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Research Proposal

The United Kingdom is one of the countries that provide universal healthcare to all its citizens. This has resulted into concerns on whether the free access to medical care has resulted into lower standards of service. Birmingham is one of the most populated cities in the country. This paper shall highlight the research that will be done towards identifying how quality of healthcare can be improved in the city’s hospitals. The paper contains the methodology on how the research shall be carried out. The paper shall also highlight how the research carried out will complement the existing knowledge base.

The research will be oriented towards particular aims. Firstly, it will seek to identify means through which patients can obtain safer healthcare. The research will identify means through which injuries or additional illnesses can be minimized in Birmingham hospitals. Secondly, the research aims to provide efficient solutions to issues concerning healthcare quality issues in Birmingham. It seeks to identify how services can be oriented towards scientific knowledge, as they are provided to the city residents and other benefactors. Thirdly, the research aims to provide Birmingham healthcare providers with knowledge on how they can focus their services towards patients. This includes the patient’s needs, values or other preferences, which ensure that they guide clinical choices. A large population (Birmingham Community NHS Trust 2013) characterizes Birmingham. This research is aimed at providing insights on how timely healthcare services can be provided, devoid of inefficient waits and delays. Finally, the research aims at providing Birmingham healthcare providers with knowledge on how their services can be made more efficient. For instance, the research will provide insights on how to avoid wastes related to facilities, supplies, concepts, and energy (Cohn & Hough 2008).

The research shall improve the knowledge base by providing specific tools that can be used in the Birmingham area. Similarly, it will offer healthcare practices that meet the needs of localities that feature the same characteristics as Birmingham. Secondly, it will offer additional insights on how cost efficient and the National Health Service (NHS) can achieve patient-centred healthcare services.

The research on healthcare quality shall be carried out alongside Donabedian’s methodology. Medical care facilities shall be analyzed with reference to their resources (inputs), activities (processes), and results (outputs or outcomes). The inputs relate to people, infrastructure or technology in use (Donadebian 2005, pp. 691–729). The activities relate to what care is provided, and how it is facilitated. The outcomes relate to changes in health status or satisfaction of the patient. Interviews and questionnaires shall be used in collecting feedback from the respective stakeholders. The research shall be carried out in three phases, in accordance to the fundamental components of quality improvement in healthcare facilities (Boaden 2008).

The first phase shall relate to the collection and analysis of information related to resources used in Birmingham medical facilities. The second phase shall focus on collection and analysis of information relating to how care is provided. The third phase shall focus on collection and analysis of information regarding the outcomes of care provided in Birmingham hospitals. The analyzed data shall then be pooled. Finally, issues and their potential recommendations shall be provided. Ethical issues that may be encountered in the research relate to what healthcare providers consider as efficient processes. For instance, patients may not be provided with some facilities in the efforts of streamlining costs.

Step 1 Step 2 Step 3 Step 3
Research on Inputs Research on healthcare processes Research on medical care outcomes Development of recommendations to healthcare quality issues


Section 2

The study of healthcare improvement has developed as a result of contributions’ various theories. This section discusses such theories, and how they can be applied in the research. Consequently, an efficient method shall be developed for the research.

Avedis Donabedian is a physician who pioneered in the study of healthcare service quality and its outcomes. He is responsible for the Donabedian theory of quality healthcare, which he developed as a researcher at the University of Michigan in 1966. Similarly, he developed the Donabedian Model. This conceptual model highlights how researchers can examine the quality of service in healthcare providers. The Donabedian model models the quality of healthcare that can be assessed following collection of information from three components. These are structure, process, and outcomes (Mcdavid & Huse et al. 2013).

Structure relates to facilities used in the provision of healthcare services. For instance, structure may be presented through institutional buildings, staffs, equipment utilized or financial resources. Through structural factors, the behaviours of providers in healthcare systems can be determined. Consequently, the institutional average for its quality of care can be determined. In the model, process represents the connections between service providers and their patients. These are generally all the actions involved in the provision of healthcare. For instance, how the medical care is provided in the institution through diagnosis, treatment, education of patients, and preventive care. Similarly, the process denotes what methods the providers use in dealing with their patients. Donabedian’s theory places equal emphasis on measurement of processes, as of quality of care. To measure processes, data can be sourced from healthcare records, interviews with stakeholders or general observations of the premises (Grol & Wensing et al. 2013).

In the model, outcomes refer to how the patients or a local population’s state of health is affected by the services provided by the respective healthcare institution. For instance, outcomes relate to changes observed in the patient’s health status. Similarly, outcomes can be observed through patient satisfaction. Finally, it can be observed through quality of life, as a result of healthcare services. Outcomes have been widely regarded as the most significant indicators of quality in healthcare systems (Parsley & Corrigan et al. 1999).

Deming’s theory of knowledge has played a significant role in shaping management approaches in contemporary organizations (Walshe & Smith 2011). It has been applied in healthcare institutions with considerable success. The theory advocates for the use of systems thinking within the healthcare sector. For instance, the theory is applied in management of supply chains in healthcare systems (Walshe & Smith 2011). Deming advocated for elimination of variation in the organization. This implies that all processes should follow the same procedures (Standing 2010). This approach assists by reducing exorbitant costs that arise from inefficient procedures. Consequently, service providers can grant cost-effective services to patients. Similarly, Deming’s theory provides healthcare providers with insights on how they can increase safety in their operations, albeit at the same time (Myers 2011).

