PCPH eMagazine Spring 2018

Spring 2018 The biology of being sedentary Marginal Voices: A quest to improve mental health diagnosis among the deaf community Clinical pharmacists in Primary Care: A safe solution to the workforce crisis?Should doctors be criminalised? Building a coaching culture across the medical school and beyond

Spring 2018 In 2018, the National Health Service (NHS) celebrates its 70th anniversary. With the creation of the NHS in 1948, universal health coverage was finally implemented in the UK, with the NHS replacing the previous patchy health coverage schemes that had left many people with limited access to health services. Although the NHS has achieved much since 1948, in recent years we haveseen the NHS facing new challenges such as the very slow real-terms percapita increase in NHS spending since the global financial crisis in 2008. Inthis edition of our newsletter, you can read about the work we are doing tohelp the NHS continue to deliver comprehensive and high-qualityhealthcare to the residents of the UK. This includes our work on the use ofvideo-consultations and on using professional groups such as pharmaciststo take on some of the work currently carried out by doctors. Professor Azeem Majeed Head of Department of Primary Care and Public Health Imperial College London We welcome feedback on the ARCHIVE newsletter and are taking submissions for future issues. Email your news, events,achievements and stories to [email protected] PCPH eMagazine Team Subscribe Unsubscribe Javier Gallego Mehrosa MemoodCopyright © 2018 Department of Primary Care & Public Health, Imperial College London

In the News Photo: Doctor by MIKI Yoshihito - Creative CommonsA study published in the journal BMJ Quality and Safety concluded that extendingGP opening hours will not ease the rising burden on Accident and Emergencydepartments. The observational study was led by Imperial College London. Leadauthor Dr Thomas Cowling from Imperial College's Department of Primary Care andPublic Health and colleagues compared patients' experiences of GP surgeries withthe number of Accident and Emergency visits in their areas in England from 2011-2012 to 2013-2014. They examined reports from NHS England's annual GP PatientSurvey, and included patients registered to 8,124 GP surgeries.They measured levels of patient satisfaction using The study suggests that better satisfaction withthree factors: the ease of making an appointment, GP hours, for example because of extendedopening hours, and overall opening hours, does notexperience. They then \"The government must find affect the number of visitsmatched these responses with alternative ways to handle made to A&E in theirA&E departments in their area current pressures on Accident geographical area.to observe any correlation However, making thewith the number of visits to and Emergency departments. appointment bookingA&E. Overall, areas where This could include for example process easier for patientspatients were happier with improving access to GP was associated withthe ease of making slightly fewer A&E visits inappointments, which could be appointments during normal that area. The researchfor example by using online opening hours rather than supports findingbooking systems, saw slightly spending scarce NHS resources alternative options forfewer visits to A&E on extended opening schemes.\" easing the burden ondepartments. However, Accident and Emergencysatisfaction with surgery Senior Author Professor Azeem Majeed departments, and castsopening hours and overall doubt on thepatient experience seemed to have no impact on Government's proposals to extend GP surgeryA&E visit rates. hours to ease the burden.Times Belfast Telegraph OnMedica Pulse Daily Mail Eureka Alert

Evaluating health system in Brazil covered the environmental problems Iraq is facing such as, Lack of Water,Prof Christopher Millett, Dr Matthew Desertification, Pollution, and theHarris and Dr Thomas Hone were recently environmental effect on Health in Iraq.awarded funding by the MRC/Newton It aimed at:Fund for collaborative research in Brazil.This was part of the Brazil CONFAP-MRC 1. Showing the current situation ofCall for Health Systems Research Mental Health in Iraq.Networks. The research project aims toevaluate the health system and health 2. Addressing the challenges that theimpacts of a major expansion of primary Mental Health system is currentlycare doctors in the country. The Mais facing.Medicos programme has imported over14,000 Cuban doctors into Brazil to work 3. Finding guidelines for the Iraqiin primary care in underserved areas. Such government to improve thea large expansion of human resources for Mental Health system.health in a middle-income country isremarkable and likely to have major Professor Salman Rawaf and Dr Mayseffects. To-date, little has been published Raheem (pictured) were both keynoteon the impact of this programme. The speakers. Professor Salman gave a talkresearch will involve qualitative and entitled, ‘The Environment and Health inquantitative research located in the Iraq: what is next?’ Dr Mays RaheemFederal District and the state of Paraiba, presented, ‘What we do not know aboutin conjunction with Brazilian investigators Mental Health in Iraq’. Both presentationsbased at the University of Brasilia and the were very well received.Federal University of Paraiba. Researchstarts in April until Oct 2020. This will be agreat opportunity for researchers at PCPHand the wider college to strengthen theirrelationships with Brazil.Contributing to improvements inPublic Health in IraqOn the 18 February 2018 the IraqiEnvironment and Health Society UKorganised a conference ‘Degradation ofthe Environment in Iraq and its Impact onPublic Health’. The conference was held atUniversity College London (UCL) and

. formulate innovative ideas about major European Healthcare challenges.Sandpits event with SPHR inCambridge Dr Grazia Antonacci is a research associate in Healthcare Management at the NIHR CLAHRCThe Sandpit event, held 13 -14 December, NWL and Imperial College London, School ofwas attended by wide representation from Public Health and Business School. She is alsoacross the SPHR (School for Public Health a member of the Centre for Health EconomicsResearch) members; 50 academic members of and Policy Innovation. Her interest includethe School were joined by 13 national and 9 the design implementation and sustainabilitylocal policy or practice representatives. Much of innovation in healthcare system. Grazia iswas achieved in the spirit of collaboration. currently involved in research on theThere were three separate sandpit groups, introduction of approaches and technologiesone focussing on each of the agreed research designed to improve the quality of health andprogrammes: healthcare services. Before joining CLAHRC NWL and Imperial College, she worked in a 1. Children and Young People. pharmaceutical and consulting firm as well as 2. Public Mental Health in the administration of an Italian research 3. Places and Communities.. hospital (8years), IRCCS Casa Sollievo della Sofferenza (FG). Her Education includes aPotential research questions/plans were European PhD in Enterprise Engineeringdeveloped by the groups, which where than (healthcare management), a postgraduateshared with the wider audience. There was Degree in Management of Healthcareconsideration to the three cross-cutting Organisation and a MSC in Managementthemes (Health Inequalities, Changing Engineering.Behaviour at Population Level and Equitableand Efficient Public Health Systems). For more information on the role of the EHPMoving forward, they need to reflect on the continue to the Imperial College Businessoutputs from the Sandpit and move to the School article.next stage by agreeing the researchprogrammes for SPHR over the next fouryears, what the key research questions areand to agreeing the programme of workwithin each research theme.CLAHRC Research Associate, GraziaAntonacci, appointed to EuropeanHealth ParliamentOn 17 October 2017 the third edition of theEuropean Health Parliament (EHP) wasofficially launched in Brussels. Dr GraziaAntonacci was selected to join the parliamentalong with 55 young professionalsrepresenting European Members States. Theambition is to reinvent European Healthcareby enabling young professionals fromdifferent backgrounds to debate and

