Wagstaff, Duncan; (2023) Does PQIP change how data are used for local quality improvement? An evaluation of the national Perioperative Quality Improvement Programme. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This Thesis investigated whether and how the Perioperative Quality Improvement Programme (PQIP) supported local teams to use data for quality improvement of major elective surgery in the NHS. This complex intervention was challenging because of the difficulties local teams faced in collecting, sharing and using data within the multidisciplinary context of perioperative care. A scoping review identified gaps in the existing literature of how data from national perioperative programmes had been used for local quality improvement, and hence informed three interacting mixed-methods empirical workstreams: non-participatory qualitative fieldwork in two case study NHS Trusts before and after they engaged with PQIP data; a national survey of perioperative clinicians and managers; and participatory qualitative fieldwork with the central PQIP Project Team. Perioperative teams were motivated to use local data for improvement, but lacked the time, support or resources to do so. This did not change after engaging with PQIP. Local staff agreed with PQIP’s aims to improve perioperative complications but struggled to collect sufficient data to effect change. However, this study only covered the early part of PQIP’s implementation which may yet gain greater traction. Successful strategies to support the use of data for improvement were identified at the micro, meso and macro levels. Data collection was more effective in local contexts which dedicated resources to this activity. Local ‘champions’ spanning professional boundaries were influential in coordinating data collection, analysis and sharing. Organisational-level strategies successfully supported the training, implementation and coordination of QI at the micro level. Financial incentives attached to national clinical audits catalysed greater local multidisciplinary collaboration to use these data for improvement. Future research should investigate how to navigate these contextual influences in order to make best use of the considerable resources invested in national quality improvement programmes.

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