Star Trekkin' across the (research and quality improvement) universe

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University

Does improving the quality of care from health organisations need research? This was the question asked at the Annual Network Event of the Clinical Research Network for the North East and Cumbria. The network has been successful over the last four years in bringing together a wide range of clinical staff across the region and promoting and supporting high quality health research, which was celebrated at the event, but the organisers didn’t shy away from asking some tough questions.

Q (John de Lancie) pictured behind Captain Jean-Luc Picard (Patrick Stewart)

While the network has put a strong focus on numbers, particularly related to regional recruitment targets for patients in trials, its clinical Director, Professor Stephen Robson, acknowledged that this was only part of the story and that it also ignored what happened later in the research process. For instance, how do we ensure that the research findings get adopted by practice organisations? Brilliant studies are useless if they don’t result in changing clinical practice. But how to change this practice?

The event therefore put a renewed focus on quality improvement. How can we help health professionals to improve their practice? One of the network’s partners, the Academic Health Science Network for the North East and Cumbria (AHSN NENC), joined forces last year with NHS Improvement and the Health Foundation to play a leading role in the national roll out of the Q community.

Unfortunately for us ‘Trekkies’, this is not a new Star Trek episode about the famous Q tormenting various Starfleet Captains; instead, the Q community is a force for good that connects health professionals across the UK to improve health and care quality. The community supports members in their existing improvement work and tries to enhance their skills, helps members to share ideas and enable them to make changes in their organisations that benefit patients.

For this episode, Q came out of the 2013 Berwick report, which followed the publication of the Francis Report into the breakdown of care at the infamous Mid Staffordshire Hospital. The report urged health organisations to make better use of members of staff with improvement expertise and made a case for a system devoted to continual learning and improvement. In response, NHS Improvement (with support from the Health Foundation) developed the Q community in 2015, which now has 236 members in the North East (5000+ nationally) and is expected to grow considerably over the next few years.

I unashamedly applied to become a member of this network last year and they were crazy enough to accept me, so I was looking forward to the Q workshop at the annual event, led by Suzy Cook. The workshop looked at the link between research and quality improvement but, to my surprise, focused on the differences and argued that they should be viewed as separate activities with distinct aims, following different processes and timescales. Research was described as a linear and long-term process that is mostly concerned with the effectiveness of existing and new services, while quality improvement was pictured as a more cyclic and shorter term process with linked PDSA cycles (Plan-Do-Study-Act) that focus on the sustainability of services.

This distinction does not do justice to both activities and feels like a rather odd separation: why can’t research inform what practice needs to improve and how? And what about evaluating quality improvement; isn’t research a key component of the PDSA cycle? Luckily, participants in the workshop raised the same objections and an alternative view was provided in the next workshop by Seamus O’Neill, Chief Executive of AHSN NENC.

He argued instead that there was a clear link between research and quality improvement by looking at the adoption of research in the NHS. Quality improvement needs evidence to select the right intervention in the right context. Just sinking money into an innovation because we think it is going to make a difference will not impress funding and commissioning bodies. At the same time, he warned that many quality improving and cost-saving interventions are not used by health care organisations. They are either not aware of them (clinicians do not read journal articles) or they do not know how to adopt them (how can we make it work here?). According to Seamus, this is where quality improvement can come in: using dedicated health professionals, such as the Q community, and their skills to study, plan, do and act on the research evidence.

Researchers and quality improvement professionals need each other, not to put more clear blue water between them, but to make both activities more useful and effective. Even Q in Star Trek perhaps saw the wisdom of this when he remarked: “I look at the universe in an entirely different way now. I mean, I can't go around causing temporal anomalies or subspace inversions without considering the impact it'll have”. (Star Trek: Voyager: The Q and the Grey #3.11, 1996).

North East and North Cumbria - Annual Network Event: Research Matters was held on 26 April at the Stadium of Light in Sunderland.

Photo attribution: “John de Lancie, Denise Crosby (at back), Patrick Stewart, Star Trek TNG, "Encounter at Farpoint," 1987” by Classic Film © 2015: https://www.flickr.com/photos/29069717@N02/20607700773

Destination Start Trek London

Posted by Rosemary Rushmer

Ok, so I am a Trekkie...(always have been, always will be – feel better now I’ve ‘fessed-up’).

A couple of weeks ago I went along to the first Star Trek convention in the UK for ten years – Destination Start Trek London at the ExCel centre. I was amazed at the number of people who turned up, the place was mobbed. There were fans dressed as ‘Q’, Klingons, STNG crew members and lots of female ensigns from the original series, even one Seven-of-Nine. 

Poster of William Shatner as Captain Kirk at Destination Star Trek London; Suzanne Plunkett/Reuters

Now, these were people who could really get into the spirit of things! It was colourful, crowded and loud. I felt a sense of community…literally thousands of people who shared the same love of a TV franchise, each eager to see and to learn about their own favourite series, characters, plots and behind-the-scenes news. It was simply – completely out-of-this world…and fun! 

I listened as Sir Patrick Stewart discussed the similarities between Shakespearian drama and the sets, plots and acting on STNG, and was persuaded by his insights. I smiled as I saw the ages and mix of people there and wondered what enabled the franchise to have such ‘reach’. I was in awe as I stood just centimetres away from the Heroes of Star Trek – the Original Series, who, each week as a child, had beamed me light years from my small home to alien and exotic worlds. I remembered the gift of imagination and ‘what if…’ they helped me realise and how (I hope!) that has never left me. 

I was intrigued as the producers (Ronald Moore and Brannon Braga) talked about the creative aspects (and compromises) behind the plots. They recalled how when they created the Cylons in Battlestar Gallactica their aim was to create the most despicable, evil and scary villains possible and planned to clad them in hi-tech uniforms to achieve this. However their dreams were cut-down by financial constraints. 

They next tried to computer-generate the Cylons in uniform, but the technology was not possible. Then, the ingenious twist occurred to Ron Moore – ‘why put them in uniform? Why not make them look exactly like us?’ The ‘creative process’, (and its clash of pressures), resulted in a villain, undetectable, and much more formidable. It opened up plots which were not possible if we had been able to spot the Cylons before us. It set me thinking about getting research evidence into practice (typical!). There will always be multiple pressures, and the need to change tack, but maybe, this could lead to better blended solutions. 

To end the weekend, my youngest son went to get an autograph from Data, and was surprised when Brent Spiner told him that had he been raised in the USA, his nickname would be ‘Bert’ – so guess who has a new family nickname (one small comment can change a life forever…sorry Robbie!)