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.