SAPC Madingley Hall Conference 2018 The Imperial College GP teaching team were well represented at this year’s Society for Academic Primary Care (SAPC) regional conference held on 25 & 26 January in Madingley Hall, Cambridge. Presentations from the team were positively received and included some of the following highlights:MADING

Clockwise from top left: Ali Dhankot, Senita Mountjoy, Laura Storm, Maham Stanyon, Ellie Gunning, Ravi Parekh, Emma Keeling, Sonia Kumar, Jenna MollaneyGLEY 2018

Sonia Kumar and Arti Maini presented the Ravi Parekh and Shivani Tanna presentededucational Communities of Practice (eCoP) findings from research with GP tutors statingmodel that they developed together with Jo that, “Madingley was a great opportunity toHorsburgh (Lead for Educational Research). showcase the research we have carried outThis model has been designed to support staff looking at the key barriers and motivators forto develop evidence-based, innovative community GP tutors taking on students incurricula while in turn contributing to the their GP Practice. One of the key areas thatevidence base. The eCOP model offers an came out of the research, was the idea ofapproach to management of change in service learning, by trusting our students andmedical education and in other organisational preparing them before entering their clinicalsettings seeking to develop as learning placements, the students are able to provideorganisations. a service for the patients in the GP practice and 'learn through doing\". Encouraging thisSenita Mountjoy, Ellie Gunning and Laura model can allow for the GP surgery to have aStorm presented work on the novel ‘Virtual motivated and conscientious member of theToddler’ session for teaching child team, and allows for the students to learn realdevelopment to medical students. The session life clinical practice through their patients. \"employs facilitated e-learning; blendedlearning, to take students through child For further details about any of thesedevelopment assessments. Results of the projects, please contact Jo Horsburghqualitative research showed that students (Lead for Educational Research)value the session and the experiential learningopportunity, enabling them to improve theirconfidence in child developmentalexaminations. Most importantly, theirresponses suggested that this approach couldbe utilised effectively in other areas where itis challenging to access patients.Ali Dhankot, Noreen Ryan and Josh Gaonpresented their novel teaching sessiondesigned to teach leadership to medicalstudents based on the Medical LeadershipCompetency Framework. This session uses asimulated disaster scenario (a suspectedterrorist attack) to engage students inleadership skills. They are currently in theprocess of evaluating the outcomes usingfocus groups.Data from the WATCCH (widening access tocareers in community healthcare) project waspresented by Farah Jamil. Thematic analysis offocus groups with Year 12 students recruitedto a summer placement highlighted anobvious work experience gap in GeneralPractice. However, greater awareness wasshown by the students of the range ofhealthcare professional roles, which allowedfor better decision making about their futurecareers.

Maham Stanyon reflects on her experience of admission to healthcare professionsattending the conference: from students from disadvantaged backgrounds lead by Dr Jamil, who“Madingley is always a treat, friendly displayed some of the incrediblefaces and a lovely welcoming creative work the students didatmosphere to novice presenters like reflecting on their experiences duringmyself. A diverse range of the programme. I was overwhelmedpresentations this year, with and heartened by the team supportparticular highlights including a taste during my presentation, anof the innovative leadership and exploration of the use of educationalprofessionalism session from year 5 communities of practice to aidrun by Drs Ryan, Dhankot and Gaon international trainees in learning thethat has students participating in a academic 'hidden curriculum';disaster scenario and an update from particularly as this project moves intothe ground-breaking Year 3 Medicine the unchartered waters, combiningIn the Community course from Drs sociological principles, anthropologyTanna and Parekh, showcasing some with educational research. Overall aof the fantastic early results from wonderful two days, filled withtheir data. Further highlights included exciting discussions, new possibilitiesan evaluation of the WATTCH project, and old friends.”a project looking at increasing



Fellowship Programme for Healthcare ImprovementRowan Myron, Catherine French, Paul Sullivan, Ganesh Sathyamoorthy, James Barlow & Linda PomeroyImproving the quality of healthcare involves collaboration between many different stakeholders.Collaborative learning theory suggests that teaching different professional groups alongside each other mayenable them to develop skills in how to collaborate effectively, but there is little literature on how this worksin practice.Further, though it is recognised that the Fellowship, which included bringingpatients play a fundamental role in multiple perspectives to discussions ofquality improvement, there are few real world problems, was valued byexamples of where they learn together participants who reflected on the safe,with professionals. To contribute to egalitarian space created by theaddressing this gap, we review a programme. Participants (healthcarecollaborative fellowship in Northwest professionals and patients) found thisLondon, designed to build capacity to way of learning initially challenging yetimprove healthcare, which enabled ultimately productive. Despite thepatients and professionals to learn pedagogical and practical challenges oftogether. Using the lens of collaborative developing a collaborative programme,learning, we conducted an exploratory this study indicates that opening upstudy of six cohorts of the year long previously restricted learningprogramme (71 participants). Data was opportunities as widely as possible, tocollected using open text responses include patients and carers, is anfrom an online survey (n = 31) and semi- effective mechanism to developstructured interviews (n = 34) and collaborative skills for qualityanalysed using an inductive open coding improvement.approach. The collaborative design of Full Article



Professionals learning together with patients: An exploratory study of a collaborative learning

MEDIA MENTIONSAn article entitled ‘The impact of private onlinevideo consulting in primary care’, by Louis Peters,Geva Greenfield, Azeem Majeed and BenedictHayhoe was published in Journal of the RoyalSociety of Medicine and has received extensivemedia coverage.

