disability associated with HIE. Very expensive servo-controlled devices are currently used in high-income settings to induce TH, whereas low-income settings rely on the use of low-tech devices such as water bottles, ice packs or fans. Cooling mattresses made with phase change materials (PCMs) were recently developed as a safe, efficient, and affordable alternative to induce TH in low-income settings. This frugal innovation has the potential to become a reverse innovation for the National Health Service (NHS) by providing a simple, efficient, and cost-saving solution to initiate TH in geographically remote areas of the UK where cooling equipment might not be readily available, ensuring timely initiation of treatment while waiting for neonatal transport to the nearest cooling centre. The adoption of PCM cooling mattresses by the NHS may reduce geographical disparity in the availability of treatment for HIE in the UK, and it could benefit from improvements in coordination across all levels of neonatal care given challenges currently experienced by the NHS in terms of constraints on funding and shortage of staff. Trials evaluating the effectiveness and safety of PCM cooling mattresses in the NHS context are needed in support of the adoption of this frugal innovation. These findings may be relevant to other high-income settings that experience challenges with the provision of TH in geographically remote areas. The use of promising frugal innovations such as PCM cooling mattresses in high-income settings may also contribute to challenge the dominant narrative that
Svedberg P, Reed J, Nilsen P, et al., 2022, Towards successful implementation of artificial intelligence in healthcare practice: A research program, JMIR Research Protocols, Vol: 11, ISSN: 1929-0748
Background:The uptake of artificial intelligence (AI) in healthcare is at an early stage. Recent studies have shown the lack of AI-specific implementation theories, models or frameworks that could provide guidance for how to translate the potential of AI into daily healthcare practices. This protocol provides an outline for the first four years of a research program seeking to address this knowledge-practice gap through collaboration and co-design between researchers, healthcare professionals, patients and industry stakeholders.Objective:The first part of the program focuses on two specific objectives. First, to build an understanding of implementation of AI in healthcare and to develop a theoretical framework that can facilitate AI implementation in daily healthcare practices. Second, to carry out empirical AI implementation studies guided by the framework for AI implementation, thus generating insights and learning for enhanced knowledge and refinement of the framework.Methods:This research program uses a logic model to structure to the development of a methodological framework for planning and evaluating implementation of AI systems in healthcare and to support capacity building for its use in practice. The logic model is divided into time-separated stages, with a focus on theory driven and co-produced framework development. The activities are based on both knowledge development, utilizing existing theory and literature reviews, and method development by means of co-design and empirical investigations. The activities involve researchers, healthcare professionals and other stakeholders, thus creating a multi-perspective understanding of how the implementation of AI systems should be approached to increase likelihood of successful implementation and application in clinical practice.Results:The project is funded by the Swedish Innovation Agency and the Knowledge foundation for a period of 8 years in total starting from July 2021.Conclusions:There is a need to advanc
Gama F, Tyskbo D, Nygren J, et al., 2022, Implementation frameworks for artificial intelligence translation into health care practice: scoping review., Journal of Medical Internet Research, Vol: 24, Pages: 1-13, ISSN: 1438-8871
BACKGROUND: Significant efforts have been made to develop artificial intelligence (AI) solutions for health care improvement. Despite the enthusiasm, health care professionals still struggle to implement AI in their daily practice. OBJECTIVE: This paper aims to identify the implementation frameworks used to understand the application of AI in health care practice. METHODS: A scoping review was conducted using the Cochrane, Evidence Based Medicine Reviews, Embase, MEDLINE, and PsycINFO databases to identify publications that reported frameworks, models, and theories concerning AI implementation in health care. This review focused on studies published in English and investigating AI implementation in health care since 2000. A total of 2541 unique publications were retrieved from the databases and screened on titles and abstracts by 2 independent reviewers. Selected articles were thematically analyzed against the Nilsen taxonomy of implementation frameworks, and the Greenhalgh framework for the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health