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Multi-method evaluation of a national clinical fellowship programme to build leadership capacity for quality improvement
  1. Madalina Toma1,
  2. Avril Blamey2,
  3. Dawn Mahal3,
  4. Nicola M Gray1,
  5. Laura Allison3,
  6. Shobhan Thakore3,
  7. Paul Bowie3,4,5
  1. 1School of Nursing and Health Sciences, University of Dundee, Dundee, UK
  2. 2Avril Blamey Associates, Glasgow, UK
  3. 3Medical Directorate, NHS Education for Scotland, Edinburgh, UK
  4. 4School of Health and Social Care, Staffordshire University, Stafford, UK
  5. 5Institute of Health and Welbeing, University of Glasgow, Glasgow, UK
  1. Correspondence to Professor Paul Bowie; paul.bowie{at}


Background This paper reports the results of the evaluation of the Scottish Quality and Safety Fellowship (SQSF)—a 10-month, lead-level international educational programme established in 2008 with the overarching aim of developing clinicians with advanced quality improvement knowledge, technical ability and essential leadership skills. The evaluation explores four levels of educational and practice outcomes associated with (1) the reaction of fellows to SQSF participation, (2) learning gained, (3) subsequent behaviour changes and (4) the overall impact on national and international level capability and capacity building.

Methods A theory-informed multi-method design was applied using (1) a search and review of the SQSF organisational database to tabulate personal, professional and demographic characteristics; (2) semi-structured telephone interviews with 16 participants using purposive and self-selected sampling; and (3) a cross-sectional online evaluation survey across all 10 cohorts involving 222 fellows

Results SQSF was positively perceived as a high-quality learning experience containing a well-balanced mix of theory and practice, with a majority of respondents reporting career changing benefits. Most participants reported improved social, behavioural and emotional skills, knowledge and attitudes and, with sustained support of their host organisations, were able to apply and share learning in their workplace. The impact of the SQSF on a wider national and international level capability and capacity was both mediated and moderated by a wide range of interrelated contextual factors.

Conclusions This multi-method evaluation demonstrates that SQSF has achieved significant positive outcomes for the great majority of participants. Some tentative recommendations are provided with the aim of further enhancing fellowship content, delivery, transfer and future evaluations of wider impacts at regional, national and international health system levels.

  • continuing education
  • continuing professional development
  • education
  • evaluation methodology
  • healthcare quality improvement
  • leadership

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  • Contributors PB and MT were responsible for planning the study and led the data collection and analysis. AB and DM contributed to research tool design and data collection while NMG, LA and ST were involved in analysis and interpretation. MT drafted and led the writing of the manuscript. PB, AB, DM, NMG, LA and ST participated in critically appraising and revising the intellectual content of the manuscript. All authors read and approved the final manuscript.

  • Funding SISCC is funded by the Scottish Funding Council, Chief Scientist’s Office, NHS Education for Scotland and The Health Foundation with in-kind contributions from participating partner universities and health boards. The grant reference number is 242 343 290 was received from SFC on behalf of all funders. Additional funding and resource was provided by SKIRC, NHS Education for Scotland.

  • Competing interests MT, AB, NMG, DM and PB have no conflict of interest to declare. ST and LA are senior SQSF programme leaders and are responsible for its design and delivery.

  • Patient consent for publication Not required.

  • Ethics approval Under UK ‘Governance Arrangements for Research Ethics Committees,’ ethical research committee review is not required for service evaluation or research which, for example, seeks to elicit the views, experiences and knowledge of healthcare professionals on a given subject area. Similarly, ‘service evaluation’ that involves NHS staff recruited as research participants by virtue of their professional roles also does not require ethical review from an established NHS research ethics committee. However, informed consent to participate in the study was obtained from all participants. Data collected were securely stored in line with organisational research governance and data protection procedures to protect confidentiality.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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