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Institute for Global Health

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Quality Improvement

UCL Global Quality Improvement brings together a team of expert researchers, evaluators and practitioners from across UCL who are interested in improving global healthcare and health, particularly in low-income countries and resource-poor settings throughout the world. Our unique approach to quality improvement is founded on five core principles:

1. Whole systems thinking. The inter-relationships between the patient, clinical and non-clinical workers in the health system, different levels of the health system ranging from the community to tertiary referral systems, and required human and material resources and training, supervision and management structures are all considered as part of one dynamic complex adaptive system.

2. Accountability. The people involved in making health systems work must be accountable to the individuals and local communities the health system is there to benefit. Data for decision-making is key as it not only can be used to encourage quality improvement and track it, but can also be a mechanism by which service providers can be held to account. Community-linked death reviews involving the community of the deceased as well as healthcare workers can also increase accountability.

3. Participatory approach. We believe a participatory, grounded and bottom-up approaches involving healthcare professionals, patients and wider communities as well as researchers-in-residence are crucial to understand whole systems, increase buy-in to quality improvement efforts, and consequently design and implement interventions that are effective in specific contexts; and build accountability.

4. Evidence-based. Evidence on what works to improve quality of care in low-income settings is scarce. Our approach is based on the highest standards of scientific and academic rigor, using innovative mixed methods approaches to research and evaluation.

5. Innovation. With expertise in a variety of research and evaluation methodologies related to quality improvement we aim to effectively use both plausibility and probability designs as part of a single research strategy to rigorously determine not only whether the interventions we test work but also how, why and in what circumstances they work. We use methods ranging from tailored formative research to cluster randomised controlled trials with accompanying detailed multidisciplinary theory-based evaluations, and encourage the use of researchers-in-residence.

Meet the team

tim-colbourn

Dr Tim Colbourn

Lecturer in Global Health Epidemiology & Evaluation 
UCL Institute for Global Health


Tim specialises in evaluation of quality improvement approaches, using methodologies including randomised trials, process evaluation, realist evaluation and economic evaluation. He was one of the evaluators of the MaiKhanda quality improvement trial in Malawi and is focused on improving quality of maternal and newborn care both at community and health facility levels in low-income settings throughout the world. Tim strongly believes in the UCL approach of ensuring local and global institutional buy-in to quality improvement approaches.

Relevant publications
Ongoing relevant work
Relevant teaching

bejoy-nambiar

Dr Bejoy Nambiar

Research Associate
UCL Institute for Global Health


Bejoy is the systems improvement researcher working towards improving the quality of maternal, newborn and child health. He has been based in Malawi for the past 8 years, evaluating various quality improvement projects. He has been experimenting with a wide range of research methods including randomised trials for measuring impact and theory based evaluation to understand intervention mechanisms. He believes that a whole systems approach is needed to achieve quality improvement especially in resource poor settings. This presents a challenge for evaluation as well as an opportunity. 

Relevant publications
Ongoing relevant work

dougal-hargreaves

Dr Dougal Hargreaves

Honorary Consultant Paediatrician
University College Hospital

Health Foundation Improvement Science Fellow
UCL Institute of Child Health


Dougal’s current research focus is using data on geographical variation in child health outcomes and paediatric care activity within the UK to guide national and local quality improvement strategies.




Relevant publications
Previous experience

martin-marshall

Prof Martin Marshall

Professor of Healthcare Improvement


Martin Marshall is Professor of Healthcare Improvement at UCL, lead for Improvement Science London and general practitioner serving a diverse socio-demographically deprived community in East London. His main interests are in the fields of improvement science, knowledge mobilisation, health system organisation and redesign (particularly in primary care), quality improvement and comparative health system analysis. He now spends most of his time working at the interface between academia and practice. In the past he has held senior roles in government and in the charitable sector and he has extensive experience as an advisor and consultant in the field of quality improvement in Europe, North America and Australasia.

