Title: Quality, Safety and Outcomes Policy Research Unit
Funder: Department of Health and Social Care

Abstract: Overall The vision for the PRU is to deliver an integrated programme of policy-relevant research, using robust empirical methods, strong theoretical frameworks and a patient and person-centred perspective to inform quality improvement (safety, effectiveness and experience) in the NHS and social care. Our work will be grounded in a thorough understanding of the relevant policy developments. We will produce research that is relevant and useable by policy makers. In proposing themes for our programme, we are guided by five key policy questions: Are appropriate measures available and in place to monitor quality of health and social care? What can we learn from specific cases and incidents of poor quality? Can we identify and understand system-level variations in quality? Can we identify effective approaches to promote quality? Can we identify effective mechanisms for dealing with the consequences of poor quality and in particular, for resolution after harmful events? The PRU would provide three types of research. First, short-term responses to policy-makers needs, involving rapid and pragmatic reviews of the evidence, synthesis of expert opinion and analysis of existing datasets. These studies might inform initial policy development and scoping in line with the above questions (e.g. recommendations about population &ndash; or place-based &ndash; quality indicators). We would ensure an effective responsive facility is in place to address priority policy needs. Second, short- to medium-term research projects that would involve analysis of secondary data and some primary data. This will include quantitative data supplemented by qualitative data e.g. interviews with NHS and local authority staff, supplemented with literature reviews, case studies etc. These studies, for example, could provide early evaluation of policy around learning from incidents or analysis of variation in quality/safety (avoidable deaths, lower-than-expected effectiveness). Third, longer-term research projects that: more fully assess and model policy development across the range of research themes; consider implications for policy in new areas (e.g. safety mechanisms in generalist medical care or social care); and ensure better knowledge exchange and research impact. Conducting full evaluations would be beyond the scope of core PRU resources, but we would be well-placed to develop collaborations and seek bespoke funding. Governance and management Given the broad scope of the QSO PRU, we propose a collaboration from three main HEI institutions: University of Oxford, University of Kent, London School of Hygiene and Tropical Medicine, with valuable additional support from the Picker Institute and the Hull-York medical school. We propose a management and governance structure (described in that section), that is built around a core directorate team, each representing one of the three main HEIs, plus one of the PPI applicants. Our management/leadership approach is based around well-established principles (e.g. strong communication; shared expectations; clear of lines of accountability etc.). The external governance function will come through the commissioning relationship with DHSC and through the advisory group. Delivery To deliver the aims of the PRU we will combine a long-term investment in policy research capacity and expertise, building on our experience of previous PRUs. Given the breadth of issues to be covered we have put together a wide range of experts, ranging from doctors, economists, health service researchers, statisticians and psychologists to socio-legal scholars and implementation scientists. We will balance having a broad range of co-applicants at more senior levels with a team of earlier career researchers. We will have strong links with clinicians through our involvement with medical royal colleges and specialist associations. We outline the importance of policy engagement for the PRU, identifying the policy areas of DHSC and the ALBs that associate with each theme, and will implement a series of activities to ensure effective engagement. We propose having an evolving core work programme combined with a facility to provide effective responsive research. Both will be developed with the benefit of significant policy and practitioner engagement, using effective management and governance mechanisms. We will maintain good capability and readiness through the on-going activities outlined above. We will also have a good breadth of expertise and critical mass, giving the capacity to be responsive. Responsive mode requests would be channelled through the director, deputy and associate directors. Patient & Public Involvement (PPI) We propose to make a significant investment in PPI. First, we would have a public involvement strategy and implementation group (PI-SIG) that would work with the PRU directorate to guide the operation and strategic development of PPI in the PRU. Second, we propose to have a PPI researchers group (PIRG) to deliver key PPI activities as outlined below. The research team will also have a dedicated PPI research coordinator and a PPI lead. Equality/inequality Our strategy in regard to inequality issues is three-fold. First, analyses of existing data should account for protected characteristics such as age, gender and disability where possible; second, primary research should seek full representation in terms of participants, and use appropriate methods to engage people from a range of backgrounds. Third, implications for policy from the research should seek to audit the likely impact on inequality. Risks and challenges Based on previous experience, key risks are as follows: Engagement with policy-makers. The dynamic composition of DHSC staff requires on-going communication. This is most readily achieved via the PRU liaison officer and via our presence in policy networks. Management of a collaboration. Collaborations bring great strengths (diversity and expertise) but management lines are more diffused. Strong management principles, including regular communication is vital, as are initiatives to ensure a shared sense of purpose &ndash; see management section. Balancing impact with academic rigour. A key strength of PRUs is in producing scientifically robust research. PRUs also need to be responsive and provide research findings in the most useful form. We will strike the right balance e.g. publishing in academic journals and also having strong reporting and knowledge exchange and impact activities. A challenge with all complex programmes is to keep projects on time and on budget, particularly recognising the inherent uncertainties associated with research and external dependencies. We will address these challenges by: contingency/risk planning; using our scale/scope to adapt and re-purpose; and good communication.

