SAPPHIRE’s Natalie Armstrong has recently been awarded a Health Foundation Improvement Science Fellowship, in this blog she reflects on her experiences so far and what she’ll be getting up to over the next three years.
What is an Improvement Science Fellowship, and why did I want one?
The Health Foundation’s Improvement Science Fellowship scheme offers a unique development opportunity for future leaders in improvement science research practice in healthcare. The scheme funds fellowships for original, applied research dedicated to improving healthcare in the UK for up to three years. Successful applicants also participate in a tailored leadership development programme including action learning sets, coaching, and masterclass sessions, and have the opportunity to work with the Health Foundation Improvement Science Development Group, an international group of experts from disciplines within the field of improvement science.
So having said all that, it’s probably fairly obvious why I wanted one! I realised I was at a stage in my career where I really wanted an opportunity to take stock of the work I’d done so far and think carefully about the direction I wanted my future research to take. As a sociologist, I’m particularly keen to champion the value of social science within healthcare improvement work. I believe strongly that social science theory and methods are essential for surfacing implicit theories of change, and for ensuring we really understand the context in which improvement efforts are undertaken and how and why they play out in the ways they do. It is becoming more accepted that understanding how and why improvement efforts work (or indeed don’t) is crucial; as well as this, I am keen that social science theory also be used to more effectively understand the possible negative effects of such activities, particularly where these are unintended and unanticipated.
What are my plans for the Fellowship?
My plans for the Fellowship are to draw together strands of my work to date into a consolidated focus on overdiagnosis and overtreatment, which are issues I’ve been thinking about for a while now. These are increasingly being recognised as a significant problem in healthcare but are yet to receive sustained attention in the improvement science field.
Overdiagnosis and overtreatment occur when a diagnosis is ‘correct’ according to current standards but the diagnosis or associated treatment has a low probability of benefitting the patient, and may instead be harmful. Alongside efforts to raise awareness of the issue, significant attention is being paid to how decision aids for patients and professionals might help in reducing overdiagnosis and overtreatment. The intention for my Fellowship, though, is to focus on the system level factors that may be both contributing to the problem and mitigating against its effective resolution. This is important because it is unlikely that any significant progress on overdiagnosis is possible while the system is aligned to doing more rather than less.
Because of my previous work in population-based screening, I’m planning to focus primarily on overdiagnosis and overtreatment in that context but will be thinking more widely as well. As a medical sociologist by background I will primarily locate my work within that discipline, drawing on the sociology of diagnosis to think about how diagnosis is central to the framework within which medicine operates, the sociology of screening to look at how screening programmes function as social interventions as much as medical, and the sociology of deviance to think about how features of the healthcare system may make it challenging for clinicians and patients to behave in ways that might be considered ‘deviant’.
What have I been up to so far?
Despite the fact that my fellowship doesn’t officially start until March, I’ve already been busy attending events and getting to know the members of my fellowship cohort. One of the really special things about this scheme is the strong cohort model it adopts and the intensive leadership development programme that you complete as a group alongside your research.
I am very fortunate to be part of a diverse and extremely interesting cohort. At our two-day induction session in January we had some fascinating and wide-ranging discussions: we debated the role of different forms of evidence and disciplinary perspective in healthcare improvement, looked at different leadership styles, and were encouraged by our excellent facilitators Fiona Reed and Andrew Constable to think carefully about what we wanted to use our fellowships for and how we’d know if we’d achieved those objectives. It was fascinating to hear each other’s plans, and to get a better understanding of what we each wanted to get out of the next three years. Perhaps most importantly we began to identify common areas of interest and ways in which we could add value to each other’s work.
I had a great discussion with Paula Baraitser about overdiagnosis in sexual health and the tensions between doing what guidelines suggest and what might actually be in the patient’s best interests. A discussion with Christian Subbe about his work developing patient-created health records to improve safety in hospitals got some of us talking about what happens if patients and professionals differ in their assessments of what’s happening.
I also really enjoyed engaging with the previous three cohorts of Improvement Science Fellows, who I met at a two-day cross-cohort networking event at the end of January. Talking with current and past fellows opened up yet more shared interests and potential collaboration opportunities. So many themes cross-cut much of our work, such as the effective use of data to drive improvement and the risks associated with clunky, ad-hoc workarounds, that we’ll have plenty to talk about over the next three years!
So I’m all set to start properly in March – first up is a visit to me in my ‘natural environment’ from Fiona and Andrew. I’m really looking forward to them meeting the SAPPHIRE team and hearing more about the work we do here.