Case study: Implementing enhancements to existing quality improvement interventions in Dementia Care

Michael Sykes is a nurse with experience of leading improvements across health sectors in NHS England and Scotland, including leading national improvement work. Michael led the NHS Institute for Innovation and Improvement’s Leading Improvement in Patient Safety (mental health) programme and is currently the quality improvement lead for the National Diabetes Audit. He also held quality assurance and improvement roles within NHS organisations; for example, he was Patient Safety Manager at Tees, Esk and Wear Valleys NHS FT and Clinical Governance Manager at NHS Tayside. 

Tell us about your PhD? 

My research interest is in implementation science, with a focus on implementing enhancements to existing quality improvement interventions. For example, clinical audit is a much-used intervention to assurance and improve care. There have been over 140 randomised controlled trials of audit and feedback, and these describe that it is variably effective; for example, giving feedback verbally and in writing may enhance improvement. Further evidence and theory describe additional components associated with greater improvement; for example, non-punitive feedback may enhance improvement. If we implement these components into current practice, we may achieve greater improvements in care.  

I have been fortunate to be supported by the NIHR to undertake my research. They funded my M(ClinRes) at Newcastle University, where I undertook a systematic review of audit and feedback in dementia care (Sykes et al, 2018). More recently, I gained an NIHR Doctoral Research Fellowship. As well as giving me training in research skills and support to develop a research network, the fellowship funded a study to describe and enhance audit and feedback in dementia care. 

During my PhD, I studied how six hospitals in four NHS Trusts undertook audit and feedback in dementia care. This work focussed on the National Audit of Dementia, as well as what we called ‘ward monitoring audit’ undertaken each month by ward managers at each organisation. I worked with stakeholders in a co-production group, iteratively presenting the findings back to the group for challenge and to develop the description. The co-production group’s input was supported by a wider advisory group. Together we used the description of current practice, evidence and theory to identify potential enhancements. We then used further evidence and theory to consider how to implement the enhancements into practice. As a result of this work, we produced an educational intervention for clinical dementia leads and for clinical audit leads within Trusts to support them to select, and gain commitment for, actions to improve patient care. You can read more about our findings in this article.

Throughout the study, it has been great to work with some of the key stakeholders, including patients, carers, clinical staff, health service managers, and representatives of national bodies. This was done to generate the findings informed by their perspectives. There is some evidence that this may have influenced impact; for example, the newly commissioned National Audit of Dementia reflects some of the key findings from our study.

How do you juggle clinical and academic work demands? 

My clinical work involves supporting improvement from the National Diabetes Audit (NDA). I took on this role part way through my doctorate, as I initially felt it was important to focus full-time on my PhD. This full-time focus gave me the ‘head-space’ to think through the study, and in particular the purpose and design of the co-production work. More recently, I have taken on the NDA work one day a week. I really enjoy the balance of research and evidence-informed improvement. I feel each informs and refreshes the other. I am fortunate in that I am largely able to manage my own workload, so as to balance the ebb and flow of each. 

What message you would give others interested in becoming a clinical academic?

I have been very fortunate to get tremendous support: from people in my Trust with academic experience, from funders and research support organisations like the Clinical Research Network, and from stakeholders and researchers in my field and beyond. So, my key message would be that there is lots of support out there, you just need to ask. 

I would maybe also note that the nursing, midwifery and allied health profession clinical academic pathway may be less secure than career progression in a Trust, but it can also be incredibly rewarding and lots of fun!

Follow me on Twitter: @msykes09