Lay abstract: Overall The vision for the PRU is to deliver an integrated programme of policy-relevant research, using robust empirical methods, strong theoretical frameworks and a patient and person-centred perspective to inform quality improvement (safety, effectiveness and experience) in the NHS and social care. Our work will be grounded in a thorough understanding of the relevant policy developments. We will produce research that is relevant and useable by policy makers. In proposing themes for our programme, we are guided by five key policy questions: Are appropriate measures available and in place to monitor quality of health and social care? What can we learn from specific cases and incidents of poor quality? Can we identify and understand system-level variations in quality? Can we identify effective approaches to promote quality? Can we identify effective mechanisms for dealing with the consequences of poor quality and in particular, for resolution after harmful events? The PRU would provide three types of research. First, short-term responses to policy-makers needs, involving rapid and pragmatic reviews of the evidence, synthesis of expert opinion and analysis of existing datasets. These studies might inform initial policy development and scoping in line with the above questions (e.g. recommendations about population &ndash; or place-based &ndash; quality indicators). We would ensure an effective responsive facility is in place to address priority policy needs. Second, short- to medium-term research projects that would involve analysis of secondary data and some primary data. This will include quantitative data supplemented by qualitative data e.g. interviews with NHS and local authority staff, supplemented with literature reviews, case studies etc. These studies, for example, could provide early evaluation of policy around learning from incidents or analysis of variation in quality/safety (avoidable deaths, lower-than-expected effectiveness). Third, longer-term research projects that: more fully assess and model policy development across the range of research themes; consider implications for policy in new areas (e.g. safety mechanisms in generalist medical care or social care); and ensure better knowledge exchange and research impact. Conducting full evaluations would be beyond the scope of core PRU resources, but we would be well-placed to develop collaborations and seek bespoke funding. Governance and management Given the broad scope of the QSO PRU, we propose a collaboration from three main HEI institutions: University of Oxford, University of Kent, London School of Hygiene and Tropical Medicine, with valuable additional support from the Picker Institute and the Hull-York medical school. We propose a management and governance structure (described in that section), that is built around a core directorate team, each representing one of the three main HEIs, plus one of the PPI applicants. Our management/leadership approach is based around well-established principles (e.g. strong communication; shared expectations; clear of lines of accountability etc.). The external governance function will come through the commissioning relationship with DHSC and through the advisory group. Delivery To deliver the aims of the PRU we will combine a long-term investment in policy research capacity and expertise, building on our experience of previous PRUs. Given the breadth of issues to be covered we have put together a wide range of experts, ranging from doctors, economists, health service researchers, statisticians and psychologists to socio-legal scholars and implementation scientists. We will balance having a broad range of co-applicants at more senior levels with a team of earlier career researchers. We will have strong links with clinicians through our involvement with medical royal colleges and specialist associations. We outline the importance of policy engagement for the PRU, identifying the policy areas of DHSC and the ALBs that associate with each theme, and will implement a series of activities to ensure effective engagement. We propose having an evolving core work programme combined with a facility to provide effective responsive research. Both will be developed with the benefit of significant policy and practitioner engagement, using effective management and governance mechanisms. We will maintain good capability and readiness through the on-going activities outlined above. We will also have a good breadth of expertise and critical mass, giving the capacity to be responsive. Responsive mode requests would be channelled through the director, deputy and associate directors. Patient & Public Involvement (PPI) We propose to make a significant investment in PPI. First, we would have a public involvement strategy and implementation group (PI-SIG) that would work with the PRU directorate to guide the operation and strategic development of PPI in the PRU. Second, we propose to have a PPI researchers group (PIRG) to deliver key PPI activities as outlined below. The research team will also have a dedicated PPI research coordinator and a PPI lead. Equality/inequality Our strategy in regard to inequality issues is three-fold. First, analyses of existing data should account for protected characteristics such as age, gender and disability where possible; second, primary research should seek full representation in terms of participants, and use appropriate methods to engage people from a range of backgrounds. Third, implications for policy from the research should seek to audit the likely impact on inequality. Risks and challenges Based on previous experience, key risks are as follows: Engagement with policy-makers. The dynamic composition of DHSC staff requires on-going communication. This is most readily achieved via the PRU liaison officer and via our presence in policy networks. Management of a collaboration. Collaborations bring great strengths (diversity and expertise) but management lines are more diffused. Strong management principles, including regular communication is vital, as are initiatives to ensure a shared sense of purpose &ndash; see management section. Balancing impact with academic rigour. A key strength of PRUs is in producing scientifically robust research. PRUs also need to be responsive and provide research findings in the most useful form. We will strike the right balance e.g. publishing in academic journals and also having strong reporting and knowledge exchange and impact activities. A challenge with all complex programmes is to keep projects on time and on budget, particularly recognising the inherent uncertainties associated with research and external dependencies. We will address these challenges by: contingency/risk planning; using our scale/scope to adapt and re-purpose; and good communication.

Research activity codes: 8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health categories: GENERIC HEALTH RELEVANCE;INFECTION