The 2015 Garrod Lecture:why is improvement difficult?

The pressing need to measure and improve antibiotic use was recognized.40 years ago, so why have we failed to achieve sustained improvement at scale? In his 2014 Reith Lectures about the future of medicine, the US surgeon Atul Gawande said that failure in medicine is largely due to ineptitude (failure to use existing knowledge) rather than ignorance (lack of knowledge). Consequently, it is notable that most interventions to improve antimicrobial prescribing are either designed to educate individual practitioners or patients about pol-icies or to restrict prescribing to make practitioners follow policies. Interventions that enable practitioners to apply existing knowledge through decision support, feedback and action planning are relatively uncommon. There is an urgent need to improve the design and reporting of interventions to change behaviour. However, achieving sustained improvement at scale will also require a more profound understanding of the role of con-text. What makes contexts receptive to change and which elements of context, under what circumstances, are important for human performance? Answering these questions will require interdisciplinary work with social scientists to integrate complementary approaches from human factors and ergonomics, improvement science and educational research. We need to rethink professional education to embrace complexity and enable teams to learn in practice. Workplace-based learning of improvement science will enable students and early-career professionals to become change agents and transform training from a burden on clinical teams into a driver for improvement. This will make better use of existing resources, which is the key to sustainability at scale

Why people attend science festivals : interests, motivations and self-reported benefits of public engagement with research

As a form of public engagement, science festivals have rapidly expanded in size and number over recent years. However, as with other domains of informal public engagement that are not linked to policy outcomes, existing research does not fully address science festivals’ impacts and popularity.This study adduces evidence from surveys and focus groups to elucidate the perspectives of visitors at a large UK science festival. Results show that visitors value the opportunities science festivals afford to interact with scientific researchers and to encounter different types of science engagement aimed at adults, children and families. The most significant self-reported impact of attending a science festival was the development of increased interest and curiosity about new areas of scientific knowledge within a socially stimulating and enjoyable setting

The Control of Methicillin-Resistant Staphylococcus aureus Blood Stream infections in England

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI) is a major healthcare burden in some but not all healthcare settings, and it is associated with 10%–20% mortality. The introduction of mandatory reporting in England of MRSA BSI in 2001 was followed in 2004 by the setting of target reductions for all National Health Service hospitals. The original national target of a 50% reduction in MRSA BSI was considered by many experts to be unattainable, and yet this goal has been far exceeded (∼80% reduction with rates still declining). The transformation from endemic to sporadic MRSA BSI involved the implementation of serial national infection prevention directives, and the deployment of expert improvement teams in organizations failed to meet their improvement trajectory targets. We describe and appraise the components of the major public health infection prevention campaign that yielded major reductions in MRSA infection. There are important lessons and opportunities for other healthcare systems where MRSA infection remains endemic

Who needs what from a national health research system: Lessons from reforms to the English Department of Health's R&D system

This article has been made available through the Brunel Open Access Publishing Fund.Health research systems consist of diverse groups who have some role in health research, but the boundaries around such a system are not clear-cut. To explore what various stakeholders need we reviewed the literature including that on the history of English health R&D reforms, and we also applied some relevant conceptual frameworks. We first describe the needs and capabilities of the main groups of stakeholders in health research systems, and explain key features of policymaking systems within which these stakeholders operate in the UK. The five groups are policymakers (and health care managers), health professionals, patients and the general public, industry, and researchers. As individuals and as organisations they have a range of needs from the health research system, but should also develop specific capabilities in order to contribute effectively to the system and benefit from it. Second, we discuss key phases of reform in the development of the English health research system over four decades - especially that of the English Department of Health's R&D system - and identify how far legitimate demands of key stakeholder interests were addressed. Third, in drawing lessons we highlight points emerging from contemporary reports, but also attempt to identify issues through application of relevant conceptual frameworks. The main lessons are: the importance of comprehensively addressing the diverse needs of various interacting institutions and stakeholders; the desirability of developing facilitating mechanisms at interfaces between the health research system and its various stakeholders; and the importance of additional money in being able to expand the scope of the health research system whilst maintaining support for basic science. We conclude that the latest health R&D strategy in England builds on recent progress and tackles acknowledged weaknesses. The strategy goes a considerable way to identifying and more effectively meeting the needs of key groups such as medical academics, patients and industry, and has been remarkably successful in increasing the funding for health research. There are still areas that might benefit from further recognition and resourcing, but the lessons identified, and progress made by the reforms are relevant for the design and coordination of national health research systems beyond England.This article is available through the Brunel Open Access Publishing Fund

