Round up for November 2018


Welcome to this second roundup from the Evidence and Evaluation for Improvement Team in the Improvement Hub. Our aim is to highlight key learning across research and evaluation for quality improvement and implementation in health and social care. If you are interested in finding out more about our evidence or evaluation services please drop us an email at

Highlights in this roundup include:

  • Learning from the Scottish Improvement Science Collaborative (SISCC) Seminar on the use of behaviour change strategies for improvement
  • New systematic review evidence relating to optimal patient engagement strategies and their outcomes
  • Briefings from the Improvement Analytics Unit on the impact of initiatives aiming to reduce hospital use in England


Using behaviour change strategies to support improvement

Learning from our work to support the evaluation of improvement is that theory of behaviour change should underpin an outcomes based approach to designing and evaluation improvement work. With many overlapping theories of behaviour change, this complexity can be a barrier to using behaviour change theory to underpin the design and evaluation of improvement interventions. The Scottish Improvement Science Collaborating Centre (SISCC) and the Nursing, Midwifery and Allied Health Professions Research Unit (NMHAP) recently brought together academics and NHS and social care practitioners to consider how we can better utilise behaviour change strategies to support improvement activities.

The behaviour change wheel developed by researchers at UCL was presented as a useful tool for improvement implementers and evaluators seeking to apply behaviour change strategies. The wheel provides a simplified framework for understanding behaviour change theory as a ‘behaviour system’ which sits at the centre and comprises of three central conditions: capability, opportunity and motivation (termed with COM-B model).

A recently published qualitative analysis of the implementation of a falls prevention programme using the Behaviour Change Technique (BCT) Taxonomy illustrates how behaviour change techniques can underpin the design and implementation of improvement and the behaviours being targeted for change at different levels within an organisation. A number of behaviour change techniques could be identified from the analysis of the multi-level falls programme that targeted professional and patient behaviour. There were also gaps identified at an organisational level where change was directed towards attitudes rather than behaviours.

Evaluating the impact of improvement initiatives on hospital use: learning from the Improvement Analytics Unit briefings

Recent briefings from the Improvement Analytics Unit, a partnership between the Health Foundation and NHS England, examine the impact of recent improvement initiatives on hospital use. The analysis of the effects of introducing multidisciplinary integrated teams (ICTs) in North East Hampshire and Farnham show that A&E attendances and emergency admission were higher for patients referred to ICTS compared with a control group which was attributed to unmet care needs being identify by the ICTs.

In a previous briefing, evaluation of the Sutton Homes of Care vanguard also showed how outcomes can be emergent in the earlier stages of implementation. The results from this evaluation were inconclusive about whether enhanced support led to lower or higher levels of hospital use in the participating care homes. A relatively small sample of people participating in the study and the way that the intervention was implemented explained help to explain why the evaluation was limited in the conclusions that could be drawn.

These evaluations also highlight the important role that formative evaluation plays when investigating the impact of complex change initiatives, allowing for the flexibility to capture and understand what might be unexpected in terms of the benefits being experienced. The EEvIT team are working to support evaluation informed by a personal outcomes approach that captures the benefits being experienced by individuals at the same time as understanding the change happening at a service level.

Engaging patients in improving the quality of care

Researchers have recently synthesised the substantive body of research on patient engagement strategies to provide a coherent picture of the how different strategies have been used for optimal engagement and the experiences of patient being engaged. The findings from this review suggest that strategies that facilitate engagement relate to enhance design, recruitment, participation, leadership and the receptiveness of context. Engagement in the form of co-design were associated with positive outcomes at an organisational level such as shifting culture to promote further patient participation and developing new competencies and collaborative learning. More consultative forms of engagement were associated with outcomes relating to discrete products.