CHIR produces research which supports practitioners, policy-makers, and other stakeholders facing the complex challenges of embedding healthcare innovations; that is, implementing innovations sustainably and at scale.
Our research aims to develop the evidence base for improving the sustainable implementation and spread of healthcare innovations by identifying generalisable aspects and mechanisms of the way such innovations are adopted, adapted and embedded across different contexts. Our work connects the introduction of innovations to the shifting work patterns and organizational changes required to scale and sustain them in practice.
By drawing on the expertise of two highly ranked Schools at City, University of London - Bayes Business School and the School of and Psychological Health Sciences – the Centre provides the interdisciplinary approach needed to analyse, evaluate and improve this dynamic process of embedding innovation. We are working across a range of academic fields such as health sciences, organisational studies, implementation research and social sciences and deploy of a range of methodological tools, including both the tracking of innovation journeys over time, and cross-sectional comparison of innovations.
Our work involves multiple projects which reflect the major themes of our approach as being;
- Evidence-based and interdisciplinary;
- Understanding the processes of implementing and spreading innovations;
- Encompassing different types of innovation across multiple levels of healthcare systems;
- Addressing different external and organizational contexts for innovation spread and implementation;
- Assessing patient and public involvement in embedding innovations.
The spread of innovations in healthcare is a complex and multi-faceted process. Our research addresses different aspects of this process as highlighted by the following headings:
Review of spread and adoption approaches across the AHSN Network
In recent years, the rate of adoption of innovations in healthcare practice has increased. However, spreading such innovations at a large scale beyond an initial pilot site is still a challenge. There is a lack of understanding of what makes innovations spread successfully across different contexts. The Academic Health Science Networks (AHSN) as key innovation arm of NHS England are aligning key stakeholders together for spreading innovations in health and social care at the regional level. The study will investigate and determine lessons for spread and adoption of innovations from an analysis of the different approaches developed and applied by the 15 AHSNs in England.
Understanding the different approaches of spread of innovation among AHSNs will provide useful guidance at the operational level for change agents within AHSNs, at the senior staff level for determining capacity and resources required for spread, for health and social care staff in receipt of support from AHSNs, and the wider academic community by investigating how relevant theory has been operationalised in real world settings.
During the COVID-19 pandemic, the AHSNs were changing their approaches to rapidly implement and spread innovations in response to the pandemic. The study will also explore the approaches to rapid implementation and spread taken by AHSNs during the first three months of the COVID-19 pandemic to provide formative feedback to AHSNs to support their spread work during the course of COVID-19 and gather early insights on what works in rapid implementation.
Learning from adoption and Implementation processes of digital technologies across the UCLPartners Innovation Network
The Academic Health Science Network UCLPartners has set up a network of staff members at 23 NHS trusts who are leading on innovation in their trusts with the aim to support and improve the adoption and implementation of innovations in these trusts. Some trusts have developed standardised processes that other trusts could learn from with the aim to optimise this process across the network.
This qualitative study aims to explore effects and determinants of the adoption and implementation process of digital innovations in the NHS trusts represented in the UCLPartners Innovation Network.
The role of implementation process in shaping technology innovation outcomes in healthcare
The outcome of a technological innovation is dependent upon the way in which the innovation is implemented. The process of implementation interacts with other contextual factors, at multiple levels, and also with the innovation itself. This study aims to contribute to a more systematic and integrated understanding of the role of the implementation process for healthcare innovations. It employs a two-phased in-depth analysis investigating 34 technology implementation journeys across 12 NHS trusts.
In phase I, through 121 interviews we unpack rich implementation process dynamics within each of the specific organizational cases. In phase II, by applying Qualitative Comparative Analysis (QCA), we identify which configurations of characteristics of the innovation, the implementation process and the organisational context are linked to innovation outcomes.
Translating Artificial Intelligence in Healthcare
Artificial Intelligence (AI) based innovations promise a ‘paradigm shift’ in healthcare services and the way they are delivered. There is a currently a significant public investment in these innovations, yet little understanding of how widely these are used in practice.
This research focuses on exploring the translational challenges of implementing AI based innovations in healthcare, focusing on the organisational and cultural issues as well as the role of professionals and the public in this process. With the growing investment and focus on the role of AI technologies in healthcare, this work speaks to the direct need to invest more and learn more about translating these technologies into health care systems in the UK and globally.
Therefore, this work has potential impact for a range of stakeholders including policy makers, private companies, NHS professionals and patients.
Evaluation of the UCLPartners Proactive Care Programme
As part of NHS England's COVID-19 recovery plan, UCLPartners has developed a series of Proactive Care frameworks combined with comprehensive implementation support to help people living with long term conditions stay well at home. They are underpinned by four key principles: virtual by default, mobilising the wider primary care workforce, step change in self-management, and optimising use of digital tools.