Strategic appraisal of environmental risks: a contrast between the United Kingdom's Stern Review on the Economics of Climate Change and its Committee on Radioactive Waste Management

In this article, we compare two high-profile strategic policy reviews undertaken for the U.K. government on environmental risks: radioactive waste management and climate change. These reviews took very different forms, both in terms of analytic approach and deliberation strategy. The Stern Review on the Economics of Climate Change was largely an exercise in expert modeling, building, within a cost-benefit framework, an argument for immediate reductions in carbon emissions. The Committee on Radioactive Waste Management, on the other hand, followed a much more explicitly deliberative and participative process, using multicriteria decision analysis to bring together scientific evidence and stakeholder and public values. In this article, we ask why the two reviews were different, and whether the differences are justified. We conclude that the differences were mainly due to political context, rather than the underpinning science, and as a consequence that, while in our view “fit for purpose,” they would both have been stronger had they been less different. Stern's grappling with ethical issues could have been strengthened by a greater degree of public and stakeholder engagement, and the Committee on Radioactive Waste Management's handling of issues of uncertainty could have been strengthened by the explicitly probabilistic framework of Stern

Strategic appraisal of environmental risks: a contrast between the United Kingdom's Stern Review on the Economics of Climate Change and its Committee on Radioactive Waste Management

In this article, we compare two high-profile strategic policy reviews undertaken for the U.K. government on environmental risks: radioactive waste management and climate change. These reviews took very different forms, both in terms of analytic approach and deliberation strategy. The Stern Review on the Economics of Climate Change was largely an exercise in expert modeling, building, within a cost-benefit framework, an argument for immediate reductions in carbon emissions. The Committee on Radioactive Waste Management, on the other hand, followed a much more explicitly deliberative and participative process, using multicriteria decision analysis to bring together scientific evidence and stakeholder and public values. In this article, we ask why the two reviews were different, and whether the differences are justified. We conclude that the differences were mainly due to political context, rather than the underpinning science, and as a consequence that, while in our view “fit for purpose,” they would both have been stronger had they been less different. Stern's grappling with ethical issues could have been strengthened by a greater degree of public and stakeholder engagement, and the Committee on Radioactive Waste Management's handling of issues of uncertainty could have been strengthened by the explicitly probabilistic framework of Stern

Strategic appraisal of environmental risks: a contrast between the United Kingdom's Stern Review on the Economics of Climate Change and its Committee on Radioactive Waste Management

In this article, we compare two high-profile strategic policy reviews undertaken for the U.K. government on environmental risks: radioactive waste management and climate change. These reviews took very different forms, both in terms of analytic approach and deliberation strategy. The Stern Review on the Economics of Climate Change was largely an exercise in expert modeling, building, within a cost-benefit framework, an argument for immediate reductions in carbon emissions. The Committee on Radioactive Waste Management, on the other hand, followed a much more explicitly deliberative and participative process, using multicriteria decision analysis to bring together scientific evidence and stakeholder and public values. In this article, we ask why the two reviews were different, and whether the differences are justified. We conclude that the differences were mainly due to political context, rather than the underpinning science, and as a consequence that, while in our view “fit for purpose,” they would both have been stronger had they been less different. Stern's grappling with ethical issues could have been strengthened by a greater degree of public and stakeholder engagement, and the Committee on Radioactive Waste Management's handling of issues of uncertainty could have been strengthened by the explicitly probabilistic framework of Stern