The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL).Data from project teams’ responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as ‘engaged,’ ‘partially engaged’ and ‘non-engaged.’ Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a ‘diversity of opinion’ measure was derived to assess response variance over time.Of the 19 teams, six were categorized as ‘engaged,’ six ‘partially engaged,’ and seven as ‘non-engaged.’ Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness.The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This study indicates the SM provides a potentially useful approach to measuring teams’ views on the likelihood of sustainability and prompting action. Securing engagement of teams with the SM was challenging and redesign of elements may need to be considered. Capacity building and facilitation appears necessary for teams to effectively deploy the SM.

This paper assesses the strength of the evidence on the impact of the physical environment on mental health and well‐being. Using a systematic review methodology, quantitative and qualitative evaluative studies of the effect of the physical environment on child and adult mental health published in English between January 1990 and September 2005 were sought from citation databases. The physical environment was defined in terms of built or natural elements of residential or neighbourhood environments; mental health was defined in terms of psychological symptoms and diagnoses. A total of 99 papers were identified. The strength of the evidence varied and was strongest for the effects of urban birth (on risk of schizophrenia), rural residence (on risk of suicide for males), neighbourhood violence, housing and neighbourhood regeneration, and neighbourhood disorder. The strength of the evidence for an effect of poor housing on mental health was weaker. There was a lack of robust research, and of longitudinal research in many areas, and some aspects of the environment have been very little studied to date. The lack of evidence of environmental effects in some domains does not necessarily mean that there are no effects: rather, that they have not yet been studied or studied meaningfully.

The Olweus checklist, along with most of the questionnaires commonly used in bullying research, is anonymous. The respondent is not required to put down his/her name. This has been accepted as the ‘best suited’ method of assessing bullying. However, this assumption has not been adequately tested, and there is contrary evidence that this method is more conducive to obtaining more truthful responses from the respondents. This study tested the issue of anonymity versus non-anonymity experimentally using a balanced design. A total of 562 elementary school children (grades 1-8) from two inner-city schools in Toronto took part in the study. The findings supported the hypotheses that the respondents did not differ in their report of the incidence of either bullying or victimization, regardless of whether they were required to identify themselves by writing down their names on the questionnaire forms. The advantages of using non-anonymous questionnaires in bullying and victimization research, as well as in intervention work in schools, are highlighted.

Interventions to optimise the hydration of care home residents can be effective. Plan-Do-Study-Act cycles provide an effective methodology to implement new interventions into existing practice in care homes. Sustainable change requires strong leadership, organisational support and teamwork.

Improving the quality of healthcare involves collaboration between many different stakeholders. Collaborative learning theory suggests that teaching different professional groups alongside each other may enable them to develop skills in how to collaborate effectively, but there is little literature on how this works in practice. Further, though it is recognised that patients play a fundamental role in quality improvement, there are few examples of where they learn together with professionals. To contribute to addressing this gap, we review a collaborative fellowship in Northwest London, designed to build capacity to improve healthcare, which enabled patients and professionals to learn together. Using the lens of collaborative learning, we conducted an exploratory study of six cohorts of the year long programme (71 participants). Data were collected using open text responses from an online survey (n = 31) and semi-structured interviews (n = 34) and analysed using an inductive open coding approach. The collaborative design of the Fellowship, which included bringing multiple perspectives to discussions of real world problems, was valued by participants who reflected on the safe, egalitarian space created by the programme. Participants (healthcare professionals and patients) found this way of learning initially challenging yet ultimately productive. Despite the pedagogical and practical challenges of developing a collaborative programme, this study indicates that opening up previously restricted learning opportunities as widely as possible, to include patients and carers, is an effective mechanism to develop collaborative skills for quality improvement.

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Developing an improvement leaders fellowship programme and the evaluation of the integration of patient fellows

Myron, R et al 2017 Patients and professionals learning together: an evaluation of an intergrated change management fellowship programme for healthcare improvement.