A number of areas across England are underway with implementation of the frameworks. The aim of this evaluation is to examine the initial impact of the Proactive Care Programme on the management of long-term conditions in primary care in the early implementation sites. This study is co-funded by UCLPartners.
Rapid review on critical success factors for implementing remote triage services
This rapid review aims at synthesising the scientific evidence on key practice lessons for implementing remote triage services to inform the roll-out of the new NHS 111 First service in England.
We will compile key concepts and metrics for implementation success, major implementation barriers and facilitators and take an in-depth look into selected international cases of telephone helpline services in Europe.
This study is co-funded by UCLPartners.
Role of medical professionals in the development of emergency guidance regulating the allocation of healthcare resources during the COVID-19 pandemic
This study uses a qualitative approach (interviews) to investigate the role of medical professionals in the development of emergency guidance regulating the allocation of healthcare resources (PPE, human resource, patient management) during the first phase of the pandemic in England (March-June 2020).
The goal of our study is to understand the allocation process during the first phase of the pandemic to improved healthcare provision in future phases of the pandemic or in the event of a public health crisis of a similar scale.
Spread of a social prescribing tool in the NHS
GP practices in the UK face significant increases in workload due to a combination of staff shortages and the escalating pressures posed by chronic conditions and illness. In response to this growing demand, the NHS long-term plan mandates much greater use of digitally-based services in the coming period. The widespread popularity of social media as a means of exchanging information also indicates the potential acceptability and benefits of new digital services for patients.
The primary aim of the study is to understand how such a digitally-based service – a social prescribing tool, is being adopted and applied in GP practices by multiple health professionals working in the practice. Greater understanding of the factors enabling or constraining effective adoption and implementation will be of benefit to the developers and users of this particular service by helping to improve its further development, and supporting take up amongst patient groups.
The study will also serve a wider need in the UK healthcare community by showing how an innovative tool can be more effectively embedded into existing healthcare organizations and practices to secure significant benefits for staff and patients.
Diffusion of "Startback" triage screening tool
The Startback tool is an innovative triage screening tool. It is developed for GPs and physiotherapists to help assess patients with lower back pain, stratify them into low, medium, or high risk categories, and provide them with matched treatments. We follow the journey of the tool diffusion from 2015 to 2018, and show the variation in different professional groups’ responses (GPs, physiotherapists) to the innovation and the way it is adapted. In doing so, we are able to demonstrate dynamics of distributed leadership in the spread of innovations and the interplay between innovation adaptation and professional practice.
This project not only contributes to the literature on innovation diffusion in public service, but also provides valuable implications for policy and practice.
Exploring hybrid delivery model of reducing parental conflict interventions in health and social care services
Parental conflict is a significant cause of distress and mental health problems for parents and children involved and contributes to an increased use of health, social care, and legal services. Supporting parent(s) in conflict can help reduce the negative impact on families and children and there are a range of programmes designed to support parents develop positive communications and co-parenting arrangements. However, take-up of these services are rarely targeted at families from minoritised groups with little evidence on different modes of delivery and how best to spread and scale more widely within health, social care and community sectors.
The Race Equality Foundation have developed an innovative programme of support for parent(s) and will aim to roll this out to nearly 900 parents in England and Wales over 18 months. The programme brings parents together to develop skills in communication, conflict resolution, positive modelling and staying child-focused with the view to reduce the frequency and intensity of conflict to support child wellbeing. They will be trialling an in-person and hybrid model of delivery and CHIR will be evaluating the implementation, spread and scale of the programme through a mixed-methods approach. The study is funded by the Department for Work and Pensions for 18 months (finishing in late 2024)
Investigating the potential of a community-based music intervention to support maternal mental health in South India: A scoping study
Mental health problems during pregnancy and after birth (the perinatal period) affect the mother, can also have long-term adverse effects on her child. Perinatal mental health problems are a particular challenge in low- and middle-income countries (LMICs) where they can be at least twice as frequent as in higher-income countries. Research in The Gambia worked to co-develop with local women’s music groups a Community Health Intervention through Musical Engagement (CHIME)to support antenatal mental health. With careful consideration of cultural context, an adaptation of CHIME should be possible in contexts like India where music is already an integral part of the traditions around health.
The purpose of this pump-priming project is to investigate the potential of a community-based music intervention for perinatal mental health in South India. Within this qualitative scoping study, interviews, and focus groups with experts in perinatal mental health and traditional musical practices in South India will be conducted. Through a thematic analysis, intersections between maternal care and traditional music practices will be identified. This work will lead to the formation of an interdisciplinary team across the UK and South India and suggested adaptations and potential challenges of implementing CHIME in this new context.
