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The thesis of this case study is that a demonstration project, encompassing an organisational change, utilising the principles that underpinned a Department of Health (1993) policy for maternity care, has been influential in corroborating and establishing a philosophy for maternity services in industrialised countries within the 21st century.
The project provided an evidence-based approach to standards and quality of midwifery care. It demonstrates outcomes influencing national and international guidelines and policies for maternity practice. As a result, current midwifery guidelines for the UK and other countries, such as Australia, New Zealand, The Netherlands, Sweden and Canada, include elements of continuity of care/r (including one-to-one care and case loading) informed choice for women and evidence-based practice.
This systematic evidence, evaluating the effectiveness of midwife-led care, has helped to shape policy improvements in promoting access to midwifery care and reducing health inequalities nationally (e.g. NHS, Department of Health [DH]) and internationally (e.g. Australia, Brazil & US). The review was recognised by the DH and updated rapidly to inform NICE intrapartum guidelines. As part of the Commissioning, Service Delivery and Organisation theme, the Maternal and Early Childhood Health Research Group (MACHRIG) led by Professor Hora Soltani, in collaboration with the Sheffield Teaching Hospital-Jessop Wing (STH-JW) and maternity user representatives, has initiated an awareness campaign to encourage information sharing on types of maternity care and to enhance the implications of findings for women and staff via the hospital website and targeted seminars. It is envisaged that its impact will continue to grow through an extensive dissemination strategy and media coverage.
The Whole System Demonstrator (WSD) research programme is a project funded by Policy Research Programme Department of Health and led by academic staff at City University London which investigates how technology can help people manage their health and safety while maintaining their independence. The WSD evaluation provides scientific evidence that has influenced and continues to influence public policy debate in the UK and internationally. It has shaped UK Department of Health policy and strategies regarding deployment of tele-assistive devices to meet the growing health and social care demands in a changing population. And it is helping to shape manufacturers' design of services with the user in mind and how health and social care providers offer tele-assistive services.
The University of Aberdeen's Business School has built a strong programme of research focussing on managing strategic change, particularly in the healthcare sector. Using a conceptual framework which explores the complex interplay between organisational context, content and process, the University has completed a number of studies looking into patient safety, quality and service redesign, four of which are described here. Because the work routinely involves health care stakeholders across the research pipeline, from articulation of the research problem, through to recommendations and the delivery of solutions, impact is wide-ranging, including changes in staff behaviours, improvements to safety, and significant financial savings.
Research conducted at the University of Manchester (UoM) has shaped the design of national systems of accreditation for general practice in the UK, Europe and beyond. Accreditation systems set standards that reflect key aspects of the organisational systems and processes in general practice that are needed to ensure delivery of good quality care. Accreditation systems also provide a kite mark of quality assurance and act as a platform for supporting continuous quality improvement. UoM developed indicators of quality in general practice structure and organisation and demonstrated how they could be used effectively to improve quality. Working in partnership with health professional organisations, governmental organisations and other universities, UoM used knowledge from the research to develop systems for general practice accreditation now used in the UK and across Europe.
Beneficiaries of this research are patients in intensive care and healthcare staff. This research has had impacts in two distinct but related areas:
These advances are informed by our synthesis and application of rigorous, innovative methodologies relating to questionnaire development and real-time data collection.
Research by Community and Health Research Unit (CaHRU) broadly impacted on healthcare provision and care received by patients from ambulance services. The research directly informed policy and was a key factor in improving prehospital care for emergencies by directly influencing care systems, regulators, ambulance services, paramedics, and service users, initially in the East Midlands and subsequently throughout England from 2008 onwards.
The research which aimed to improve quality of ambulance care led to: development of new clinical quality indicators for ambulance services in England; benchmarking of service quality; initiatives to address gaps in care; measurable improvements in managing pain, heart attack, stroke, asthma and diabetes across all English ambulance services. Regulators now use these quality indicators to assess ambulance trusts in England.
Maternal health and mortality remains a major concern in the developing world. Research led by Prof Arri Coomarasamy and colleagues at the University of Birmingham has demonstrated the effectiveness of non-typical support for maternal health in low- and middle-income countries worldwide, focused on the benefits of bringing in traditional birth attendants and non-physician clinicians to support the slow process of developing more capacity amongst skilled birth attendants in these regions. Prior to this work, these individuals were considered unsafe and inappropriate to support births, even though they were conducting millions of deliveries in the developing world. Prof Coomarasamy's team's research clearly demonstrated that this is not the case. This has had a major impact on international thinking about the valuable role of non-physician support for maternal health and mortality, reflected in the latest World Health Organisation task-shifting recommendations. In these and other related issues, policy and public awareness has been further supported by Prof Coomarasamy's crucial role in Ammalife, an international maternal health charity focused on the developing world.
(1) Enhancing the awareness of (i) women of childbearing age suffering from epilepsy and prescribed new and/or older generation AEDs, and (ii) their healthcare professionals. Empowering both to make informed decisions through evidence-based practice that will reduce/prevent the risk of harm to unborn children potentially exposed to AEDs in early pregnancy.
(2) A change in the process by which GlaxoSmithKline (GSK) practices post-marketing epidemiological surveillance of the new generation AED `lamotrigine' in pregnancy.
(3) Benefit to the methodological practice of other researchers in Europe involved with AEDs and epidemiological surveillance
(4) Contribution to building European system for reproductive safety evaluation
Adult Social Care (ASC) is a growing sector which currently employs 1.6 million care workers and benefits 1.8 million care recipients. Research carried out by Manchester Metropolitan University (MMU) into the recruitment, development and retention of ASC workers has had a direct impact on ASC policy, management practice and human resource (HR) practice.
In the area of health, welfare and public policy, the primary research impact was on the Adult Social Care Recruitment and Retention Strategy 2011. Among ASC managers and HR practitioners, the research findings informed and stimulated debate over the conduct of ASC work and the benefits of good HR practice.