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Mind the Gap

June 21, 2013
Dominique Allwood Dominique Allwood joined ISL in January 2013 as a Fellow in Improvement Science.

‘Mind the gap’ is something most Londoners hear everyday when they travel around on the busy and crowded underground. The warning is telling us to take caution when crossing between the train and platform.

I’ve recently started as a Fellow in Improvement Science at ISLondon.  I’ve had lots of people ask me about my role and about improvement science more generally. The contribution of science to improve healthcare is frequently discussed and the notion of a ‘gap’ comes up a lot in the conversations – the gap between what we know to work from academics, and what is actually put into practice by managers and clinicians in order to improve the health system.

I’ve held clinical, managerial and health services research roles and these experiences have given me some understanding of the issues and challenges we face when trying to unite the two sides of the ‘gap’. Most recently I have come from a busy job as a clinical transformation manager at an Acute Trust. It’s been challenging and thoroughly enjoyable because I have been actively involved in and leading on health system improvement. But whilst undertaking change at the front line, it is obvious that despite intentions of people wanting to do a ‘good’ job to improve health care, there is frequently a lack of focus on using evidence of improvement, looking at what is known and what works. There are very few problems in the health system that are ‘new’ but yet we often approach them as if they are. In our busy day jobs there is little focus to reflect on how we made decisions or why things were done in the way that they were.

A first glance the gap seems to be quite daunting and I’m keen to find out what lies in the ‘gap’ between what is known and what happens. I’m in a privileged position and I’ve been able to have conversations with a range of people within the Academic Health Science Centres , ISLs partner organisations. There is a huge amount of work going in that gap. It’s been fascinating to get an insight and two things struck me the most; the multi-disciplinary nature of the work occupying this gap, and secondly the spectrum on which they all lie. If there was a metaphorical bridge spanning the gap, there would be those starting the crossing from the academic side, and there are others who set off on the journey from the clinical side. My awareness of what lies in within this gap is slowly increasing. The challenge is how to make this more widely accessible and re-frame what may often be seen as an area of uncertainty.

This ‘gap’ on the tube is quite obviously a potential danger. Some gaps are an unknown chasm laying in front of us. However, sometimes gaps are a space of possibility and potential, full of opportunity, some even have a crossing that bridges either side together. My role is a new one that has been created to allow a doctor in training to develop skills and experience to work across the interface between research and service improvement and I hope that this year will allow me to develop my own and others awareness and understanding in this area and I hope to contribute practically to ‘bridging’ the gap through projects I will be undertaking. If you’d like to find out more please get in touch

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