Workforce and resource pressures in the UK several questions. A particular concern, givenNational Health Service mean that it is continued development of antimicrobialcurrently unable to meet patients’ resistance, is that some companies appear toexpectations of access to primary care. In an use ease of access to treatment withera of near-instant electronic communication, antibiotics as an advertising strategy. Thewith mobile online access available for most article examines online video consulting withshopping and banking services, many people private general practitioners in the UK,expect similar convenience in healthcare. considering its potential impact on patientsConsequently, increasing numbers of web- and the National Health Service, and itsbased and smartphone apps now offer same- particular relevance to antimicrobialday ‘virtual consulting’ in the form of Internet stewardship.video conferencing with private generalpractitioners. Questions remain about the safety of online consulting and of the working practices ofWhile affordable and accessible private some private companies. Appropriateprimary care may be attractive to many regulation is essential to ensuring that thesepatients, the existence of these services raises services offer safe and effective care to patients. This will require a carefully tailored approach on the part of regulators such as the Care Quality Commission. For example, it has not been necessary to develop standards on advertising when assessing National Health Service general practices, but this will be essential in monitoring the actions of private online general practice services.Key messages 1. Offering rapid, affordable access to primary care advice, private online GP consulting services are expanding 2. Concerns about safety and working practices (including antibiotic prescribing) should urgently be addressed 3. Increasing online access to healthcare is an NHS priority, and there may be opportunity for the NHS to engage with private providersFull Article Pulse GP The Sun

Imperial College EIT HealthInnovation Day

EIT Health is a consortium of more than 50core partners and 90 associate partnersfrom leading businesses, research centresand universities from across 14 EUcountries. The goal of EIT Health is tocontribute to increasing the competitivenessof European industry, improve the quality oflife of Europe’s citizens and thesustainability of healthcare systems.Imperial College London is the lead partnerin EIT Health’s Innovation Day Programmeaiming to inspire and train students in thefield of healthcare innovation.

The Imperial Innovation Day began bright and early with a coffee reception at 8:30am.Seventy-six participants signed in and mingled before heading into the Lecture Theatre to bewelcomed by Dr Filippos Filippidis. Professor Helen Ward gave a brief history of EIT activitiesand the next guest speaker was Rosemary Gallagher who focused on EIT Health and futurepotential opportunities. Dr Somai Melek gave a macro view of current challenges inhealthcare before introducing the case challenges for the day, sourced from CARE Campus.Following from this the expert panel of five senior citizens took their places and led adiscussion focusing on unmet needs and challenges for elderly care giving.Thereafter, the hands on work started with a Participants were encouraged to go out andDesign Thinking session and students moved to conduct short interviews to try and gain somethe workshop area where they had been insight, as well as making use of advice from theallocated into teams of five. Guided by expert citizens. Both the teams and the expertJacqueline de Castillo the teams hit the ground citizens were incredibly engaged andrunning and immediately started throwing ideas enthusiastic about the challenge and reallyaround and building up their whiteboards with enjoyed the opportunity to exchange ideas.infinite post-it notes. Teams were strongly encouraged to make prototypes no matter how basic and all of

these processes were guided and overseen by scores were aggregated and the top five teamseleven hardworking facilitators. The time for were shortlisted to take part in the final pitches.lunch arrived and students were so focused andkeen that most had to be strongly urged to The finalists were announced and came up toactually take a lunch break! present to the entire group as well as answering questions from the panel of assessors. ThePitch coaching took place after lunch and teams Awards Ceremony saw three very deserving andwere then given a final opportunity to develop proud teams pick up their Gold, Silver andtheir solutions and create their pitches. After a Bronze Awards and gift vouchers. There was ashort break with a lot of coffee, teams were very exciting atmosphere and everybodysplit into three rooms to present their first involved felt the day had been inspirational andround pitches. Three of the assessors were in incredibly rewarding. As everyone headed off toeach of these rooms scoring the teams. After the Student Union to celebrate a constructivethis the whole group congregated back in the and exciting day, there was a definite feeling ofLecture Theatre for an inspirational talk from Dr accomplishment and success after a day filledNicholas Andreou describing Locum's Nest with innovation!healthcare start-up journey. During this time

MARGINAL VOICES

A quest to improve mental healthdiagnosis among the Deafcommunity in the UKWritten by MPH Student Ms Reda MisghinaEach year in the UK, at least 1 in 4 people experience a mental health problem.When faced with a mental health illness, we often hear the words ‘it helps totalk about it’. The tool of communication in Deaf individuals makes it so that‘talking’ takes a different format in their ability to convey thought. Variousmisconceptions about Deafness and the obstacles faced to access mental healthservices must then be conceptualised differently.Deafness as an identityIn the UK, around 10 million people are considered to be Deaf. The heterogeneous formsof what it means to be Deaf renders it a complex subject. Forms of identification is aninteresting factor. For example, there is a distinction between a deaf person (lower case‘d’) which refers to those with severe hearing problems or who became hard of hearinglater in life, compared to a Deaf person (capital ‘D), referring to people that were borndeaf or became so soon after birth.Deafness and mental healthThe size of the problem of Deaf people with mental health issues is currently unknown.There are various estimates that will paint a picture of the extent of its severity butreliable evidence is either preliminary or out of date. It has been widely acknowledgedthat Deaf people are twice as likely to have mental health issues as hearing people and40% of Deaf people will experience a mental health issue at some point in their lives.Going beyond the language fixTranslating the conceptual theory of the Deaf identity and Deaf mental health intopractice as a public health matter is a challenge yet to be fully met. Community-basedmental health for the Deaf community has been led by charities acting on behalf ofprimary and secondary mental health services. Currently, SignHealth is the only Deafhealth charity that offers a psychological therapy service for Deaf people with ‘BSLHealthy Minds’. This essential service has helped connect patients to a Deaf therapist, ora hearing but fluent BSL user done in the effort of addressing the gap found in primarymental health.ConclusionIn order to close the gap between mental health issues and medical services it isparamount to conduct interventions at a local level and start to implement BSL friendlypsychological services at a national level. Recognising the cultural distinctiveness of theDeaf community is a pre-requisite to how medical and public health professionals canassess their need for effective response.This essay was awarded a prize by the Royal Society for Public Health.Full Essay



This year’s School of Public Health Away Day was held in January at Queen’s Club inWest London. Academic staff and Departmental Managers from across the entireSchool met to discuss upcoming developments and opportunities. Deborah Ashby(Interim Head of the School) introduced the day and gave a general update on SPH.There were presentations from Professors Helen Ward and Paul Aylin on the School’seducation offering, including the newly launched MSc in Health Data Analytics, andplans for our new Global Master of Public Health course were announced. Theafternoon was an opportunity to have discussions on a number of Athena SWANtopics as the School works towards resubmitting its silver application this autumn,and this was led by Professor Steven Riley. There were also talks on the vision for theFaculty of Medicine and the School of Public Health’s move to White City andanother discussion session, on REF 2021, led by Professors Neil Ferguson and PaulElliott.

