Dr Alexandra Ziemann is a Senior Research Fellow at the Centre for Healthcare Innovation Research, City University of London. She has a background in public health, health services research, and implementation science. Her research focuses on improving the spread of innovations across health and social care systems.
Alexandra’s current work investigates implementation and spread approaches applied by Academic Health Science Networks across England, the influence of external contextual factors on the implementation of innovations, and the adaptation of innovations that spread from high to low- and middle-income countries.
Before joining City, Alexandra worked at the Centre for Implementation Science, King’s College London and the National Institute for Health Research (NIHR) Collaboration of Leadership in Applied Health Research and Care (CLAHRC) South London. Alexandra is a board member of the European Implementation Collaborative and an Honorary Board Member of the UK Implementation Society.
The Academic Health Science Network (AHSN) UCLPartners developed the Proactive Care Frameworks (PCF) to support people with long term conditions during the pandemic and support the primary care system with post-pandemic recovery. PCF consists of patient risk stratification/prioritisation, optimising workforce capacity and utilising digital resources to support self-management, remote support, and personalisation of care. In 2021, we evaluated the pilot implementation of PCF in six regions to derive insights informing ongoing implementation and spread efforts.
The six-month pragmatic evaluation applied a mixed-method comparative case study approach. Guided by a Theory of Change, co-developed with implementation stakeholders, we assessed the impact of PCF implementation on care and work processes, workforce and patient/carer experience, health inequalities, and the implementation process. We analysed quantitative data from a survey among AHSNs and qualitative data from 41 implementation stakeholder interviews at AHSNs, local authorities, and general practices, and observations of nine Communities of Practice.
Risk stratification supported clinicians to be more efficient and prioritise their work, freeing up time for higher skilled clinicians to see more complex patients. Staff reported an improved fit between patient needs and practice workforce, and increased patient knowledge, motivation and self-management skills. Critical learning included the need for realistic timeframes for implementation, dedicated implementation support, and sufficient engagement with both strategic leads and staff on the ground to allow for local adaptation and building ownership.
Rapid and pragmatic evaluation of early real-world implementation provided valuable formative insights to improve ongoing implementation. It also offered the opportunity to generate initial evidence about the potential impact of an innovation lacking an established traditional evidence base. Further rapid evaluation cycles should be conducted to gather direct patient/carer feedback, clinical and cost-effectiveness outcomes information, and identify core form and functions of PCF to improve local adaptation and spread.