Relevant publications

Monica Lakhanpaul

Prof Monica Lakhanpaul

Programme Director for the Children and Young People’s theme for UCL Partners' Academic Health Science Network
Deputy Theme Lead for the children and young people’s North Thames CLAHRC
Head of the Population, Policy, Practice Program, Institute of Child Health
Professor of Integrated Community Child Health 
Honorary Consultant Community Paediatrician, Whittington Health


Monica's overall vision and passion is to work across traditional boundaries putting children and their families at the centre of healthcare. Monica’s research focuses on reducing variation in practice and improving outcomes for children by utilising an integrated applied health research approach to collaboratively design and deliver tailored interventions to address suboptimal care across the patient pathway thereby crossing primary, community and hospital care, social care and education.

Relevant publications

Michelle Heys

Dr Michelle Heys

NIHR Clinical Lecturer in Child Public Health and Global Health Epidemiology
UCL Institute for Global Health


Michelle is a paediatrician and a paediatric epidemiologist with a passion for delivery of high quality care both at the individual and system level. Her research interests are life course epidemiology of cognition and cardiovascular risk and health service configuration and evaluation for newborn babies, children and young people. Along with colleagues at IGH, she is developing a project to improve outcomes for newborns born in hospital facilities in Bangladesh and Malawi. She has led initial work in rural Nepal examining the unmet health and education needs of children and young people with atypical child development including autism and ADHD.

Relevant publications
Relevant teaching

Christina Pagel

Dr Christina Pagel

Reader in Operational Research
UCL Clinical Operational Research Unit & Department of Applied Health Research


Christina has a background in both mathematics and physics and has been working in Operational Research applied to health care since 2005. Her main interest is in using information to help people within health services make better decisions. Often this will involve mathematical modelling or other Operational Research techniques, but sometimes it can be just presenting the data in a more intuitive way. She wants her work to be relevant to, and used by, those working within the health services and so she is also very interested in the process of how to get theoretical knowledge into practical application. She has been an embedded researcher at Great Ormond Street Hospital Intensive Care Unit since 2013, spending 2 days a week there.

Relevant publications

susana frazao pinheiro

Dr Susana Frazao Pinheiro

Programme Director, Healthcare Management 
UCL School of Management


Susana has worked with the UN and Ministries of Health on the development of national health strategic, and monitoring and evaluation plans for almost a decade, as well as in emergency situations. She was a postdoctoral fellow on a clinical trial for an HIV vaccine at Oxford. Her passion to find solutions to improving access to quality healthcare has led her to work with both communities and senior health professionals in countries such as Angola, Haiti, Guinea-Bissau, The Gambia, Mozambique. Susana has conducted research in the UK, Portugal, USA.


Relevant work/publications
Relevant teaching

Felicity

Dr Felicity Fitzgerald


Felicity is a paediatric infectious diseases trainee, who asked her PhD supervisor for 5 weeks out to volunteer working clinically in the West African Ebola response. She returned 7 months later having set up the largest and most comprehensive paediatric cohort study to emerge from the outbreak to date, working with Sierra Leonean colleagues and support from Save the Children and LSHTM. This followed up children from their first attendance and testing at health care facilities, to transfer to specialist treatment centres and post-discharge. She has learnt many lessons about trying to perform research in an outbreak setting, with a backdrop of fragile health infrastructure and high background morbidity and mortality. She hopes to put these experiences to good use in the future, working on how best to incorporate research and data collection into an emergency response, and was recently invited to speak at LSHTM's Centre of Evaluation's symposium on "Evaluating the Ebola Response". More broadly, she is interested in building on her PhD expertise in bacterial molecular diagnostics to design safe and effective treatment pathways for children presenting with signs of infection in resource limited settings. She is committed to pragmatic and participatory operational research in developing settings with the aim of improving paediatric care sustainably.