care technologies. RESULTS: In total, 7 articles met all eligibility criteria for inclusion in the review, and 2 articles included formal frameworks that directly addressed AI implementation, whereas the other articles provided limited descriptions of elements influencing implementation. Collectively, the 7 articles identified elements that aligned with all the NASSS domains, but no single article comprehensively considered the factors known to influence technology implementation. New domains were identified, including dependency on data input and existing processes, shared decision-making, the role of human oversight, and ethics of population impact and inequality, suggesting that existing frameworks do not fully consider the unique needs of AI implementation. CONCLUSIONS: This literature review demonstrates that understanding how to implement AI in health care practice is still in its early stages
Hindocha CN, Antonacci G, Barlow J, et al., 2021, Defining frugal innovation: a critical review, BMJ Innovations, Vol: 7, Pages: 647-656, ISSN: 2055-8074
Frugal innovation (FI), which has gained traction in various sectors, is loosely defined as developing quality solutions in a resource-constrained environment that are affordable to low-income consumers. However, with its popularity, multiple and diverse definitions have emerged that often lack a theoretical foundation. This has led to a convoluted conceptualisation that hinders research and adoption in practice. Despite this plethora of perspectives and definitions, scholars do agree that there is a need for a unified definition. This critical review across the management, entrepreneurship, business and organisation studies literatures explores the multiple definitions of FI that have appeared in the last two decades and seeks to examine the commonalities and differences. One definition is supported by a theoretical underpinning, and main themes include affordability, adaptability, resource scarcity, accessibility and sustainability, however, there remains significant ambiguity around what constitutes an FI. Defining FI as a concept should not deter from focusing on its core aim and identifying an FI may be best achieved by comparing it to an incumbent alternative, rather than against an ill-defined concept. There is merit in developing a common understanding of FI to support strategies for its successful acceptance and diffusion globally.
Mindell J, Bartington S, Janda KB, et al., 2021, Using the Middle-Out Perspective to augment advocacy for smokefree legislation, Publisher: OXFORD UNIV PRESS, Pages: 340-340, ISSN: 1101-1262
Mindell JS, Parag Y, Bartington S, et al., 2021, USING THE MIDDLE-OUT PERSPECTIVE TO INCREASE SIGNALISED CROSSING TIMES FOR PEDESTRIANS, Publisher: ELSEVIER SCI LTD, ISSN: 2214-1405
Antonacci G, Lennox L, Barlow J, et al., 2021, Process mapping in healthcare: a systematic review, BMC Health Services Research, Vol: 21, ISSN: 1472-6963
IntroductionProcess mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare.MethodsWe developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC–Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach.ResultsThe framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward.PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient i
Huddy JR, Ni MZ, Barlow J, et al., 2021, Qualitative analysis of stakeholder interviews to identify the barriers and facilitators to the adoption of point-of-care diagnostic tests in the UK., BMJ Open, Vol: 11, Pages: 1-9, ISSN: 2044-6055
OBJECTIVES: This study investigated the barriers and facilitators to the adoption of point-of-care tests (POCTs). DESIGN: Qualitative study incorporating a constant comparative analysis of stakeholder responses to a series of interviews undertaken to design the Point-of-Care Key Evidence Tool. SETTING: The study was conducted in relation to POCTs used in all aspects of healthcare. PARTICIPANTS: Forty-three stakeholders were interviewed including clinicians (incorporating laboratory staff and members of trust POCT committees), commissioners, industry, regulators and patients. RESULTS: Thematic analysis highlighted 32 barriers in six themes and 28 facilitators in eight themes to the adoption of POCTs. Six themes were common to both barriers and facilitators (clinical, cultural, evidence, design and quality assurance, financial and organisational) and two themes contained facilitators alone (patient factors and other (non-financial) resource use). CONCLUSIONS: Findings from this study demonstrate the complex motivations of stakeholders in the adoption of POCT. Most themes were common to both barriers and facilitators suggesting that good device design, stakeholder engagement and appropriate evidence provision can increase the likelihood of a POCT device adoption. However, it is important to realise that while the majority of identified barriers may be perceived or mitigated some may be absolute and if identified early in device development further investment should be carefully considered.
