Introduction to the Research of CHIME

The research of CHIME is concerned with building academic discipline and the evidence-base to support information, quality and governance of health care, so that this system may work well, to the benefit and not to the harm of its users and staff.

The research is characterised by:

Its engagement within practically relevant local, national and international scales of health care delivery
Its multidisciplinarity and close linkage with education for professional practice
Its focus on informatics methods and standards to clarify and support:
- the decisions required in customisation and delivery of clinical interventions, optimised on an individual patient basis
- the knowledge-base through which clinical interventions are justified
- the records of care provided, through which ethical and legal professional practice is evidenced, integrated and communicated
Its parallel focus on:
- the whole system nature of quality and risk management
- the management of quality and risk through appropriate information and governance
- organisational development whereby the system can continuously evolve to deliver the highest achievable quality of services

"In attempting to arrive at the truth, I have applied everywhere for information but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison. If they could be obtained, they would enable us to decide many other questions besides the one alluded to. They would show subscribers how their money was being spent, what amount of good was really being done with it or whether the money was not doing mischief rather than good."
Florence Nightingale, 1854

These concerns remain strongly evocative of dilemmas facing health services, internationally, today. Understanding the efficacy and effectiveness of health care interventions requires a disciplined approach to the measurement and analysis of the behaviour of increasingly complex systems; systems, moreover, where the potential for benefit and the potential for harm, are often closely coupled. Lack of a systems approach and discipline underlies many failures, to this day, to get to grips with the nature of the challenge posed by Florence Nightingale, and thereby to achieve the much sought-for organisational change that might better deliver the highest achievable quality of services.

A key message from contemporary literature on clinical risk is that achieving quality and avoiding harm are system level issues and require a discipline encompassing of the relevant system dynamics and behaviour. It is now more widely appreciated that system failures can radically degrade the expected benefits of individual health care interventions. Better understanding of complex health systems, drawing on the experience of other sectors, such as air-transport, and greater clarity of endeavour in seeking to learn how their governance may be improved, has led health care policy makers to articulate the essence of a health care service in terms of:

the values it embodies
the standards whereby component services and interventions are expressed and regulated
the total system for providing services, including the people involved, the organisations and resources deployed and the information and information sub systems used to describe, analyse and communicate throughout.

Managing change within such a complex setting requires insight into the behaviour of the total system from the perspective of many disciplines.

This page last modified 25 November, 2008 by CHIME Webmaster