Reviewing Practice and Service
Healthcare organisations must always be seeking ways to improve services and reduce costs of delivering such services. Reviewing existing practices and service is the first step in this process, providing an initial 'situational analysis'. Here, service evaluation is key. CLAHRC-LNR has developed an Evaluation toolkit that you may use. The QIPPs programme also provides a number of resources. A Health Needs Assessment is also necessary as it provides a systematic method for reviewing the health needs of a population.
Identifying examples of 'Best Practice' and finding relevant local and national guidelines help with benchmarking and goal setting, while guidance on producing clear, evidence-based, user-friendly guidelines will help in assisting practices to meet identified service standards.
Finding guidelines and best practice
Funding for Evaluation Research
Quality, Innovation, Productivity and Prevention programme (QIPP)
Guidance on producing evidence-based guidelines
Health Needs Assessment (HNA)
An HNA provides a systematic way for identifying the health needs of a population, allowing for health services to be tailored to the needs of the local area.
DrCath has published information on what a HNA comprises, while NICE publishes a practical guide for those undertaking an HNA.
Finding guidelines and best practice
A number of resources are available:
- NICE guidance
- NICE Pathways
- The Improvement Network, with best practice examples in the East Midlands
- NICE guidance on using/implementing guidance
- Pulse - provides latest news on medically-focussed clinical subjects
- Stroke Association report - Improving Stroke Services across the UK - brings together 12 case studies of stroke services in the UK, with recommendations on improving services across the board for stroke survivors and carers
- DrugScope links to guidance literature relating to alcohol and substance misuse and drug dependence
Evaluation toolkits
CLAHRC-LNR has developed its own evaluation toolkit, which you can download (available shortly).
Topic-specific evaluation toolkits are also available:
- Telehealthcare toolkit - for helping to make a viable business case for the introduction of new technology to assist with the provision of healthcare in the home.
- The MS Society provide a toolkit for helping organisations implement NICE guidance concerning care of patients with multiple sclerosis.
- End-of-life care learning evaluation toolkit - for helping stakeholders assess the success of end-of-life care learning events.
Funding for evaluation research
The NIHR Evaluation, Trials and Studies Co-ordinating Centre (NETSCC) provides a number of funding programmes for evaluating healthcare interventions and organisation structure; also public health research. It runs five evaluation research programmes:- Efficacy and Mechanism Evaluation (EME)
- NIHR Health Services Research (HSR)
- NIHR Health Technology Assessment (HTA)
- NIHR Public Health Research (PHR)
- NIHR Service Delivery and Organisation (SDO)
NETSCC has a publication available outlining funding options for evaluation research in health.
Quality, Innovation, Productivity and Prevention Programme (QIPP)
The Quality, Innovation, Productivity and Prevention programme is a national Department of Health strategy involving all NHS staff, patients, clinicians and the voluntary sector. It aims to improve the quality and delivery of NHS care while reducing costs to make £20bn efficiency savings by 2014/15. These savings will be reinvested to support the front line.
eQIPP provides a wealth of resources on:
- improvement tools
- examples of where service improvement achievements have been made across the patient pathway, many of which can be adopted and adapted into other clinical areas and settings
eQIPP is part of NHS Improvement which is instigating clinical patient pathway redesign in defined patient condition areas.
Patient Experience Network
The aim of the Patient Experience Network (run by the NHS Institute for Innovation and Improvement) is to share ideas and best practice amongst NHS staff to drive improvement in patient experience. The network provides case studies, learning programme and events. It is also in the process of producing an evidence-based guide to help you and your organisation to understand and use patient experience to improve services. This will be a free online resource to be launched soon. You are encouraged to email them to register your interest. The network's next event is on the 8th March, 2012 - A Practical Guide to Measuring and Improving Patient Experience.
Guidance on producing evidence-based guidelines
The AGREE instrument provides a very clear framework for assessing the quality of clinical practice guidelines. The clearer and more evidence-based the guideline, the more likely it will be used. It is also a useful reference for structuring the content of guidelines in development.
According to AGREE, any guideline should contain information or be structured around six domains. These are:
- Scope & Purpose (overall aim of the guideline, specific clinical questions and the target patient population)
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Stakeholder Involvement ( extent to which the guideline represents the views of its intended users.
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Rigour of development (explicit reference to the processes used to gather and synthesise the evidence, the methods to formulate the recommendations and to update them).
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Clarity and Presentation (language and format of the guideline)
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Applicability (consideration needs to be given to likely organisational, behavioural & cost implications of applying guideline).
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Editorial Independence (statement must be made as to the independence of the recommendations and acknowledgement of possible conflict of interest from the guideline development group.
The Scottish Intercollegiate Guidelines Network (SIGN) produces a guideline developer’s handbook and other resources.
The ADAPTE Collaboration is an international collaboration of researchers, guideline developers and guideline implementers who aim to promote the development and use of clinical practice guidelines through the adaptation of existing guidelines. ADAPTE provides a framework and training resources for guideline developers, healthcare providers and policymakers to aid them in adapting guidelines. ADAPTE is a partner of the Guidelines International Network (G-I-N).
The GRADE Working Group (Grading of Recommendations, Assessment, Development and Evaluation) has developed an approach to grading the quality of evidence and the strength of recommendations. This will help guideline developers in making decisions and qualifying the strength of evidence around recommendations. GRADE provides evidence grading software to help with this approach.