Sounderajah V, Patel V, Varatharajan L, et al., 2020, Are disruptive innovations recognised in the healthcare literature? A systematic review, BMJ Innovations, Vol: 7, Pages: 208-216, ISSN: 2055-8074
The study aims to conduct a systematic review to characterise the spread and use of the concept of ‘disruptive innovation’ within the healthcare sector. We aim to categorise references to the concept over time, across geographical regions and across prespecified healthcare domains. From this, we further aim to critique and challenge the sector-specific use of the concept. PubMed, Medline, Embase, Global Health, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium were searched from inception to August 2019 for references pertaining to disruptive innovations within the healthcare industry. The heterogeneity of the articles precluded a meta-analysis, and neither quality scoring of articles nor risk of bias analyses were required. 245 articles that detailed perceived disruptive innovations within the health sector were identified. The disruptive innovations were categorised into seven domains: basic science (19.2%), device (12.2%), diagnostics (4.9%), digital health (21.6%), education (5.3%), processes (17.6%) and technique (19.2%). The term has been used with increasing frequency annually and is predominantly cited in North American (78.4%) and European (15.2%) articles. The five most cited disruptive innovations in healthcare are ‘omics’ technologies, mobile health applications, telemedicine, health informatics and retail clinics. The concept ‘disruptive innovation’ has diffused into the healthcare industry. However, its use remains inconsistent and the recognition of disruption is obscured by other types of innovation. The current definition does not accommodate for prospective scouting of disruptive innovations, a likely hindrance to policy makers. Redefining disruptive innovation within the healthcare sector is therefore crucial for prospectively identifying cost-effective innovations.
Cisnetto V, Barlow J, 2020, The development of complex and controversial innovations.Genetically modified mosquitoes for malaria eradication, Research Policy, Vol: 49, ISSN: 0048-7333
When there is significant uncertainty in an innovation project, research literature suggests that strictly sequencing actions and stages may not be an appropriate mode of project management. We use a longitudinal process approach and qualitative system dynamics modelling to study the development of genetically modified (GM) mosquitoes for malaria eradication in an African country. Our data were collected in real time, from early scientific research to deployment of the first prototype mosquitoes in the field. The 'gene drive' technology for modifying the mosquitoes is highly complex and controversial due to risks associated with its characteristics as a living, self-replicating technology. We show that in this case the innovation journey is linear and highly structured, but also embedded within a wider system of adoption that displays emergent behaviour. Although the need to control risks associated with the technology imposes a linearity to the NPD process, there are possibilities for deviation from a more structured sequence of stages. This arises from the effects of feedback loops in the wider system of evidence creation and learning at the population and governance levels, which cumulatively impact on acceptance of the innovation. The NPD and adoption processes are therefore closely intertwined, meaning that the endpoint for R&D and beginning of 'mainstream' adoption and diffusion are unclear. A key challenge for those responsible for NPD and its regulation is to plan for the adoption of the technology while simultaneously conducting its scientific and technical development.
Ni M, Borsci S, Walne S, et al., 2020, The Lean and Agile Multi-dimensional Process (LAMP) - a new framework for rapid and iterative evidence generation to support health-care technology design and development, Expert Review of Medical Devices, Vol: 17, Pages: 277-288, ISSN: 1743-4440
Introduction: Health technology assessments (HTA) are tools for policymaking and resource allocation. Early HTAs are increasingly used in design and development of new technologies. Conducting early HTAs is challenging, due to a lack of evidence and significant uncertainties in the technology and the market. A multi-disciplinary approach is considered essential. However, an operational framework that can enable the integration of multi-dimensional evidence into commercialization remains lacking.Areas covered: We developed the Lean and Agile Multi-dimensional Process (LAMP), an early HTA framework, for embedding commercial decision-making in structured evidence generation activities, divided into phases. Diverse evidence in unmet needs, user acceptance, cost-effectiveness, and market competitiveness are being generated in increasing depth. This supports the emergence of design and value propositions that align technology capabilities and clinical and user needs.Expert opinion: We have been applying LAMP to working with medical device and diagnostic industry in the UK. The framework can be adapted to suit different technologies, decision needs, time scales, and resources. LAMP offers a practical solution to the multi-disciplinary approach. Methodologists drive the process by performing evidence generation and synthesis as and by enabling interactions between manufacturers, designers, clinicians, and other key stakeholders.
