A healthy perspective

The Health Hub is one of the projects within the University of Leeds’ Building Sustainable Societies Transformation Fund programmes and is connecting social scientists with healthcare and medical professionals to drive best practice within the NHS.
The main thrust of the project is to bring different disciplines together – both from academia, the medical profession and within policy spheres – to come up with solutions to improve the NHS. Ray Pawson, Professor of Social Research Methodology in the School of Sociology and Social Policy, has developed two key methodologies which can help health services understand some of their long-standing issues. Called realist evaluation and realist synthesis, these methodologies provide a framework for explaining how health care interventions work, for whom and in what circumstances.
One of the hub’s main projects is a realist synthesis of demand management for planned care, funded by the National Institute for Health Research. This project aims to review existing research and policy to understand the causes of demand and capacity problems in the NHS and explore levels of success of different referral management interventions in addressing these problems, taking into account the circumstances in which they are most effective. The plan is to develop guidance for NHS decision makers and policy makers to target referral management interventions more effectively to ensure the patient is seen by the right person, at the right time and in the right setting. .
All the projects being worked on within the hub involve a range of stakeholders who provide different perspectives grounded in the real world of the NHS. The demand management project for example, includes clinicians, NHS commissioners, health economists and NHS service users – or patients.
“Realist methods, such as those devised by Professor Pawson, provide us with a way of understanding not just whether an intervention works or not but also why it’s working, and what factors influence its success. An intervention that works in Burnley on a Saturday afternoon may not work in Blackpool on a Wednesday morning. The circumstances in which an intervention is implemented can have a crucial impact on its success and realist methods allow us to understand this,” says Dr Joanne Greenhalgh, Principal Research Fellow in the Health Hub. “By applying realist methods to evaluate healthcare interventions we can answer questions of more practical relevance to policy makers, clinicians and patients.”
Further projects will examine how patient’s views of the outcomes of health interventions are being used to judge that quality of hospital care. The health hub is planning to apply realist methods to understand how and why data from patient reported outcome measures (or ‘PROMs’) might improve that quality of patient care. Dr Greenhalgh explains: “Traditionally, the success of healthcare interventions is only measured in clinical terms. So a successful outcome might be that the patient’s joint has been repaired but this doesn’t tell you whether the patient can walk or is in pain. Patient Reported Outcome Measures can provide this information. They are now being used as standards to judge the quality of hospital care and we’re interested in understanding how different stakeholders, such as patients, clinicians and commissioners, make sense of and use this information in their decision making.”]]>