Photo by Connor Tarter – Creative Commons Professors Azeem Majeed and Raanan Gillo tragic case of 6 year old Jack Adcock, who d what may be its final punitive phase, with t from the medical register.

Azeem Majeed and Raanan Gillon contribute to Bawa-Garba debateon joined the discussion regarding thedied from sepsis in 2011, and reachedthe erasure of a trainee paediatrician

In a rapid response letter to a sepsis that resulted in deathBMJ editorial on ‘criminalising that they were justlydoctors’, Prof Azeem Majeed convicted? Or were theywith co-author Paul Morgan, involved in just one of manyargues that the real lesson of cases where sub-optimalthe Bawa-Garba case should management of sepsishave been the enormous public contributed to death?health toll of sepsis and thedifficulty of diagnosing it, and NICE guidance NG51 andcertainly not ‘the conviction of Quality Standards QS161 have ‘Given the scale of mortality from sepsis and the many delays and errors so oftenseen in its management, why then were Dr Bawa-Garba and Ms Amaro convicted of gross negligence manslaughter?’health professionals’. only recently set out the expectations of what bestThey point out that NHS practice in sepsis care shouldEngland estimates an annual look like – several years afterdeath total of some 37,000 the convictions of Dr Bawa-from sepsis. Given the scale of Garba and Ms Amaro.mortality from sepsis and themany delays and errors so They also argue that ‘We needoften seen in its management, an objective review of sepsiswhy then were Dr Bawa-Garba deaths to identify theand Ms Amaro convicted of contribution of sub-optimalgross negligence management to the death andmanslaughter? Was their identify lessons for the futuremanagement of Jack Adcock so in a non-judgmental manner,far out of line from the and not the prosecution ofmanagement of other cases of health professionals, if we are

to improve clinical outcomes judgment was consistent withfor patients with sepsis’. the guidance and that he very much hopes the judgment willRaanan, in an article-length be appealed. He also arguesletter, argues that the GMC that in future the GMC shouldshould not have referred the separate convictions based onTribunal judgment (suspending remediable medicalDr Bawa-Garba for a year and incompetence – even if thisrequiring review before the was very severe and fatal – butsuspension was lifted) to the where no additional ‘heinous’High Court and that the Court’s behaviour or attitudes wereupholding of the GMC’s desire involved, from otherto strike off Dr Bawa-Garba convictions.from the medical registershould be appealed. He argues The GMC’s course in such casesthat the conclusion in that should be to withdraw thejudgment simply does not doctor’s license to practise andfollow from the premises on facilitate and encouragewhich the judgment states that remedial training so that theconclusion is based. In essence doctor can be returned to safethe judgment states that the medical practice as soon asTribunal’s judgment was not possible, with the public thusconsistent with the extensive regaining the services of apublished guidance to medical doctor. In this way the GMCpractitioner tribunals, and in would, in such cases, fulfil itsparticular that it was triple legal obligation ofinconsistent with several protecting the safety ofspecified paragraphs of that patients, maintaining medicalguidance. standards and maintaining public trust.Raanan argues that there is astraightforward Read the BMJ editorialcounterargument to show how, Read the full letters of response by choosingon the contrary, the Tribunal’s the ‘Responses’ tab and scrolling down to Azeem and Raanan’s letters.

Tech Mentors 2012_Photo by Dave Caleb_All Creative Commons_BW Many people at Imperial will have heard something about coaching - a powerful approach to support learning and development which has been expanding in recent years in both education and health. As part of their drive in leading excellence in medical education, Dr Arti Maini and Dr Sonia Kumar from the Undergraduate Primary Care Teaching team have been leading on developing a coaching culture across the Medical School at Imperial (supported through Medical School Innovation funding). In addition to her educational role as Deputy Director for Undergraduate Primary Care Education at Imperial, Arti is an accredited coach, coach trainer and supervisor and co-author of the book ‘Coaching for Health’. She works as a coach for the Imperial Coaching Academy and sits on its strategy group. A large number of educators have been from the Imperial College Academic Health trained in this coaching approach: the Science Centre. All those trained are able to undergraduate primary care teaching team, access ongoing coaching supervision to Imperial’s academic GP VTS, community GP support their learning. Work is in progress tutors, personal tutors and the Career with Imperial’s Ed Tech team to develop Champion network and research facilitators innovative digital learning modules in

coaching for education and health so watch “I guess if you have an issue it makes it easierthis space! to deal with because you now have like a structure of exactly...you know the exactArti is now working closely with the EDU structure of how to solve your own problemsoffering coaching courses that are formally essentially”.accredited by the Royal College of Physicians. “I've noticed quite significant transformationThe coaching programme has attracted in the way I interact with people. I'm muchattention nationally and internationally and more receptive and I think I listen more. Imedical schools across the UK and Canada are find... Well we are listening in conversationkeen to learn more about our approach. but I find a lot of the time we aren't listening. So the quality of listening has gone up…it justExamples of quotes from faculty include: makes the conversation a lot better”.“The session felt tailored and it was good tobe able to practice. For me it worked Going forward, the Undergraduate Primaryperfectly and exceeded my expectations”. Care team are developing health coaching to“The most surprising thing about the course incorporate a socially accountable ethos,was how transformative it was”. building in ‘service learning’ approaches“This has radically changed my view of the across its courses. Students in Year 3 and Yearpower of language and I don’t think I 5 who have trained in health coaching skillsappreciated it until doing this course”. have started working with patients from“I can see multiple scenarios for the coachee- diverse local communities, holdingcentred approach to empowering conversations to support themcoaching/teaching/training”. with their issues around health and lifestyle.“The course has reinforced myunderstanding of how beneficial a tool this They look forward to develop the healthcan be and developed my skills significantly”. coaching courses further over the coming year as they will continue to work with theIn parallel to training medical educators, Arti department’s Self Care Academic Researchhas also been busy training medical students Unit (SCARU), Imperial’s communityin Year 3 and Year 5 in health coaching skills engagement team at the new White City(supported through funding from HENWL). campus, with White City Enterprise and theEvaluation so far has been very positive Dalgarno Trust in North Kensington and Drdemonstrating positive impact for patients Paquita de Zulueta who leads the Grenfelland for the students themselves. Arti has Clinical Outreach Team.been working with the Head of AcademicSupport for the Early Years to explore how They will be offering a new Special Choicecoaching may best be used to maximise the Placement on Health Promotion in 2018-19successfulness of learning approaches. where students from Year 5 will have the opportunity to learn health coaching skills andExamples of quotes from students are: put them into practice in making a real“I think patients… feel quite empowered. meaningful difference to local communities.They're sort of very motivated about what todo next and it's nice to see that you've sort They are currently evaluating the studentof left them with that sense that they can health coaching training throughchange what they want”. questionnaires and focus groups and interim“I think it makes the medical student more findings suggest a positive impact on patients,valuable to, you know, the hospital or the host GP practices and on the studentsGP”. themselves. Over the coming year we will be“It’s just generally my motivation seems to looking at how to increase patientbe increased”. involvement in health coaching course evaluation and research.If you would like to find out more about the coaching-related work being carried out by ourdepartment, please contact Arti Maini or Sonia Kumar.

