Programme for improvement, implementation and evaluation research (PIIE)

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The Programme for Improvement, Implementation and Evaluation Research (PIIE) studies and uses research into how changes have been implemented, the results of the change for different stakeholders, and what helped and hindered the change.

Improvement: the aim of is to contribute to real performance improvements in health care through creating and applying knowledge about effective change.

Implementation: we know more about what works than we know about how to put it into practice. The programme studies and provides tools to adapt changes which work in one place so they can be implemented in different situations. This includes understanding the politics of implementation and power issues.

Evaluation: many changes have mixed results for different stakeholders. The programme carried out evaluations and helps others to monitor and evaluate their own changes and services.

Research Group leader

Professor

John Ovretveit

Phone: +46-(0)8-524 839 35
Organizational unit: Medical Management Centre
E-mail: John.Ovretveit@ki.se


Sub-programmes

PIIE has three sub-programmes - details are under each heading.

1. Value improvement

The purpose of this sub-programme is to provide evidence and assistance to implement improvements which both raise quality and reduce costs.

Examples: Aspirin can reduce the likelihood of subsequent strokes and the risk of MI, and is likely to reduce costs and increase quality of life in patients who have low risk of gastrointestinal bleeding (Alexandrov et al 1997). Some quality improvements to increase appropriate secondary prevention have been reported to be effective and possibly cost-effective for public funders to invest in (RCT by Ornstein et al 2004, also Øvretveit et al 2007, 2008), and some reported to be ineffective, especially for guideline implementation (McAlister 2009).

An employer health management program was reported to provide a $4.6-to-$1 return-on-investment in reduced total healthcare costs to the employer (Aldana 2001).

Can we save money by improving quality?
Marshall M, Øvretveit J
BMJ Qual Saf 2011 Apr;20(4):293-6 Marshall M, Øvretveit J. Can we save money by improving quality? BMJ Qual Saf 2011;20:293-296.

Øvretveit J. Do changes to patient-provider relationships improve quality and save money? Forthcoming: 2012a, Volume 1 summary. The Health Foundation, London

Øvretveit J. Does clinical coordination improve quality and save money? 2011 Summary Volume 1 London: The Health Foundation

Øvretveit J. Does improving quality save money? A review of evidence of which improvement to quality reduce costs for health service providers. 2009, The Health Foundation, London

Øvretveit J. Measurement, Money and Suffering, 2009, Expert Commentary, AHRQ National Quality Measure Clearinghouse (NQMC)

Øvretveit J. Time for value-added change. Health Management, Nov/Dec 2009, p12.

Øvretveit J. Leading evidence informed value improvement in health care (2009) Leading evidence informed value improvement in health care, Kingsham Press, Chichester, UK. ISBN: 9781904235668

2. Research informed implementation

The purpose of this sub-programme is to apply research to improve effectiveness of implementation of proven changes. Also to create descriptions and evidence based theory, for guidance for practitioners to implement improvements more effectively to care practices, organisation, programmes and policies.

Example: a description of the creation of coordinated care arrangements for mental health clients in one southern area of Stockholm.

The programme applies both to changes in which the implementation process needs to 

  • copy exactly in a local situation a change which was found effective elsewhere, 
  • or changes which require local adaption to be effective.

The scientific aims are to discover which features are core and most be copied exactly, and which are changeable and need implementers creativity to adapt the change idea to their situation.

Understanding the conditions for improvement: research to discover which context influences affect improvement success.
Øvretveit J
BMJ Qual Saf 2011 Apr;20 Suppl 1():i18-23 Øvretveit J. Understanding the conditions for improvement: research to discover which context influences affect improvement success. BMJ Qual Saf. 2011;20(Suppl_1):i18-i23. http://qualitysafety.bmj.com/cgi/content/abstract/20/Suppl_1/i18?ct

Case study of how successful coordination was achieved between a mental health and social care service in Sweden.
Hansson J, Øvretveit J, Brommels M
Int J Health Plann Manage ;27(2):e132-45 Hansson J, Øvretveit J, Brommels M. Case study of how successful coordination was achieved between a mental health and social care service in Sweden. International Journal of Health Planning and Management DOI: 10.1002/hpm.1099

Improvement leaders: what do they and should they do? A summary of a review of research.
Ovretveit J
Qual Saf Health Care 2010 Dec;19(6):490-2 Øvretveit J. Improvement leaders: what do they and should they do? A summary of a review of research. Qual Saf Health Care 2010;19:490-49

An integrated health and social care organisation in Sweden: creation and structure of a unique local public health and social care system.
Øvretveit J, Hansson J, Brommels M
Health Policy 2010 Oct;97(2-3):113-21 Øvretveit J, Hansson J, Brommels M. The creation of a comprehensive integrated health and social care organisation in Sweden. Health policy 97 (2010), pp. 113-121.

3. Evaluation of complex interventions and programmes

Non-experimental evaluation in routine settings

The purpose of this sub-programme is to evaluate changes to care practices, organisation, programmes and policies in routine settings where controlled designs are not feasible.

Example: an evaluation of the implementation of integrated care over a 5 year period and explanation of the key factors speeding and slowing progress.

Evaluation of quality improvement programmes.
Øvretveit J, Gustafson D
Qual Saf Health Care 2002 Sep;11(3):270-5 Øvretveit J, Gustafson D. Evaluation of Quality Improvement Programmes. British Medical Journal, 2003:326;759-761.

Øvretveit J. Action Evaluation of Health Programmes and Change. Radcliffe Medical Press, Oxford, 2002. Publication of year award, EHMA, Baxter 2003, and BMJ books competition prize.

Øvretveit J. Evaluating Health Interventions. Open University Press, Milton Keynes, 1998. Publication of the year award 1999, association of medical managers, and distinguished publication award, EHMA 1998.

Financing

Vinnvård; UK NHS service delivery and organisation research financing agency (SDO); AHRQ (USA); Stockholm Health Care

Health Care Service and ManagementImplementation research