Centre for Healthcare Resilience and Implementation Science

Centre for Healthcare Resilience and Implementation Science

The Centre for Healthcare Resilience and Implementation Science (CHRIS), formerly the Centre for Clinical Governance Research, has a successful track record of undertaking research and evaluation projects on health sector issues since 1991. Its core interest is to investigate issues of policy, governance and leadership in the health sector. It is involved in conducting original research into clinical governance issues, providing a scholarly capability by which to evaluate health sector policies, programs and projects, and contributing to undergraduate medical, postgraduate health services management, and public health and doctoral education.

To achieve these the Centre makes use of assembled expertise and collaborators, and builds on existing staff expertise through external collaborations within Australia and internationally, including with the NSW Ministry of Health, NSW Clinical Excellence Commission, Australian Council on Healthcare Standards, Australian Commission on Safety and Quality in Health Care (ACSQHC), the International Society for Quality in Health Care (ISQua), the OECD, the Society for the study of Organising in Health Care and the World Health Organization.

Centre mission

A Centre undertaking research of national and international standing with a core interest to investigate health sector issues of policy, culture, systems, governance and leadership.

Identity

We are :

  • The people who look at sustainable health systems and make them meaningful
  • World class systems researchers
  • Experts in understanding and developing models of improvement for healthcare
  • Promoting exciting cross-disciplinary research with multiple internal and external partners, in Australia and across the world.

Principles

Our principles for projects:

  • Utility and usefulness
  • Highest quality results
  • Feasible and realistic
  • Propriety - conducted ethically
  • Accurate reporting and faithful interpretation of results
  • Pursuing inclusivity.

Six CHRIS objectives

The Centre has six main objectives. These are:

  • To undertake internationally recognised inter-disciplinary research and development projects on clinician led approaches to organising and managing clinical work across the full spectrum of care.
  • To provide a focal point for initiating and managing collaborative research and development projects on clinician led approaches to the organisation and management of clinical work. involving partners drawn from other groups within the Faculty of Medicine and Health Science, other departments within the University, Federal, State and Area health authorities and potential collaborators in other universities both within and external to Australia.
  • To provide a supportive environment for developing research skills of young health researchers from both clinical and social science disciplines.
  • To develop an international research reputation not simply in health but also in the base disciplines from which Centre members are drawn viz., policy studies, multi-disciplinary teamwork, improvement studies, discourse analysis, sociology, organisational behaviour, social theory, anthropology, health informatics and clinical studies.
  • To be an internationally recognised reservoir of knowledge and expertise on clinical work management issues with a capacity to respond to requests for advice and consultation.
  • To facilitate the development of education and training activities both within and outside the University in support of clinical governance.

Research areas

Patient safety and appropriateness of care

The landmark CareTrack Australia study revealed, in 2012, Australians receive “appropriate” healthcare in only 57 percent of consultations. A follow-up study to CareTrack Australia, “CareTrack Kids” will, for the first time, determine the percentage of healthcare encounters at which Australian children receive evidence- and consensus-based care for 16 paediatric conditions and examine the frequency and types of adverse events involving Australian children. We aim to deliver a range of important outcomes in this highly significant and overdue research. Read more.

Complexity science

Health care is increasingly recognised as a complex adaptive systems, comprised of multiple levels of interacting agents, including diverse organisations (e.g., hospitals, not-for-profits, governments, professional bodies), groups (e.g., medical teams, online patient communities) and individuals (e.g., doctor, nurse, patient, carer, pharmacist). All of this interconnection leads to nonlinearity, making understanding, influencing and improving the health care system a challenge of the greatest magnitude. For example, complexity science highlights the importance of local context, such that an intervention that works in one hospital might show little improvement or might not even be adopted in another. Furthermore, feedback loops within complex systems mean that changes may not be sustained, as their effects become self-correcting (negative feedback); alternatively, a small perturbation in one part of system, for example a doctor failing to wash their hands, may have repercussion across the entire network, such as causing frustration among their team, patient infection, culminating in a national scandal. Read more.