student news

Megan Hutchinson:Why I'm choosing general practiceBy Megan Hutchinson, fifth year medical student at Imperial College LondonWhy be a GP? A career in general practice stands out formany reasons. From the working environment to the day-to-day cases, becoming a GP has many attractions.The main appeal to me is the wide range of full circle back to the community, havingpatients you come into contact with. From followed and supported them the whole way.coughs and colds, to two-week waits andchronic conditions, you never know what will Being patients’ main doctor also allows GPs awalk in next. deeper insight into their lives. Not only are GPs privileged to have such an intimate view,And for cynics who claim that 'GP is an but by forming long-term relationships theyendless parade of the mundane and understand their patients better; adaptingrepetitive’, for me no two patients are ever their approach in the knowledge of character,the same. Different demographics, health religious or cultural views and past medicalbeliefs and presentations mean that even the history.common cold becomes new with everyhistory. But it's not all about the patients. As a GP you have the chance to build and adapt yourSecondly, as doctors we strive to help our career throughout your entire working life.patients and improve outcomes. How better From public health to specialty accreditations,to achieve this than to stop disease before it the opportunities are endless. Work with NHSstarts? Primary care means primary 111, start a new outreach project or volunteerprevention; empowering patients to take your time overseas - just like their patients, nocontrol of their health and make positive two GPs are identical. And by working andchanges. I enjoy educating patients - sharing living in the same community, you get to seeknowledge, directing them to resources and the difference you make.enabling them to make informed choices areall essential for people to take ownership of Finally, the close-knit interdisciplinary teamstheir wellbeing. formed in general practice only add to the job. In hospitals staff often rotate betweenGP-patient relationship placements, but in the community teams tend to be more stable. This means you can formBut preventive medicine isn’t the only way long-lasting relationships and always haveGPs affect health. As the primary access point, someone to ask for help or to discuss difficultGPs and the GP-patient relationship are cases with.central to how the public interact with theentire NHS. Rapport and trust are the General practice encompasses all the reasonscornerstones to patient adherence and I chose to practice medicine - interacting withengagement in services; with a strong patients, daily variety and the ability to shaperelationship, patients are more likely to my career to my interests. No other medicalpresent earlier and follow advice, thus specialty seems to offer such aimproving outcomes. comprehensive career, and I cannot imagine myself pursuing any other path.Additionally, being the first professional mostpeople present to, your actions shape their Read the shortlisted entries for thispatient journey - and you'll see them come year's ‘Choosing General Practice’ competition on GP Online

In a paper published in the Journal of the Royal Society ofMedicine, we discuss the role that clinical pharmacists couldplay in primary care.Primary care in the United Kingdom’s the general practitioner workforce,NHS is in crisis. Systematic but general practitioners take at leastunderfunding, with specific neglect of 10 years to train and decliningprimary care compared to other numbers of medical graduatesclinical specialties, has combined with internationally suggests a limited poolever-rising demand and for recruitment. In this article, weadministrative workload to place a discuss integration of clinicalnow dwindling workforce under pharmacists in general practices as aunsustainable pressure. potential solution to these problems.A major factor in the growing Pharmacists have been working inworkload in primary care is primary care teams for some time inprescribing. An aging population and non-patient-facing roles. Areas inhigher prevalence of chronic diseases which they support practices includeis leading to increased case auditing for performance targets,complexity and polypharmacy, and implementation of enhanced services,consequently greater potential for preparation for inspections by theprescribing errors. Nearly 5% of all Care Quality Commission, trainingprescriptions in general practices in staff in repeat prescribing andEngland have prescribing or providing medicines information formonitoring errors, while in some other clinicians. However, these rolesareas up to half of the prescriptions currently vary from practice toare prone to error. Although most practice. The widespread integrationerrors are of mild or moderate of pharmacists in both patient-facingseverity, they can be life-changing for and non-patient-facing roles thereforepatients and costly for healthcare has the potential to have impact insystems, accounting for around 3.7% three key areas: safety of prescribing;of preventable hospital admissions. improved health outcomes; and access to primary care throughWorkload and time pressures reduction of general practitionerexacerbate prescribing errors. workload.Concerns about workload and accessin primary care have led the UK Full StoryGovernment to pledge increases in



Working within community and social care settings is core toCLAHRC NWL. Whilst evident in all themes, two notable researchprojects are highlighted. A shared finding across these projects isthe importance of having care networks in place. DavidSunkersing discusses his work in the ‘Frailty’ theme exploringpatient networks. Sophie Spitters covers healthcare professionalnetworks as part of her work in the ‘Early Years’ theme.Frail individuals’ care networksDavid SunkersingOngoing research within the Frailty theme has illustrated the importance of the care supportnetwork of an individual – and, indeed, the interplay between physical, social, mental andenvironmental domains. One project at CLAHRC NWL seeks to greater understand the holisticand proactive approaches used in the care of a frail individual, the importance of the ‘patientnetwork’ (e.g. family, friends, physio) – and aims to understand its impacts from both a patientand healthcare professional perspective.Looking at these networks in more detail, we find that amongst the healthcare professionals inthese networks, a variation in assessments used to assess frail individuals exists. Though recentlypublished guidelines emphasise the importance of assessing frailty in individuals with existingcomorbidities (1), a lack of standardisation and a consequent variation in assessment practicesand support given across healthcare settings and professions exists (2,3). Establishing theassessment practices for frail individuals – and whether existing networks of an individual can beleveraged to maximise the management of their frailty, are areas that both require furtherresearch. As such, research into these two areas has been conducted in the community setting,acute care setting and longer-term care setting.Ultimately, identifying, assessing and managing frailty can present many challenges;understanding that frailty is a complex, long term condition can aid in providing approaches thatwill contribute towards healthy ageing and capability across the life course.

