Doctoral research projects
Developing and adopting complex health innovations. The case of
genetically modified mosquitoes for malaria eradication
Valentina Cisnetto
Funding for preventing, controlling
and eliminating malaria has risen over the past decade. Combination
therapies and insecticide-treated bednets have had visible results But the improvement curve is leveling off. WHO estimates that we
need to more than double the average annual global expenditure to achieve
universal access to malaria interventions. As well as the difficulties in
deploying interventions on the ground, current technologies have limitations,
such as insecticide resistance and resistance of the parasite to medications. Innovative
technologies, which potentially provide area-wide, durable and low-cost
protection against malaria, are in the spotlight.
This PhD is on the development
and introduction of a novel technology for malaria control, the modification of
disease-carrying vector populations through homing endonuclease genes (HEG).
This involves the development of genetically modified Anopheles mosquitoes. Over successive generations, their release should reduce the number
of native mosquitoes able to carry and transmit malaria until there are too few
remaining to sustain transmission of the disease. The HEG technology is being
developed in stages of increased complexity. Ultimately, the technology should provide
area-wide, sustainable, low-cost malaria eradication in areas where disease
transmission levels are high and current control methods inadequate.
Through fieldwork in Burkina Faso, the UK and
Italy, the study is exploring the factors shaping the development of the HEG
technology and its deployment in trial sites in Burkina Faso. The study will be
finished by September 2017.
Professional dynamics and the assimilation of innovative healthcare practice: the role of emotions
Paola Boscolo
Using ‘institutional logics’ as a
theoretical lens, the study is investigating how healthcare professionals deal
with evidence while adopting home based dialysis (HBD). Renal failure poses a
global public health challenge. Different therapies are available, but dialysis
remains the most widely used. HBD became available in the 1970s, increasingly
adopted in the 1980s and then declined in most countries, before more recent
attempts to re-adopt it. Despite positive evidence, the diffusion of HBD is low
and patchy.
The research is using
multiple-case studies in different hospitals within the Italian health system
to explore their choices about dialysis. It is focusing on the dynamics and
tensions arising from the logics of different stakeholders as a factor influencing
this innovation trajectory. The research is investigating the values and
beliefs that contribute to healthcare professionals’ choices.
The reasons why physicians decide to adopt or refute a healthcare innovation are related to a mix of emotional and scientific factors. Others have identified the role of a ‘professional logic’. The PhD research has found that both physicians and nurses hold a professional logic, but the way it shapes their behaviour is different, due to the blending of differing logics. The study will be finished in 2017.
Exploring the use of Process Mapping in
practice in the healthcare sector
Grazia Antonacci
Most
observed healthcare failures are the result of system and process rather than
human errors. Operational inefficiencies are one of the main causes of falling
performance and productivity. System redesign and the adoption of
process-oriented management practices and technologies are therefore widely
seen as crucial for improving the quality and efficiency of healthcare
delivery.
Over
the last 15 years practitioners and researchers have highlighted how approaches
to Quality Improvement (QI) from industry can be beneficial for improving the
performance of healthcare organizations. They can help to open the ‘black
box’ of hospital operations, eliminate waste, reduce process variations and
introduce a culture of shared responsibility for the continuous improvement of
patient care. Process Mapping (PM)
lies at the heart of improvement initiatives in many industries. One benefit is
that it can provide a clear and shared understanding of the reality of
processes, where there are many different stakeholders involved.
While process improvement
methods and tools, including PM, have increasingly been taken up in healthcare,
their widespread use remains limited and they
are used in many different ways.
The study is exploring challenges
in the adoption, implementation and use in practice of PM. As well as a case
study in an Italian hospital, it is investigate the use of PM and a selection
of improvement projects in North West London.
The research was completed in January 2017. Papers for publication are being prepared.