The self-determination theory tries to explain how behaviour change can be achieved in healthcare systems. This is attributable to findings that human errors are the largest source of variance in healthcare systems (Niemiec and Ryan et al. 2010, pp. 122-138). Treatment of patients is highly dependent on their personal choices (Ryan & Patrick et al. 2008, pp. 2-5). For instance, patients are primarily responsible for taking their prescribed medications. If healthcare providers are able to control behaviours related to their system, they can achieve greater effectiveness through elimination of variance (Montalvo & Dunton 2007). This theory can assist the research by pinpointing sources of human variance in the Birmingham healthcare system. Similarly, solutions can be developed for eliminating such instances of variance (Hofrichter & Bhatia 2010).

For the research, the Donabedian theory and model present the most efficient methods. It provides a streamlined approach for studying the healthcare system found in Birmingham, through its simplified background. However, components related to variance found in the other theories are also useful. For instance, variance arising from processes implemented by healthcare providers can be determined. The chosen theoretical perspective is useful to the research in several ways. Firstly, the research has been structured in four phases. The first three steps correlate to the Donadebian model of quality improvement in healthcare systems (Boaden 2008). The steps relate to structure, process, and outcomes. Similarly, the stakeholders and resources defined in the Donadebian model have been used in the research.

The first step of the researcher shall investigate factors involved in provision of healthcare services. For instance, it shall investigate the facilities of healthcare providers in the Birmingham region. This will be done through observation of medical records and the state of facilities used in provision of healthcare. The research shall then identify how the medical care is provided as per the Donadebian model. In that instance, steps involved the provision of care shall be observed. For instance, the quality of interactions between healthcare providers and their patients shall be monitored (Porter-O’grady & Malloch 2010). This is necessary for determining the sources of human variance in the Birmingham healthcare system. In that regard, issues such as poor education of patients by healthcare providers can be screened (Donadebian 2005, pp. 691–729).

Outcomes are regarded as the most significant source of information, regarding quality of care in health systems (Parsley & Corrigan et al. 1999). In the research, the same importance shall be maintained. The Donadebian model shall also be applied in the determination of outcomes. The primary focus of the research shall concentrate on the health statuses of patients and communities served by the Birmingham health system (Birmingham Community NHS Trust 2013). Similarly, changes in their respective health statuses shall be monitored. Observations such as improvements in symptoms that result from the care provided in the healthcare system shall be recorded and analyzed. For instance, patients shall be observed for pain relief because of the treatment provided, and other intended outcomes (Porter-O’grady & Malloch 2010). Unintended outcomes arising from the treatment, such as medical complications, shall also be observed. Following successful collection and analysis of information from the three phases, the results shall be compiled. Consequently, recommendations shall be developed for the Birmingham healthcare system. It is therefore seen that the Donadebian theory on quality improvement is fundamental for the success of the research.


As stated earlier, Birmingham is one of the largest urban areas in the United Kingdom. Development of a more efficient healthcare system is therefore necessary for its success as a municipality. Research shall be carried out on how the systems can be improved. Firstly, this paper highlights the aims of the proposed research activities. This is important for ensuring the validity of the research activities. Similarly, this paper shows what aspects the research should focus on. This is necessary for identifying loopholes in the Birmingham health system. Subsequently, corrective measures can be developed through the research. Information collected through the research will further the knowledge base by providing unique insights on the city’s healthcare system. The research proposal identifies the methods that will be utilised in collecting and analysing information. For instance, it identifies Donadebian methods as the preferred option for the study. The proposed methods and focuses will be necessary for success in streamlining the quality of healthcare in the Birmingham health system, through the research.



Birmingham Community NHS Trust 2013, Quality account [e-book], NHS, Birmingham, viewed 4 Nov 2013, NHS England database. < >.

Boaden, R 2008, Quality improvement, NHS Institute for Innovation and Improvement, Coventry.

Cohn, K & Hough, D 2008, The business of healthcare, Praeger, Westport, Connecticut.

Donadebian, A 2005, ‘Evaluating the quality of medical care’, Milibank Quarterly, vol.83, no. 4, pp. 691729. doi: 10.1111/j.1468-0009.2005.00397.x.

Grol, R, Wensing, M, Eccles, M & Davis, D 2013, Improving patient care, Wiley-Blackwell/BMJ Books, Chichester, West Sussex.

Hofrichter, R & Bhatia, R 2010, Tackling health inequities through public health practice, Oxford University Press, Oxford.

Mcdavid, J, Huse, I, Hawthorn, L & Mcdavid, J 2013, Program evaluation and performance measurement, Sage, Los Angeles.

Montalvo, I & Dunton, N 2007, Transforming nursing data into quality care,, American Nurses Association, Silver Spring, Maryland.

Myers, S 2011, Patient safety and hospital accreditation, Springer Publishing Company, New York.

Niemiec, C, Ryan, R, Patrick, H, Deci, E & Williams, G 2010, ‘The energization of health-behavior change: examining the associations among autonomous self-regulation, subjective vitality, depressive symptoms, and tobacco abstinence’, The Journal of Positive Psychology, vol. 5, no. 2, pp. 122138.

Parsley, K, Corrigan, P & Parsley, K. 1999, Quality improvement in healthcare, Stanley Thornes, Cheltenham.

Porter-O’grady, T & Malloch, K 2010, Introduction to evidence-based practice in nursing and health care, Jones and Bartlett, Sudbury, Massachusetts.

Ryan, R, Patrick, H, Deci, E & Williams, G 2008, ‘Facilitating health behaviour change and its maintenance: Interventions based on self-determination theory’, The European Health Psychologist, vol.10, no. 1, pp. 2–5.

Standing, M 2010, Clinical judgement and decision-making, Open University Press, Berkshire, England.

Walshe, K & Smith, J 2011, Healthcare management, McGraw Hill/Open University Press, Maidenhead, Berkshire, England.

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Originally posted 2017-08-07 20:24:40.



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