Healthcare professional networks Sophie Spitters In the Early Years theme, ongoing research highlights the importance of networks between healthcare professionals. I follow a series of improvement projects that aim to improve the care for children with allergic diseases. All project teams started off with similar ideas. They wanted to improve the patient journey in the healthcare system and they wanted to implement nurse-led clinics in the community to do so. However, they encountered difficulties and saw opportunities that led them to change the plan. Some changes were small, some were rather hefty (4). However, when asking people about their projects, I noticed one thing kept coming up. People kept mentioning the value of the interactions they had with different professionals; the value of relationships. The relationships that were established across the allergy improvement projects came in different shapes and forms. In one project specialist doctors met up with GPs during lunch time to discuss queries about the allergic diseases of patients in general practice. In another project, school nurses shared concerns about the asthma of their pupils via phone with specialist nurses. They would give guidance on what to do or suggest to refer the child to their community clinic. A third project implemented multidisciplinary clinics in secondary care, run by consultants, nurses and dieticians together. This way, patients could get their tests, medication and education all in the same appointment. And healthcare professionals could easily check-in with their colleagues. These relationships make a network of healthcare professionals who look after children with allergic diseases. Through this network, expertise is shared and actions are coordinated, which supports better care and better experience for patients. The English poet John Donne once said, “No man is an island”. In support of this statement, our work in community and social care settings demonstrates that proactive use and development of networks, whether that be a patient or healthcare professional network, offers many benefits.References 1. National Institute for Health and Care Excellence. [Online]. Multimorbidity: clinical assessment and management. 2016. [Last accessed 31 August 2017]. Read 2. Sunkersing, D., Reed, J., Martin, F. and Bell, D. Frailty: Assessment and Communication within a Care Home Setting. Poster presented at: Past, Present and Future of Medicine: Society for Acute Medicine and the Royal College of Physicians of Edinburgh Conference; 2016 September 12-13; Edinburgh, United Kingdom. 3. NHS Improvement. [Online]. Rapid Improvement Guide to: Identifying and managing frailty at the front door. 2016. [Last accessed 31 August 2017]. Read 4. Spitters, S.J.I.M., Reed, J. and Warner, J.O. Tailoring Interventions in the diffusion of an allergy program. Poster presentation at: International Forum on Quality and Safety in Healthcare; 2017 April; London, United Kingdom. Read

By David SalmanAcademic Clinical Fellow in Primary CarePCPH, Imperial College LondonSupervisors: Prof Azeem Majeed, Prof Alison McGregorI am an ST2 academic clinical fellow (ACF) trainee in primary care at ImperialCollege, and aim to develop both an academic and clinical special interest insports and exercise medicine alongside general practice. My current researchinterest is to better understand why sedentary lifestyles are so harmful. The aimsof this are both to develop an increasing body of robust evidence to helpinfluence change away from societies and lifestyles geared towards beingsedentary, but also to better understand how individuals in certaincircumstances, such as suffering from disabilities or being hospital or bed-bound,may be affected and how they can be helped.Being sedentary is an independent risk underpinning the harm it causes. Being afactor for all-cause mortality and multi- multisystem disease, its effects aresystem morbidity, from cardiovascular widespread, encompassing humoral,disease, diabetes and obesity, to depression immune, genetic, mechanobiological andand cancer. (This has been known since the metabolomics systems. The study of1950’s, when Jerry Morris produced his metabolism and metabolites (metabolomics)landmark study demonstrating an increase provides information on the interplayin cardiovascular mortality in bus drivers between intrinsic (genetic output) andwhen compared to conductors.) Moreover, extrinsic (environmental input) factors, andthe effects of being sedentary are only as such would allow us to understand thepartially compensated by physical activity, complex gene-environment interactionsmeaning that being sedentary is an actively occurring in the field of physical activity andharmful process. Despite this, in the UK health. Metabolic signatures already allowapproximately a quarter of women and a us to distinguish cancerous from benignfifth of men do less than 30 minutes physical tissue and the microbiome signature ofactivity a week, and around 80% of children athletes is markedly different from those ofare not achieving recommended levels of sedentary individuals. My current workphysical activity. To change this situation will spanning both the PCPH (Azeem Majeed)require more than providing information on and the musculoskeletal lab (Alisonphysical activity levels to people. A McGregor) seeks to explore the metabolicconcerted effort is needed to increase signatures of sedentary and activeaccess to facilities and to change the way individuals as part of a wider study ofpeople travel and work. biomarkers of osteoarthritis. I hope to use this preliminary data to apply for post-Furthermore, we do not comprehensively doctoral funding in the future, andunderstand what constitutes ‘being hopefully, one-day, to help contribute to asedentary’, and the biological processes society that promotes physical activity.





NIHR CLAHRC NWLImprovement LeaderFellowship Study Visitto SwedenBetween 26 Feb and 1 March 2018 a group of 7Improvement Leader Fellows from NIHR CLAHRCNWL attended an international conference inJonkoping, Sweden for a study visit…

The study visit was a chance for Fellows to take Sunita Sharma spoke on her improvementtime away from the busy ‘coal-face’ of delivery work in Chelsea and Westminsterand normal clinical commitments. The maternity services, which focuses onJonkoping Microsystem Festival is an unusual adopting design thinking approach toconference. It brings together a range of inpatient postnatal care in a busy Nationalinternational clinicians and those interested in Health Service hospital.improving healthcare. The conference hadseveral exciting plenary speakers. The NIHR Sunita created this drawing image whichCLAHRC NWL Fellows and team heard from summarises her experience in Jonkoping.Stefan Liljegren, who “spoke powerfully” on hisexperience of leading one of the first Ebolahospitals in West Africa during the crisis in2014. “His reflection on working in suchoverwhelming frontline chaos whilst stillimproving care was remarkable” - RowanMyron.Fellows also heard from Chris Dancy about theintersection of health and technology (and howwe are all becoming cyborgs).A number of the NIHR CLAHRC NWL fellowswere accepted to speak at the conference.Two further NIHR CLAHRCNWL Fellows were on theteam who won ‘HighestPerforming Team’ and‘People’s Choice’ award,as judged by NigelEdwards (CEO of NuffieldTrust) and Goran Henricks,CEO of Qulturum.Tai Frater, Occupational therapist, Brunel University, spoke on her work withthe Children’s Trust and her project on shared decision making with childrenwith traumatic brain injury.“It was a huge honour to present my CLAHRC fellowship project at theClinical Microsystems Festival in Jonkoping Sweden. My small but perfectlyformed audience were very interested in my work on supporting childrenwith brain injuries to participate in healthcare decisions and helped meconsider future directions for my project. I was also able to share ideaswith a brain tumour team who were developing their service to be morepatient-centred. All in all a very special experience.”

