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Clinical Effectiveness Group


A five-year research programme investigating why certain types of Quality Improvement projects improve or worsen healthcare inequalities.

About Quality Improvement

Every year, health care organisations across the country undertake thousands of projects to improve the quality of patient care; which we call Quality Improvement (QI).  These Quality Improvement projects range from large national programmes to small initiatives led by staff in a single hospital ward or GP practice. 

While there is not one definition of what quality of care means, most definitions include fairness. For example, good quality hospital care means that everyone should benefit equally from hospital treatment when they need it, regardless of their wealth, gender, age or ethnicity. 

Healthcare inequalities are differences in healthcare experiences or outcomes across or between certain groups of patients, such as those on low incomes or belonging to a minority ethnic group. Quality Improvement projects have the potential to improve inequalities, but they can also make things worse. For example, NHS initiatives that encourage hospitals or GP surgeries to reach a particular target can mean that staff focus on easy to reach patients first to achieve that target, rather than disadvantaged groups.  

Our aim 

This research programme aims to understand why certain types of Quality Improvement projects improve or worsen healthcare inequalities, and develop new training and resources in collaboration with patients and staff to help hospitals use Quality Improvement to address healthcare inequalities.   

The programme brings together three separate research fields: health inequalities, Quality Improvement and co-production (developing a solution in collaboration with patients and staff).  


The research programme has five phases: 

  • Phase 1: Literature review - We will review previous studies to understand what types of QI projects improve or worsen inequalities, why, for which groups, and in what circumstances.  
  • Phase 2: Staff interviews - We will take this new understanding from the literature review to hospital staff who undertake QI projects across the country, find out what they think and whether they think anything is missing. These hospital staff members will be invited from an existing QI community.  
  • Phase 3: Hospital case studies - We will work with four hospitals based in Liverpool, Sunderland, Peterborough and London to identify and examine the impact on inequalities in completed QI projects. This will involve looking at the data with an inequalities lens, looking at any reports, and speaking to those involved.  
  • Phase 4: Co-production of resources - We will work in equal partnership with staff and patients to develop training and resources. This will be jointly led by patients and staff who will decide how to organise the process and how to spend the budget for that part of the research. 
  • Phase 5: Evaluation - We will roll out the new training and resources in six hospitals and monitor the impact. We will ask each hospital to change how they do QI over 12 months. We will collect information to see how much the resources and training have changed QI projects to address inequalities and any broader hospital changes. 


Graphic with phase titles and arrows: Phase 1 - Literature Review, Phase 2 - Staff interviews, Phase 3 - Hospital case studies, Produce overarching theory, Phase 4 - co-production of resources, Phase 5 - Evaluation

Equal-QI phases graphic [PDF 165KB]

We believe this research will lead to a step-change in hospitals using QI projects to address healthcare inequalities and help staff to think about inequalities across all aspects of their work. Our findings and resources will be shared widely and in different ways so that other clinical and research teams can also benefit. 


The research programme started in November 2022. It’s a five-year programme, ending May 2028. 

Project partners 

Academic institutions 

  • THIS Institute, University of Cambridge 
  • University of Oxford 
  • University of Essex  


  • North West Anglia NHS Foundation Trust 
  • Barts Health NHS Trust 
  • South Tyneside and Sunderland NHS Foundation Trust 
  • Royal Liverpool and Broadgreen, Liverpool University Hospitals NHS Trust 

Q Community (part of Health Foundation)

Healthcare Quality Improvement Partnership

Royal College of Physicians

NHS Confederation

More information

To find out more, please contact lead researcher, Dr John Ford: 


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