Barlow J, Tan S, 2019, Challenges in addressing Anti-Microbial Resistance (AMR) through Drug-related Solutions, Publisher: Policy Innovation Research Unit
The UK Five Year Anti-Microbial Resistance Strategy, 2013-2018 was released by the Department of Health (now Department of Health and Social Care, DHSC), with the Department for Environment Food and Rural Affairs (Defra) and Public Health England (PHE), in September 2013. We reviewed progress on the actions in the Strategy requested of the pharmaceutical industry, including the scale and scope of activity underway, the role of various forms of incentives to encourage pharmaceutical innovation, and the scientific, regulatory and commercial challenges experienced by industry and funders. We explored the way government efforts within and beyond the Strategy to addresscommercial viability issues have been viewed by industry, gaps in the approach taken by the Strategy, and opportunities for government to help improve the contribution of biopharma to AMR reduction.Informants recognised the efforts of the Government in responding to the challenges of developing new drugs to tackle AMR, especially the O’Neill Report, development and implementation of the Strategy, the framework of working groups, provision of new research funding, and associatedactions around antibiotic stewardship and infection prevention. The availability of ‘push funding’ (direct support for research) has grown, particularly in the form of multinational public-private partnerships to stimulate research and development for new antibiotics and novel therapies. This type of support was considered more beneficial for small and medium sized companies working on the discovery and pre-clinical stages of drug development than for large pharmaceutical companies. While smaller companies benefit from push incentives, their impact ondrug development was seen as limited unless large pharmaceutical companies, which have the capacity and resources to bring products to market, step in and acquire promising new therapies. Industry informants therefore felt that while push incentives were welcome, additi
Huddy JR, Ni M, Misra S, et al., 2019, Development of the Point-of-Care Key Evidence Tool (POCKET): a checklist for multi-dimensional evidence generation in point-of-care tests, Clinical Chemistry and Laboratory Medicine, Vol: 57, Pages: 845-855, ISSN: 1434-6621
BackgroundThis study aimed to develop the Point-of-Care Key Evidence Tool (POCKET); a multi-dimensional checklist to guide the evaluation of point-of-care tests (POCTs) incorporating validity, utility, usability, cost-effectiveness and patient experience. The motivation for this was to improve the efficiency of evidence generation in POCTs and reduce the lead-time for the adoption of novel POCTs.MethodsA mixed qualitative and quantitative approach was applied. Following a literature search, a three round Delphi process was undertaken incorporating a semi-structured interview study and two questionnaire rounds. Participants included clinicians, laboratory personnel, commissioners, regulators (including members of National Institute for Health and Care Excellence [NICE] committees), patients, industry representatives and methodologists. Qualitative data were analysed based on grounded theory. The final tool was revised at an expert stakeholder workshop.ResultsForty-three participants were interviewed within the semi-structured interview study, 32 participated in the questionnaire rounds and nine stakeholders attended the expert workshop. The final version of the POCKET checklist contains 65 different evidence requirements grouped into seven themes. Face validity, content validity and usability has been demonstrated. There exists a shortfall in the evidence that industry and research methodologists believe should be generated regarding POCTs and what is actually required by policy and decision makers to promote implementation into current healthcare pathways.ConclusionsThis study has led to the development of POCKET, a checklist for evidence generation and synthesis in POCTs. This aims to guide industry and researchers to the evidence that is required by decision makers to facilitate POCT adoption so that the benefits they can bring to patients can be effectively realised.