Ammu Matthew, Cardiac Nurse, West Middlesex University Hospital, spoke about theimprovements implemented at West Middlesex University Hospital in the Heart Failureimprovement project funded by NIHR CLAHRC NWL.“The Microsystem festival Sweden visit and the opportunity to present my QI work on'virtual clinic review of Heart Failure patients improve coding accuracy ' was an incredibleexperience. To be able to communicate the work we do to international colleagues and toknow their perspective and similar work at their part of the world was truly amazing.” A group of the NIHR CLAHRC NWL fellows participated in the Hackathon during the conference, one of which was on the winning team.Dr Rowan Myron The NIHR CLAHRC NWL Fellows and teampresented on the NIHR members would like to leave you with aCLAHRC NWL little shared learning:improvement LeaderFellowship and the “We learned quite a lot about therecently published paper Swedish tradition of Fika (fee-kah) whichon the evaluation of the centres on taking the time to have afellowship (for more break, have coffee, but the main point isinformation see the to connect with your colleagues, learnpaper). about their work and their world. The benefits of taking this time was well documented at the conference and created great opportunities for unexpected networking.” If you’d like to know more about the NIHR CLAHRC NWL fellows and their projects more details can be found on the CLAHRC NWL website. If you’d like to know more about the Microsystems Festival and the innovative work going on in Sweden you can find it on their website.

Predictors of outcomes for patients with Health Research and Care (CLAHRC)common mental health disorders receiving programme for North West London.psychological therapies in communitysettings: a systematic review Many studies have demonstrated the frequency of alcohol problems amongstPsychological therapies are increasingly patients in hospital wards. These patients,delivered in community care settings. In who are often admitted with problems notexisting literature, patient, disorder and related to their alcohol use, do not usuallyservice variables are known to have a require specialist treatment by hepatologistsignificant impact on the recovery outcomes or gastroenterologists and may miss anfor patients undergoing psychological opportunity to have their alcohol usetreatment in secondary care. The aim of this addressed.review is to establish which predictors have a The benefit of multi-contact BA in primarysignificant impact on recovery from common care has been demonstrated as an effectivemental health disorders in community public health strategy. The public healthsettings. It was identified that key predictors white paper ‘Healthy Lives, Healthy People’for recovery in a community settings from (2010) advocates ‘a more innovative,five countries. The evidence currently integrated and dynamic approach toavailable for this setting is limited, so this improving public health.’review serves as a starting point to highlight Authors: Susannah R Woodrow, Stuart Akey factors that warrant further investigation. Green, Karen J Phekoo, Vijay PB Grover,Authors: Amati, F., Banks, C., Greenfield, G., & James Lovendoski, Mike Anderson, OwenGreen, J. Bowden-Jones, Matthew R FoxtonJournal of Public Health JRSM OpenAn identification and brief advice Navigating the sustainability landscape: aprogramme for low-risk alcohol systematic review of sustainabilityconsumption in an acute medical setting: an approachesimplementation study Improvement initiatives offer a valuableThis article presents an independent research mechanism for delivering and testingcommissioned by the National Institute for innovations in healthcare settings. Many ofHealth Research (NIHR) under the these initiatives deliver meaningful andCollaboration for Leadership in Applied necessary changes to patient care and

outcomes. However, many improvement Global Lessons in Frugal Innovation toinitiatives fail to sustain to a point where their Improve Health Care Delivery in the Unitedfull benefits can be realized. This has led Statesmany researchers and healthcarepractitioners to develop frameworks, models Dr Matthew Harris, Clinical Senior Lecturer inand tools to support and monitor Public Health, published a series of articlessustainability. This work aimed to identify examining frugal and reverse innovation inwhat approaches are available to assess and healthcare with Imperial College co-authorsinfluence sustainability in healthcare and to Dr Yasser Bhatti, Hillary Watt, Joachim Martidescribe the different perspectives, and Prof Ara Darzi, and colleagues from Dukeapplications and constructs within these University, UCLA and NYU. The first studyapproaches to guide their future use. titled ‘Global Lessons In Frugal Innovation ToTherefore, choosing a sustainability method Improve Health Care Delivery In The Unitedcan pose a challenge because of the diverse States’ was funded by the US Commonwealthapproaches reported in the literature. This Fund and published in Health Affairs inreview provides a valuable resource to November. It describes five case studies ofresearchers, healthcare professionals and frugal innovations from low- and middle-improvement practitioners by providing a income countries of potential applicability insummary of available sustainability the US.approaches and their characteristics.Authors: Lennox, L., Maher, L., & Reed, J Health AffairsImplementation Science Explicit Bias Toward High-Income-Country Research: A Randomized, Blinded, CrossoverImproving patient safety for older people in Experiment of English Cliniciansacute admissions: implementation of theFrailsafe checklist in 12 hospitals across the This study was funded by the Imperial-NIHRUK Biomedical Research Centre and alsoChecklists are increasingly proposed as a published in Health Affairs in November,means to enhance safety and quality of care. provides strong evidence for unconscious biasHowever, their use has been met with in research evaluation. In a randomized,variable levels of success. The Frailsafe controlled, blinded crossover study, Englishproject focused on introducing a checklist clinicians were found to discount researchwith the aim to increase completion of key from low- and middle-income countries byclinical assessments and to facilitate rating the research as less relevant and lesscommunication for the care of older patients likely to be recommended to colleagues, evenin acute admissions. However, the Frailsafe when the research article was unchanged.checklist highlighted limitations with frailtyassessment in acute care and motivated Health Affairsteams to review routine practices. Furtherwork is needed to understand whether and Measuring the bias against low-incomehow checklists can be embedded in complex, country research: an Implicit Associationmultidisciplinary care. TestAuthors: Papoutsi, C., Poots, A., Clements, J.,Wyrko, Z., Offord, N., & Reed, J. E. The third study, titled ‘Measuring the bias against low-income country research: anAge & Aging Implicit Association Test’, was funded by the US Commonwealth Fund and published in

