Questions, questions, questions (ii)

Just returned from the SDO/HSRN conference in Liverpool with a rich mix of researchers, managers, clinicians and patients (and actually a few individuals who were all of the above).   Below are some of the questions relating to research itself – methodology, resources, capacity, dissemination – which I came across at some point of the conference.  Would be good to hear of others…

Do we need a standardised measure of readmission?   How easy is it to link datasets at a person-level and for what use?  Which datasets are currently underused or could be better linked to others (such as clinical audit)?  How can researchers deliver quick productivity (cost/benefit) impacts of service innovations to NHS managers without compromising on methods? How can we get better standardised data from independent and third sector?  What learning will we be able to draw from WSD when complete – the biggest health services trial of its kind?  How can research on organisations deal with rapid change in the structures and systems being studied?  How can we use story-telling techniques to engage patients and staff in service re-design?  Do we need a pan-European health service research forum?  What are the limits of standard systematic review methodology for health service research questions?  Which European country is most productive in terms of health service research outputs (spare our blushes)?  What post-doctoral fellowship opportunities exist in health services research?  How can we educate managers better on the flaws with using uncontrolled before-after studies to evaluate local interventions (given regression to the mean)?  Do we know enough about what works for those patients excluded from trials (eg only 10-15% of stroke patients might fit inclusion criteria)? Is there a gap in funding for health services research around design and built environment? How can we build knowledge of implementation science into national clinical guidelines ie making the delivery as evidence-based as the treatment?  What mechanisms work for better `push’ and `pull’ of evidence into practice?  What unit of analysis for competition could be used when comparing pathways across a whole system of care, as opposed to hospitals?  How can we test the reliability of measures (of patient experience) used to compare organisational performance?

[With a nod to The Interrogative Mode http://www.guardian.co.uk/books/2010/nov/07/padgett-powell-interrogative-mood-review]

Questions, questions, questions (i)

“A boss knows all, a leader asks questions.”  [Russell H Ewing]

Just returned from the SDO/HSRN conference in Liverpool.  With a nod to Padgett Powell and his inspired book*, The Interrogative Mode http://www.guardian.co.uk/books/2010/nov/07/padgett-powell-interrogative-mood-review, here are just some of the questions that were discussed, explored, tested and contested during packed parallel and plenary sessions.  These should be of interest to NHS managers, clinical leaders and patients (additional questions to follow for researchers …).

 If integration is the answer, what is the question?   Do staff like working in paediatric specialist outreach (`satellite’) clinics?  What kind of managed supervision of giving methadone works best? What makes a good commissioning manager? How can we do better case finding in general practice of patients with chronic kidney disease?   What effect do out of hours and daytime response services have in preventing admission to hospital for older people?   What kind of contracting and negotiation models are used by managers?  Does feeding back results of patient reported outcomes to surgeons improve their performance? How do commissioning managers use evidence?  How reliable are measures of patient satisfaction when comparing organisations?  What is the right mix of staff across disciplines in community mental health teams?  What training do care home support staff need?  Are place of death preferences different for cancer and non-cancer patients at the end of life?  What is the impact of new clinical decision support systems for urgent care on everyday work practice?  What is the association between multiple morbidity and rates of hospitalisation?  Has greater patient choice affected equity of access in the last ten years?  How do rates of revascularisation vary for different ethnic groups? What impact has Improving Access to Psychological Therapies had on service use for people with anxiety and depression?  How can we achieve continuity of care for offenders with health problems?  What impact does introducing physician assistants in anaesthesia have on use of trauma theatres?  Does active support (daily telephone calls by dedicated feeding team after discharge) improve breastfeeding rates for disadvantaged mothers? Is a chronic illness case management approach cost-effective?  Which tools work best in predicting patients at high risk of hospitalisation?  How do commissioners monitor performance of general medical services? What do we know from the evidence about the best way to get managers and clinicians to work together?  How can smoking cessation clinics draw on wider evidence of behaviour change to introduce interventions which work? What would QoF for secondary care look like?  What do patients think of enhanced recovery schemes for orthopaedics?  How are mental health organisations implementing stepped care for people with depression (and why are there no evidence-based guidelines for how to deliver this)?   What aspects of ward design and the built environment lead to safer care?  What are the service impacts of standard reviews for patients six months after a stroke?  Are the views of patients and clinicians different on the quality and safety of different places of birth and why does this matter? 

*Extract from the inimitable original:

“Are your emotions pure? Are your nerves adjustable? How do you stand in relation to the potato? Should it still be Constantinople? Does a nameless horse make you more nervous or less nervous than a named horse? In your view do children smell good? If before you now, would you eat animal crackers? Could you lie down and take a rest on a sidewalk?...”