Relevant publications

sonya_crowe

Dr Sonya Crowe

Health Foundation Improvement Science Fellow & Senior Research Associate in Operational Research
UCL Clinical Operational Research Unit


Sonya has a background in physics and worked for the Department of Health before joining the Clinical Operational Research Unit at UCL in 2009. During her time at UCL she has worked on a variety of areas in healthcare, collaborating with local NHS organisations, those informing national policy and international partners working on global health problems. She is currently a Health Foundation Improvement Science Fellow, using Operational Research to explore ways of improving outcomes for infants once they've returned home after cardiac surgery and studying the role that mathematical modelling plays in the complex decision-making process of designing a better service. Her main interests are in using information to help people within health services make better decisions and drawing on learning from complementary disciplines (e.g. innovation studies and knowledge mobilisation) to enhance the effectiveness and relevance of analytical techniques within healthcare.

Relevant publications

chelsea

Dr Chelsea Morroni

Clinical Lecturer
UCL Institute for Global Health & UCL Institute for Women’s Health

Honorary Senior Lecturer in Public Health, University of Cape Town and University of Botswana
Honorary Assistant Professor of Medicine Perelman School of Medicine, University of Pennsylvania and the Botswana UPenn Partnership
Special advisor, Botswana Ministry of Health, Sexual and Reproductive Health Programme

Chelsea is an epidemiologist and sexual and reproductive health doctor working towards improving the quality of sexual and reproductive health and maternal health services in low- and middle-income settings. She has been based full-time in Botswana for the past 2 years, initiating various quality improvement projects in collaboration with the Ministry of Health and NGOs; she was previously based in South Africa for over a decade. Her team are utilizing a range of research methodologies in this work, from randomised designs to process and economic evaluations, as well as developing a series of health service-based demonstration projects and clinical centres of excellence.


michael emes

Dr Michael Emes

Deputy Director
UCL Centre for Systems Engineering


Michael is Deputy Director of UCL Centre for Systems Engineering and Head of the Technology Management Group at UCL's Mullard Space Science Laboratory (MSSL). He completed his first degree in Engineering, Economics and Management at St John’s College, Oxford, and a PhD at MSSL in developing ultra-low temperature cooling systems for spacecraft. He previously worked as a strategy consultant for Mercer Management Consulting (now Oliver Wyman) on projects in retail, energy and transport. Michael now conducts teaching and research at UCL in the areas of systems thinking and engineering, technology strategy, risk management and decision-making in domains including transport, health and aerospace. He is Programme Manager and a lead trainer for the European Space Agency’s Project Manager Training Course.


till

Dr Till Bärnighausen

Associate Professor
Department of Global Health and Population, Harvard T.H. Chan School of Public Health
Programme Director
Health Systems and Impact at Wellcome Trust Africa Centre for Health and Population Studies (South Africa)


Till works on health care access, transformation of health services, and the causal impacts of HIV treatment and other global health priority interventions on population health, economic, social and behavioural outcomes. Till and his team have established the population impact of HIV treatment – delivered under the real-life conditions of a public-sector health system in rural Southern Africa – on mortality and life expectancy, employment an educational attainment, and health seeking and sexual behaviour. He has introduced several methods innovations for applied, population-based HIV research. Till is a medical specialist in Family Medicine and holds doctoral degrees in International Health Economics (Harvard) and History of Medicine (University of Heidelberg), as well as master degrees in Health Systems Management (LSHTM) and Financial Economics (SOAS). He previously worked as a physician in Germany, China, and South Africa; as a journalist in Berlin; and as a management consultant for McKinsey & Company in Europe. Till currently holds a faculty position at UCL in the Department of Infectious Disease and Population Health.


Duncan Wagstaff

Dr Duncan Wagstaff

Anaesthesia Specialist Trainee (ST5, North Central London)
Academic Clinical Fellow (UCL)
MD(res) student (Department of Applied Health Research, UCL)

Duncan is an Anaesthetist interested in exploring the use of data for clinical quality improvement. He is currently involved in the implementation and ethnographic evaluation of the new national Perioperative Quality Improvement Programme (PQIP) led by the Royal College of Anaesthetists. His other clinical academic interests include Health Economics and Global Anaesthesia. He completed his first degree in Natural Sciences (Physics) at Peterhouse, Cambridge, and then worked as a financial derivatives trader for four years before qualifying in Medicine at Green College, Oxford.