Title: Learning to Harness Innovation in Global Health for Quality Care (HIGH-Q)
Funder: Department of Health and Social Care

Abstract: Essential technologies could improve quality and outcomes of care if successfully adopted but benefits in LMIC are threatened by workforce shortages and implementation that fails to consider context and system complexity. Thus, many technologies fail, wasting valuable resources or worsening care quality. Our proposal addresses this key emerging issue in global health and with this multiple priority areas: Quality of Care, including user and staff experiences, as hospitals care for sick newborns and introduce new technologies; Health Workforce Management and Planning, as we explore how technologies can support or undermine service delivery and how this affected by staffing levels; and Integrating Health Services & Improved Data Quality and Use, by exemplifying human centred design methods to develop a tool that connects providers and families, houses key patient information and supports timely post-discharge care for vulnerable newborns._x000D_ We have extensive experience in Kenya and focus on hospitals that must provide high quality neonatal care at scale to help LMIC achieve SDG 3.2. Using neonatal care as an exemplar, we address the urgent need to advance evaluation methods used in LMIC and have two broad objectives: i) to learn how technologies can be better designed and introduced in weak health systems to yield benefits and reduce harms and waste, and ii) to build capacity for rigorous evaluation of complex interventions that inform health systems strengthening using an embedded research approach. To achieve these Work-package 1 will include a co-designed, multi-disciplinary evaluation leveraging the resources of a large existing hospital technology intervention programme to yield time-series data and adding a workforce enhancement intervention and detailed qualitative research to explore the effects on quality and technology adoption of workforce shortages. In Work-package 2, we focus on human-centred design methods to develop a contextually adapted solution to information-sharing and integration of post-discharge neonatal care. In Work-package 3 we tackle cross-cutting issues including the governance of technology related interventions and the effect technologies have on professional roles and the capabilities needed by staff to enhance the everyday resilience that sustains quality in complex social settings. _x000D_ Methodologically we aim to exemplify for all stakeholders and trainees how to use rigorous methods that take a systems perspective to examine the social and organisational processes and actors (providers and users) involved in the success or failure of technologies. Across our work we will be guided by the Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability (NASSS) framework, combining this with a realist logic for theory of change development and testing, while using multiple sub-studies to understand the routines and needs of workers and users to surface and explore complexity. _x000D_ We will achieve impact through capacity building for policy makers and other stakeholders linked to an increasingly independent Kenyan research team comprising a Co-PI, 2 post-doctoral scientists, 4 PhD students and 4 graduate scientists with national and global collaborator networks. We will directly engage government on planning for technology and workforce enhancements through its technical advisory groups and evaluation governance policies. Globally we will advance thinking and strengthen evaluation practice.

Lay abstract: Essential technologies could improve quality and outcomes of care if they are successfully adopted but benefits in poorer countries are threatened by workforce shortages and a failure to consider all the obstacles to their use up and down the system. Thus, many technologies fail, for example it is reported there are over 200,000 failed mHealth apps. This wastes valuable resources, or can even worsen care quality. Our proposal addresses this key emerging issue. In doing this we address the priority areas of Quality of Care, including families’ experiences of care; Health Workforce Management and Planning, as we explore how technologies can support or undermine routine work in settings with few staff; and Integrating Health Services & Improved Data Quality and Use, by exploring how information technologies might best support post-discharge care for sick babies._x000D_ We have two broad objectives: i) to learn how technologies can be better designed and introduced in weak health systems to yield benefits and reduce harms and waste, and ii) to build capacity of government and researchers for these difficult but important evaluations so they help poorer countries strengthen their health systems. To achieve these in Work-package 1 we will design and conduct an evaluation using multiple approaches of a large existing hospital technology intervention programme. We will deliberately change staff numbers to explore how this affects quality and technology adoption. In Work-package 2, we focus on using methods that involve staff and families to co-design an approach that helps schedule the care sick babies need after hospital discharge and ensures all health staff and families have access to key information needed for follow up care. This work will produce an outline technology for testing with new funding. In Work-package 3 we tackle cross-cutting issues including how technologies are changing the jobs people do and the skills they need individually and as teams to give quality care and explore what oversight mechanisms are needed to gain good evidence on the effects of introducing technologies in health. _x000D_ Our work is based on more than 15 years’ experience in Kenya and focuses on the hundreds of hospitals which must provide high quality care everywhere in poorer countries to help prevent babies’ deaths. We use care for sick babies as the example because modernising care for this very vulnerable group highlights many of the challenges of successfully introducing the right technologies in the right way to strengthen whole health systems, not just a few specialist hospitals._x000D_ We have long-experience of working with researchers, government, professional associations and people in practice in Kenya and have begun work with a group representing families of preterm babies. All will be involved in developing, conducting and reviewing the findings of our research. Communities using the hospitals in the study will be included in research to understand their needs and in specific activities to explain the research. We will achieve impact through all these channels and through specific policy advisory groups we are already part of in Kenya and globally. We aim to develop an independent Kenyan research team and build a network of interested researchers across more than 8 poorer countries we already have links with. More broadly we aim to change thinking so everyone considers how technologies might actually be used not just what experts say they could do.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health categories: GENERIC HEALTH RELEVANCE