System innovation scale-up in China
A system level innovation - Medical Alliance (MA) – was established throughout China in recent years following the 2009 health care reform, and has received considerable attention from policy makers, academics and international development organisations. MAs are collaborative alliances involving the integration of primary and community care organisations with secondary and tertiary care hospital providers.
The objective of MAs is to promote the usage of the newly established Community Health Centres (CHCs) and to reduce demand for hospital-based secondary and tertiary care to achieve more effective healthcare delivery. However, there are significant obstacles to adopting and scaling up such a large-scale change or system innovation. This project allow us to gain an ‘insider look’ at a few MA models across three different cities in China to examine the scale up and spread of such complex system-level innovation.
Contextualised adaptation of social care innovations spreading from high to low- and middle-income countries
Given the cost and time involved in developing and testing new interventions, low- and middle-income countries are adopting proven interventions from elsewhere. The challenge remains how to adapt and implement such interventions to fit the local context. This project develops a new practical implementation framework to support the adaptation of social work interventions in low- and middle-income countries through a scoping review and workshops with international experts and local practitioners in South Africa and Tanzania.
The framework is expected to allow for the development of practical guidance and tools targeting social care practitioners to facilitate and evaluate the adaptation process in the future. The study is co-funded by UKRI-GCRF.
Fathers Together study: Spreading innovation into prisons to support family wellbeing
The prison population is large, standing at around 85,000 prisoners in England and Wales. Most are men, many have a range of health and care needs, and many are also fathers. An estimated 300,000 children and young people are impacted by parental imprisonment which can be painful, stigmatising and upsetting and is linked to increased antisocial behaviours and increased likelihood of being involved in the criminal justice system themselves. This effects whole communities where young people from Black and minority ethnic groups are particularly over-represented in the prison population and experience many disadvantages relating to racism, discrimination and low trust in statutory agencies. Reaching out to this group is crucial to disrupt the cycles of intergeneration trauma and support population efforts to tackle health inequalities.
We are collaborating with the Race Equality Foundation to co-develop a programme to support young fathers in prison and their families to support relationships and reduce the impact of imprisonment on children. We are drawing on the wealth of experience and existing programmes delivered in community settings to examine how we can adapt and spread these to the population group and setting. We are working closely with four prisons in the South-East of England to examine the needs of the prison populations and explore factors relating to implementation, spread and scale across the prison estate, and co-develop and deliver a programme to a group of young fathers with the view to further explore wider roll-out in future research. This is a two-year study funded by the National Institute for Health and care Research (NIHR) (finishing in mid-2024)
Adapting a parenting programme to tackle youth violence
Youth violence is not an individual problem, but a community and society level problem that requires a comprehensive, multi-faceted approach to prevention and intervention. Area deprivation, poor housing, crime, and racism are important contributing factors to youth violence as well as family-level factors such as parental conflict, physical punishment, abuse, and parental imprisonment. We know that not all young people who experience these risk factors will go onto to be at risk of or involved in youth violence. Protective factors such as supportive and consistent parenting skills, nurturing and responsive social relationships, positive friendship groups, opportunities for education, sports and hobbies, and strong sense of community cohesion can act against risk factors.
We will be exploring the complex relationship between youth violence and family and communities to examine what adaptations can be made to an existing parenting programme to tackle youth violence through collaborations between health and care services and community organisations. This will include running a series of stakeholder engagement events and conducting rapid cycle testing of a parenting programme. The findings will help inform delivery of the parenting programme and inform future impact and process evaluations to examine outcomes and impact more widely. This study is funded by the Youth Endowment Fund and led by a team at UCL in collaboration with CHIR.
Scoping reviews on how innovations can tackle health inequalities
This rapid scoping review has two parts. The first part will identify key areas for targeting innovations to tackle inequalities in the English NHS and amendable factors within the NHS that could potentially reduce health inequalities.
The second part will identify needs and strategies targeting inequalities in the adoption and spread of (digital) healthcare innovations.
This study is co-funded by UCLPartners.
Role of patient and public involvement in embedding innovations in healthcare – A scoping review
Substantial evidence exists regarding patient and public involvement in research, but it is less clear what we know about patient and public involvement in the later stages of the innovation journey when innovations are implemented and spread in healthcare practice. This scoping review aims at identifying and mapping the currently available evidence regarding the role, influence or impact of patient and public involvement during different healthcare innovation stages from research and development via implementation, to scale-up and spread. Such mapping will identify current evidence gaps to derive new research objectives.