Wright S, Barlow J, Roehrich JK, 2019, Public-Private Partnerships for Health Services: Construction, Protection and Rehabilitation of Critical Healthcare Infrastructure in Europe, Competitive Government: Public Private Partnerships, Pages: 125-151
The Chapter places health sector Public-Private Partnerships (PPPs) in their wider historical context, and shows the market size over time; Europe has seen the majority of projects. We define the principal purpose of PPP as raising fresh capital on behalf of the state and introducing commercial project development capacities; all to create scalable, replicable and sustainable business models. There are two useful spectrums to consider: public to private, and “bundling” of activities to achieve risk management. We use four archetypal models to delineate bundling, with the more advanced models incorporating clinical services including outside of the hospital. Evidence in the literature is that are delivered and perform reasonably well but not noticeably better than state projects, with some dangers of locking in one of the parties, and inflexibility, particularly for the minimum-scope (buildings only) model. Payment systems vary, with “capitation” offering some benefits over others. Looking at hospital economics from first principles confirms that the infrastructure alone offers little cost leverage, and the major gains are in outsourcing clinical services. The politics of PPPs are difficult, and not getting easier. Since the global financial crisis, there have been difficulties in financing projects, either by the banks or by bonds.
Chatterjee A, Modarai M, Naylor N, et al., 2018, Quantifying drivers of antibiotic resistance in humans: a systematic review, The Lancet Infectious Diseases, Vol: 18, Pages: e368-e378, ISSN: 1473-3099
Mitigating the risks of antibiotic resistance requires a horizon scan linking the quality with the quantity of data reported on drivers of antibiotic resistance in humans, arising from the human, animal, and environmental reservoirs. We did a systematic review using a One Health approach to survey the key drivers of antibiotic resistance in humans. Two sets of reviewers selected 565 studies from a total of 2819 titles and abstracts identified in Embase, MEDLINE, and Scopus (2005–18), and the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and WHO (One Health data). Study quality was assessed in accordance with Cochrane recommendations. Previous antibiotic exposure, underlying disease, and invasive procedures were the risk factors with most supporting evidence identified from the 88 risk factors retrieved. The odds ratios of antibiotic resistance were primarily reported to be between 2 and 4 for these risk factors when compared with their respective controls or baseline risk groups. Food-related transmission from the animal reservoir and water-related transmission from the environmental reservoir were frequently quantified. Uniformly quantifying relationships between risk factors will help researchers to better understand the process by which antibiotic resistance arises in human infections.
Antonacci G, Reed JE, Sriram V, et al., 2018, Quality Improvement through Interactive Simulation, Publisher: OXFORD UNIV PRESS, Pages: 29-30, ISSN: 1353-4505
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Whole System Demonstrators team, 2018, Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study, BMC Health Services Research, Vol: 12, ISSN: 1472-6963
BackgroundTelehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial.MethodsQualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes.ResultsBarriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk p
Antonacci G, Reed JE, Lennox L, et al., 2018, The use of process mapping in healthcare quality improvement projects, Health Services Management Research, Vol: 31, Pages: 74-84, ISSN: 0951-4848
Introduction: Process Mapping (PM), provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare Quality Improvement (QI) projects. There is little empirical evidence on the use of PM in healthcare practice. This study advances understanding of the benefits and success factors of PM within QI projects. Methods: Eight QI projects were purposively selected from different healthcare settings within the UK’s National Health Service. Data was gathered from multiple data-sources, including interviews exploring participants’ experience of using PM in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results: Eight key benefits related to PM use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful PM exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator’s experience and soft skills, basic training, iterative use of PM throughout the project). Conclusions: Findings highlight benefits and versatility of PM and provide practical suggestions to improve its use in practice.