Globalization and Health in December. It differences in healthcare commissioning anddemonstrates how most people associate funding, European countries face comparableGood Research with Rich Countries, and Bad challenges such as ageing populations andResearch with Poor Countries. Automatic, increases in chronic conditions and mentalimplicit associations such as these have health problems, all of particular relevance toimplications for the spread of innovation and primary care. In a paper published in thenew knowledge from low- and middle-income Journal of the Royal Society of Medicine, wecountries. examined England’s current in-hours general practice services relative to those ofThe three articles advance a research agenda European countries in order to betteraround diffusion of innovation, promote low- contextualise the debate on extendingcost, high-value innovation in high-income general practice opening hours.country health systems and challengetraditional attitudes towards research from We found that standard opening hours inresource-poor countries. England already exceed those of most other European countries, and patients in the UKThe studies were featured in an article by are more satisfied with out-of-hours access toReuters Health, a BMJ blog by former BMJ general practice than patients in many othereditor Richard Smith, in an Imperial Today European countries. Achieving easier accessspecial report and in a special invited to primary care services seven days per weekpresentation to the Editorial Board of the would require significant investment, andBritish Journal of General Practice. must compete with other NHS priorities; politically attractive priorities should not toSeven-day access to NHS primary care: how have an undue influence in shaping resourcedoes England compare with other European allocation.countries? The existence of true patient demand forIt is often assumed that providing easier extension of general practice opening hoursaccess to community-based general practice in England is not yet fully established andduring evenings and weekends can reduce evidence for a correlation between increasingdemand for emergency and other in-hours provision and decreased emergencyunscheduled care services, promoting more department use is inconclusive. Furthermore,appropriate care and reducing the costs the demand for services likely varies based onassociated with expensive hospital-based local demographics and disease burden; iftreatment. For example, in England’s NHS general practice opening hours were to bethere is political pressure to expand general extended, those regions with the highestpractice surgeries’ opening hours to progress demand for care should be prioritised.towards a ‘seven-day NHS’. Hence, we suggest that policy-makers inWhen considering extension of primary care England should focus on improving access toopening hours in England, it is useful to GP appointments during normal openingcompare primary care access across other hours, instead of spending scarce NHScountries in the European Union. Despite resources on very poor value for money extended opening hours schemes. Journal of the Royal society of Medicine

MPH NewsOn the back of their summer projects, Carolyn Sharpe (MPH 2016) and TaliaBoshari (MPH 2017) were invited to a ministerial reception in the House ofCommons by Home Office minister Victoria Atkins MP on 18 December 2017.The meeting provided an opportunity to showcase and network around the30+ local initiatives being run through the Home Office’s Local Alcohol ActionAreas 2 (LAAA2) project. Carolyn and Talia’s work was referred to in theMinister’s speech.Carolyn and Talia spent their summer projects disorder: a manuscript is currently underin 2016 and 2017 respectively evaluating local development for peer review. Even before shepolicy implementation in the London Borough had submitted her dissertation in theof Southwark - as part of the LAAA2 summer, a copy had been requested by theprogramme. Carolyn’s work was published in national alcohol policy team at Public Healththe Journal of Public Health in December 2017 England after her findings had beenand analysed the effect of Cumulative Impact mentioned by the Home Office.Policy on alcohol availability - a nationallydelegated power on which no quantitative Both Carolyn and Talia now work as policyevidence previously existed. Talia’s officers in local public health in London,subsequent work has identified types of bringing the skills they learned on Imperial’slicensed premises (those that serve alcohol) MPH to the job of improving health for localand their impact on alcohol related crime and residents.REFERENCE: Sharpe CA, Poots AJ, Watt H, Franklin D, Pinder RJ et al., 2017, Controlling alcoholavailability through local policy: an observational study to evaluate Cumulative Impact Zones ina London borough, J Public Health (Oxf)





Introducing two members of the CLAHRC NWL PHII Team:Yewande Adeleke – Information Officer for Public Health and InformationIntelligence ThemeYewande is currently working on a Health Foundation funded project to develop an online,interactive Measurement Plan Assessment Tool. This tool will support teams to design measuresthat are scientifically valid, feasible and promote successful improvement inquality of care. In addition to this, she delivers measurementtraining and support to five healthcare Quality Improvement teamsacross Northwest London. Prior to joining CLAHRC NWL, she was aClinical Research Facilitator at the Imperial College LondonNeuroepidemiology and Ageing Research Unit, working on clinicalstudies aimed at better understanding risk and protective factorsfor age-related neurodegenerative diseases. She holds a BSc inPathology and Microbiology with Study in Industry from theUniversity of Bristol and a Master of Public Health from ImperialCollege London. Yewande has a keen interest in translationalscience and health service improvement.Dr Mable Nakubulwa – Research Associate forPublic Health and Information Intelligence ThemeMable is currently working on evaluating the effectiveness ofpublic health interventions. Mable is an Associate Fellow of theHigher Education Academy. Prior to joining CLAHRC in 2016, sheworked as a teaching fellow on the ‘Studying Psychology inHigher Education’ module and lab lead for 1st and 2nd yearundergraduate ‘Research Methods and Advanced Statistics’module at Aston University. She holds an M.A in Psychologyand Statistics (University of Glasgow), M.Sc. in Foundations ofClinical Psychology (Bangor University), and a Ph.D. in Cognitive& Affective Neurosciences, where concepts from graph theorywere adapted to support the characterisation of functionalbrain networks in atypical and delayed neurodevelopment,specifically Attention-Deficit/Hyperactivity Disorder (ADHD) and Dyslexia.Her interests are in applying advanced statistical approaches to improve our understanding ofhealthcare translational science.CLAHRC NWL is committed to learning and development, by building capacitywith the academic partners and facilitating knowledge exchange. One of theways they do this is by having our expert team members teach on differentmodules at various universities across the country.

Yewande and Mable had the opportunity to do so at Buckinghamshire New University on 12 December 2017. They were asked to run a session introducing ‘Measurement of Improvement’ for the ‘Innovation Module’ for Imperial Partners. A total of 19 students were enrolled on this course, with key learning outcomes being: a) Understanding the main reasons why we measure b) Understanding the key steps involved in measurement for improvement c) Understanding variation and using this to inform decision making Here was what they had to say about their teaching experience: “Teaching at Buckinghamshire New University was an educational experience; we received interesting questions from students which gave us food for thought. For instance, students asked about impact of seasonality on control charts. Other questions included, how much baseline data is required for the SPC charts and how to deal with low denominator sizes. Talking to students reinforced the need for greater spread of knowledge around measurement for improvement at a more industrial scale. Furthermore, it was an opportunity to reflect on practices that we typically take for granted, but are often considered challenging for frontline staff despite being crucial for enabling success in Quality Improvement. When the word ‘measurement’ was uttered, visually one could tell this had a negative connotation amongst students. This is similar to what we experience working with novice healthcare QI teams. The students appeared to be willing to learn and were engaged with the content delivered. Also, repetition helped students to grasp the core concepts. We have received interest from staff to return in the New Year and provide guidance to students as they apply the measurement for improvement concepts to their own projects (i.e. business case assignment).” The Model for Improvement is our guiding framework for accelerating improvement efforts.PHII MORE INFO

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