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Active Hospitals

Clinical Effectiveness and Research

Clinical effectiveness is about doing the right thing at the right time for the right patient. It is concerned with demonstrating improvements in quality and performance.

Clinical effectiveness includes the implementation of nationally agreed guidance, standards and clinical performance indicators reflecting ‘best practice’ (where these exist and are relevant to our services).

It incorporates a range of mechanisms required to measure and assess ‘effectiveness’. This includes clinical audit, clinical outcome measurement, quality improvement, service evaluation and benchmarking data.

“Essentially, clinical effectiveness is about doing the right thing at the right time for the right patient and is concerned with demonstrating improvements in quality and performance”

Trust SaON. Clinical-Effectiveness-Strategy. 2015.

Ensuring practice is based on the best available evidence

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Adopting an Evidence-based practice

Where appropriate the latest evidence base for physical activity related to a specific pathway should be implemented.

For example we used the NICE Guidelines for Diabetes in pregnancy in the maternity pathway. In this NICE guidance it states that women with gestational diabetes should be advised to take regular exercise (such as walking for 30 minutes after a meal) to improve blood glucose control(1).

NICE quality standards set out the way care should be provided, these will increasingly be used to hold departments and organisations to account. These standards are helpful when evaluating and benchmarking existing practice, designing and implementing local guidelines and protocols.  Furthermore, they can be helpful to influence commissioners.

When working with departmental teams, it is the role of the pathway lead to contribute and ensure that the latest evidence surrounding the standards of care specific to physical activity are included. Next steps are to ensure this standard is within local existing department guidelines. Subsequent audit can assess whether these standards are being met.


  1. Walker JD. NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March 2008. Diabet Med. 2008;25(9):1025-7.


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Designing behaviour change interventions using the COM B model

Changing behaviour is a key part of helping inactive people become active(1). The NICE guidance on individual approaches to behaviour change suggests that behaviour is related to an interaction between the ‘capability’ to perform a behaviour, and the ‘opportunity’ and ‘motivation’ to carry out that behaviour(2).

Starting a new behaviour or changing behaviour usually needs a change in one or more of these components. This theory is known as the COM-B model (3, 4). The COM-B model offers a logical approach to considering behaviour change and has been used previously to design interventions to change the practice of health care professionals.

The Behaviour Change Wheel (BCW) is a model that aims to link behaviour change frameworks with the COM-B model. The BCW guide to designing interventions provides an evidenced based stepped approach to changing behaviours encouraging intervention designers to consider a full range of options, choosing only those that are most appropriate.

Although this can be a time consuming process, it offers a comprehensive and credible evidence base approach for behaviour change interventions(3).

You can download our COM-B analysis below:

Active Hospital COM B Example


  1. Sport England. Applying Behaviour Change Theories: Real World Examples From Get Active Get Healthy Programmes
  2. Excellence NIoC. Behaviour change individual approaches. London2014.
  3. Michie S LA, R West. The Behaviour Change Wheel: A guide to design interventions: Silverback; 2014.
  4. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.


Improving mortality data and reducing healthcare associated complications

This data is likely to be recorded by the Departmental and Trust governance team. Linking physical activity secondary care interventions to positive impacts on outcome data can be challenging, especially in the early stages.  Establishing current benchmarks and understanding how physical activity could potentially influence these outcomes should be considered from the outset of an Active Hospital project .

Establishing, recording and implementing Patient Reported Outcome Measures

Patients’ perceptions of their health and experiences are key to providing excellent patient-centred care. Patient Reported Outcome Measures (PROMS) are standardized, validated questionnaires that are defined as:

‘Any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else’ (1).

Increasingly, these are standardised measures being used pre- and post- intervention. They allow the efficacy of a clinical intervention to be measured from the patients’ perspective(2), for example, the EQ-5D(3) is a common generic measure.

Once a pathway is set up it is recommended that PROMs are assessed and evaluated on a frequent basis, so that service improvement actions are suggested.  Pathway leads should confirm the specific PROMs that will be used. This data should be presented regularly at governance meeting.


  1. Kyte DG, Calvert M, van der Wees PJ, ten Hove R, Tolan S, Hill JC. An introduction to patient-reported outcome measures (PROMs) in physiotherapy. Physiotherapy. 2015;101(2):119-25.
  2. Kingsley C, Patel S. Patient-reported outcome measures and patient-reported experience measures. BJA Education. 2017/04/01;17(4):137-44.
  3. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337-43.


Patient feedback

Patient feedback regarding the service should be sought on a regular basis. Measuring patients’ experiences of care and treatment highlights areas that need to improve to provide a patient-led healthcare service.

Local patient liaison services will be able to provide a Trust wide standardised feedback form.  It is recommended that this should surveyed on a quarterly basis. This data should be presented at the local governance meeting and agreed action should be taken to improve services.

Improving outcomes

Wherever possible, clinical pathways should try to use clinically-meaningful “clinical outcome measures” that can be monitored and periodically assessed over time. For example, these could range from a number of brief interventions performed in a service by staff or self-reported levels of physical activity using a validated questionnaire (for example the Physical Activity Calculator)

Outcomes and standards should be established, and a continual audit process should be put in place to evaluate elements of the service.

Research Governance

This project will produce a number of a research opportunities to help support the evidence base around the feasibility and transferability of incorporating interventions promoting physical activity into secondary care.

Research projects should adhere to the following NICE research principles ranging from ethics to data protection:

a) Registering research projects centrally

All research and potential research projects should be registered centrally through the governance framework. This will aid collaboration and avoid replication of work.

b) Acknowledgement

All authors should acknowledge that their work is part of a project commissioned by Public Health England and funded by Sport England with money from the National Lottery.

Feasibility and acceptability study

The National Centre for Sport and Exercise Medicine (NCSEM), in partnership with the Centre for Sport and Exercise Science (CSES) at Sheffield Hallam University (SHU), were commissioned by Public Health England and Sport England to conduct an independent evaluation of the Active Hospitals Pilot.

You can read the independent evaluation report here:
Evaluation of the Public Health England and Sport England Funded Sport and Exercise Medicine Pilot in Secondary Care


Clinical Effectiveness Matrix

Use this clinical governance matrix framework to identify and resolve governance gaps and by providing assuring evidence of continuously improving quality of care.

Evaluation of the Public Health England and Sport England Funded Sport and Exercise Medicine Pilot in Secondary Care

Independent evaluation of the Active Hospitals Pilot.

Active Hospitals COM-B Analysis
Sport England: Applying Behaviour Change Theories; Real World Examples From Get Active Get Healthy Programmes