How might remote consultations widen health inequalities? When is it safe to deviate from standards? How might ambulance queues outside hospitals be prevented? These are examples of PhD research projects underway at UK universities funded by THIS Institute. They are important problems facing NHS frontline staff and managers. And each issue has real implications for patients and families. THIS Institute welcomes interdisciplinary research and thinking to tackle healthcare problems in new ways.
PhD supervisors at UK universities can apply now for funding to cover fees, a PhD student stipend and related research project costs. Awards are hosted at your institution and you design the project and select the student yourself. As well as addressing key issues in healthcare improvement from varied disciplinary perspectives, the PhD fellowships will help to build capacity for improvement research across the country.
I spoke with some of our fantastic fellows about their projects.
How can we make remote consultations work for those who most need it?
What gets in the way of good remote consultations, especially for people with limited English? What could staff do differently? These questions have become more urgent as healthcare contacts increasingly happen by phone and video. There are real differences in access, experience and outcomes for those who need healthcare most.
Laiba Husain is undertaking a project at the University of Oxford to find out more about inequalities in remote consultation. She will use observational methods, interviews and focus groups to work with diverse populations in a large London trust.
She will explore system issues, such as how to identify language needs and get the right bilingual health advocates in place before remote consultations are held. Laiba aims to produce practical tips and insights for nurse practitioners and others on what works well in remote consultations. To do this, she will develop digital personae to bring to life patient scenarios which can be used by digital health champions and others when training and supporting staff. Laiba has a public health background and told me she is enjoying learning more about improvement and the practical application of her research findings.
When is it safe to deviate from standards?
`We know what the rules are, but we can’t always do what they say.’ Refrains like this will be familiar to staff in many healthcare organisations. Debbie Clark is a critical care nurse with an interest in patient safety and human factors. She has started her PhD fellowship at the University of Leeds, exploring why and how staff deviate from existing standards and what we can learn from what happens in practice.
She is scoping the literature from healthcare and other settings, including lessons from fishing industry! Debbie is looking at the nature and consequences of working around established standards. This will help her to focus on particular areas of healthcare practice where workarounds are common, which might include electronic observations and digital systems. Ethnographic research will enable Debbie to observe `work as done’, shadowing staff in a range of settings, including those such as emergency departments which need to be highly adaptive to cope with the unpredictable.
Debbie plans to use her experience teaching nurses and as a simulation lead to work through different scenarios and test emerging lessons. Talking to her, I can see how much she gains from spanning the worlds of practice and research, to drive better understanding of what makes workarounds safer or more dangerous.
What staffing factors matter in managing ambulance queues?
Michalis Panayides deals with numbers. But there are always people behind the numbers. The pictures of ambulances queuing outside hospital doors, which in some areas in recent months have become a daily sight, are distressing for everyone. Michalis is using his mathematical modelling skills to develop new ways of addressing this problem in his PhD project at the University of Cardiff.
Drawing on ethnographic and other research on what happens to cause ambulance queues, he is making models to simulate different kinds of decisions and behaviours given different workload and staffing parameters. Using queuing theory and gaming theory, he will model different outcomes showing the impact of interventions at the interface on different parts of the system. These models can help ambulance services and hospital emergency departments to work better together to manage different levels of demand. His project brings together insights on behaviours and decision-making with mathematical models which can support better flows in a complex system. I may not understand all the algorithms which Michalis showed me, but can see the value of testing out dynamic solutions to minimise long waits in ambulances.
PhD supervisors have given positive feedback about the ease of application and support offered through the THIS Institute PhD programme, which is funded by the Health Foundation’s grant to THIS Institute. But what they value most is the chance to put forward exciting projects spanning disciplines to generate evidence to improve healthcare quality and safety. This includes work in under-researched areas that don’t always find easy support through other routes. Supervisors recognise the profile and influence of THIS Institute in healthcare improvement research, and appreciate opportunities for their students to join a diverse and vibrant wider improvement research community. Other benefits include a mentoring programme and participation in our high-profile annual event, THIS Space, with PhD fellows giving lightning talks to over 450 attendees including healthcare staff, patients, carers and researchers.
If you have a good idea for a PhD project and want to support the next generation of healthcare improvement research leaders – apply now!
Read our related blog post: Bringing fresh perspectives to healthcare improvement research
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