Health outcomes

Improving estimates of the burden of injury and disease are integral for priority-setting and to evaluate the impact of preventive strategies. Examining health outcomes following the provision of health care can be instrumental in guiding where improvements need to be made in health service delivery and health policy.  Associate Professor Rebecca Mitchell is leading a programme of research aimed at identifying where systems improvements need to be made.  The health outcomes stream is conducting large-scale, population-based studies in the areas of paediatric trauma, dementia and care transitions, unwarranted clinical variation, and a case-control study of adult injury and health service use.  By identifying different types of factors that are associated with an increased risk of care complications, along with any variation between service providers, Associate Professor Mitchell and colleagues are developing targeted strategies with the aim of lowering the incidence of complications and improving health outcomes. Read more.

Human factors and resilience

While the rate of medical error remains stubbornly high at around 10 percent in modern hospital systems, there are considerable untapped opportunities to improve care by turning our attention to what healthcare systems do well. Instead of focussing on why systems sometimes fail, resilience science engineering seeks to understand how dynamic and highly complex organisations and systems, like healthcare, usually get things right. Read more.

Implementation science

Much is made of the patient experience, but what does it mean to be the recipient of a long-term care plan, and what do we know of patients’ experiences of consultations where important, often life-changing conversations take place? How do patients respond to an unexpected diagnosis or a prognosis of long-term ill health, and how would patients wish to be better supported during clinical interactions? Professor Frances Rapport’s work, driving the Implementation Science stream, employs qualitative and multi-methods approaches to address health services research questions through trials and exploratory and complex study designs. The research aims to clarify the social, emotional, and physical determinants of ill-health. Read more.

Our people

Our people come from diverse backgrounds – academic, industry, clinical and professional. You can find people with expertise in patient safety, human factors, resilience engineering, health reform, health outcomes, systems improvements, implementation science and social networking. We have people from disciplines including medicine, nursing, and allied health professions (including speech pathology and physiotherapy). We have scientists and social scientists with expertise in fields as diverse as psychology, sociology, neuroscience, economics, public health, clinical governance and biostatistics.

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Founding Director AIHI & Director CHRIS

Professor Jeffrey Braithwaite

Professor Jeffrey Braithwaite is a leading health services and systems researcher with an international reputation for his work investigating and contributing to systems improvement. He has particular expertise in the culture and structure of acute settings, leadership, management and change in health sector organisations, quality and safety in health care, accreditation and surveying processes in international context and the restructuring of health services.

Academic staff

Professional staff

Visiting appointments

Higher degree research students 

PhD

Jadranka Dominkovic-Cook

Andre Jenkins

Kristiana Ludlow

Katherine McConnon

Luke Testa

Victoria Walton

MPhil

Brian Johnston

MRes

Kashmira De Silva

Amanda Bryan Foz

Jess Herkes

Chiara Pomare

Tania Waitokia

Our projects

Our projects focus on developing clinician led approaches to organising, managing and evaluating healthcare across the full spectrum of health care; developing the research skills of early career health researchers; developing an international research reputation of knowledge and expertise on health organisation management and healthcare quality; and to develop education and training activities in support of governance and a resilient, sustainable health system.

Our resources

CHRIS has developed a suite of resources relevant to researchers, clinicians, medical practitioners, healthcare and government policy makers, students, and industry.

Our resources

Methods

  • Methods for analysing ‘work-as-done’ including Functional Resonance Analysis Method (FRAM)
  • Methods for analysis of linked population data collections
  • Methods for assessing health outcomes
  • Methods for assessing the appropriateness of healthcare
  • Methods for soft systems

Models and approaches

  • Complexity science approaches to problem solving
  • Improvement models for enhancing organisational culture
  • Models for sustainable health systems
  • Social network analysis
  • Study designs for examining health systems at scale
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