Myron R, French C, Sullivan P, et al., 2018, Professionals learning together with patients: An exploratory study of a collaborative learning Fellowship programme for healthcare improvement, Journal of Interprofessional Care, Vol: 32, Pages: 257-265, ISSN: 1356-1820
Improving the quality of healthcare involves collaboration between many different stakeholders. Collaborative learning theory suggests that teaching different professional groups alongside each other may enable them to develop skills in how to collaborate effectively, but there is little literature on how this works in practice. Further, though it is recognised that patients play a fundamental role in quality improvement, there are few examples of where they learn together with professionals. To contribute to addressing this gap, we review a collaborative fellowship in Northwest London, designed to build capacity to improve healthcare, which enabled patients and professionals to learn together. Using the lens of collaborative learning, we conducted an exploratory study of six cohorts of the year long programme (71 participants). Data were collected using open text responses from an online survey (n = 31) and semi-structured interviews (n = 34) and analysed using an inductive open coding approach. The collaborative design of the Fellowship, which included bringing multiple perspectives to discussions of real world problems, was valued by participants who reflected on the safe, egalitarian space created by the programme. Participants (healthcare professionals and patients) found this way of learning initially challenging yet ultimately productive. Despite the pedagogical and practical challenges of developing a collaborative programme, this study indicates that opening up previously restricted learning opportunities as widely as possible, to include patients and carers, is an effective mechanism to develop collaborative skills for quality improvement.
Barlow J, Ozaki R, 2018, Building Mass Customised Housing through Innovation in the Production System: Lessons from Japan, The Routledge Companion to Contemporary Architectural History, Pages: 408-418, ISBN: 9781138940178
Chapter 25 examines the innovative approaches employed by Japanese housebuilders in providing highly customized housing. Drawing on the concept of “path dependency,” it focuses on the evolution of Japan’s large-scale industrialized housing suppliers, their differentiation from local suppliers, and potential future developments. The chapter explores how structural conditions impact the business strategies adopted by housebuilders in general. It delves into the evolution of the Japanese mass customized housebuilding industry, highlighting the innovations it has introduced throughout its production system. The chapter shows the importance of understanding the structural conditions that shape the industry and how these conditions influence the innovations and business models adopted by housebuilders. The analysis provides valuable perspectives on the trajectory of the Japanese mass customized housebuilding industry and its potential implications for the future development of affordable housing.
Dattee B, Barlow JG, 2017, Multilevel organizational adaptation: Scale invariance in the Scottish healthcare system., Organization Science, Vol: 28, Pages: 301-319, ISSN: 1047-7039
We use the case of a “whole-system” change program in a national healthcare system to empirically examine the multilevel dynamics underlying organizational adaptation. Our analysis demonstrates how the cognitive distance between agents’ causal representations affects opportunities to cooperate in hierarchical systems. Using complexity theory, we identify a scale-invariant causal pathway that can be applied recursively across many organizational levels. At each level, three coupled feedback loops determine how local agents modify their cognitive representations to include uncovered interdependencies and synchronize their adaptive search across organizational boundaries: a “boundary work” loop, a “small wins” loop, and a “parochialism” loop. Our results also point to the scale-dependency of the strength of dissipative processes across levels. These novel results further develop the theory of organizational change and have practical implications for large multilevel organizations, especially regarding the sustainability of improvements.
Barlow JG, Tucker DA, Hendy J, 2016, The dynamic nature of social accounts: an examination of how interpretive processes impact on account effectiveness, Journal of Business Research, Vol: 69, Pages: 6079-6087, ISSN: 0148-2963
Social accounts are a powerful tool in influencing the behavior of organizational members during major change. Examination of their effectiveness has largely focused on the design of accounts to influence behavioral and affective responses. However, when used in real life practice, more individualized, interpretive and agentic responses to social accounts have been found to influence effectiveness. Using an example of large-scale organizational change, moving from one hospital facility to another, we explore the dynamic and contextual interpretation of social accounts over time. Our findings expand social account theory by examining how potentially successful change communications are derailed by the relevance of the account in relation to an individual's past, by the individuals' ability to express agency and by temporality; how over time, lived experience can alter the perceived truthfulness of an account and alter its potency.
Huddy JR, Ni MZ, Barlow J, et al., 2016, Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption, BMJ Open, Vol: 6, ISSN: 2044-6055
Greenhalgh T, Annandale E, Ashcroft R, et al., 2016, An open letter to The BMJ editors on qualitative research, BMJ, Vol: 352, ISSN: 1756-1833
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