Exploring Histories and Futures of Innovation in Advanced Wound Care
Lead Research Organisation:
University of Leeds
Department Name: School of Healthcare
Abstract
The focus of advanced wound care is chronic, complex wounds, including leg ulcers, pressure ulcers, diabetic foot ulcers and dehisced surgical wounds. Although a fundamental part of everyday health care, technologies of wound care are often considered mundane and are consequently overlooked in both academic literature and medical practice. This project will bring together academic and non-academic audiences, developing cross-disciplinary engagement in an exploratory project on the interplay between histories and current practices of advanced wound care. Through three workshops the goal is to identify how an awareness and appreciation of the historical approaches and sociological discussions surrounding wound care innovation can inform current practices in a number of ways: by illuminating in more detail the manufacturer-user relationship, analysing conditions under which innovation thrive, and highlighting how particular types of product were marketed to consumers. There has been limited engagement in this field between research communities in the health sciences and humanities. In addition, the patient voice has been notably absent in discussions about research in wound care (Cullum et al, in press). The project offers a fresh interdisciplinary approach which builds on pilot work undertaken at the University of Leeds and lays the foundation for a major interdisciplinary project exploring the history and impact of advanced wound care.
Whilst much research has examined the historical context of acute surgical wounds and injuries sustained on the battlefield, the case of chronic wounds has yet to be fully investigated. In the UK, most chronic wounds are managed by community nurses with referral to specialist services, including tissue viability, surgical specialties (e.g. vascular and orthopaedic surgery), podiatry and dermatology. The historical literature has tended to concentrate on hospital-based, acute clinical activity, ignoring the fact that wound care decision making, prevention and treatment is very often the preserve of nursing as well as patients themselves. Similarly, recent historical research has emphasised the importance of global conflict in driving innovations which are applicable in far broader settings; inventions emerging from warfare are appropriated and applied in many different and unexpected ways beyond the immediate field of conflict.
The work of George Winter (1962), observing that wounds in young pigs healed more quickly if covered rather than being left open to the air, is the starting point for much contemporary wounds research because it established the idea that a wound dressing can influence outcomes. The theoretical context of the work will therefore bring together historical and sociological case studies of innovation and the established historical methodological approach of the 'medical marketplace', as well as recent research on the history of medical technology and everyday healthcare. This will shed new light on Rogers' (2003) influential work on diffusion of innovation and Greenhalgh et al's (2004) systematic review findings that successful innovation adoption requires analysis of the characteristics of the innovation itself, the perceptions of those individuals tasked with adopting the innovation, and the wider organisational cultures in place in the setting for adoption.
The project will connect academics from a broad range of disciplines with patient and industry representatives to explore how historically-grounded accounts of advanced wound care can address current challenges in the field. To this end, major outputs will include an edited collection based on the outcomes of the workshops, an industry-facing briefing document, a public panel debate, creative visual outputs and a new network of interdisciplinary scholars which will be supported in the longer-term by digital resources.
Whilst much research has examined the historical context of acute surgical wounds and injuries sustained on the battlefield, the case of chronic wounds has yet to be fully investigated. In the UK, most chronic wounds are managed by community nurses with referral to specialist services, including tissue viability, surgical specialties (e.g. vascular and orthopaedic surgery), podiatry and dermatology. The historical literature has tended to concentrate on hospital-based, acute clinical activity, ignoring the fact that wound care decision making, prevention and treatment is very often the preserve of nursing as well as patients themselves. Similarly, recent historical research has emphasised the importance of global conflict in driving innovations which are applicable in far broader settings; inventions emerging from warfare are appropriated and applied in many different and unexpected ways beyond the immediate field of conflict.
The work of George Winter (1962), observing that wounds in young pigs healed more quickly if covered rather than being left open to the air, is the starting point for much contemporary wounds research because it established the idea that a wound dressing can influence outcomes. The theoretical context of the work will therefore bring together historical and sociological case studies of innovation and the established historical methodological approach of the 'medical marketplace', as well as recent research on the history of medical technology and everyday healthcare. This will shed new light on Rogers' (2003) influential work on diffusion of innovation and Greenhalgh et al's (2004) systematic review findings that successful innovation adoption requires analysis of the characteristics of the innovation itself, the perceptions of those individuals tasked with adopting the innovation, and the wider organisational cultures in place in the setting for adoption.
The project will connect academics from a broad range of disciplines with patient and industry representatives to explore how historically-grounded accounts of advanced wound care can address current challenges in the field. To this end, major outputs will include an edited collection based on the outcomes of the workshops, an industry-facing briefing document, a public panel debate, creative visual outputs and a new network of interdisciplinary scholars which will be supported in the longer-term by digital resources.
Planned Impact
The network workshops will examine creative responses to contemporary and historical aspects of risk in innovation, bringing together academics and health professionals to examine with patients, carers and members of industry, the historical and sociological development of 'advanced' wound care in the UK and major challenges faced by the sector. We will engage with groups throughout the project, and the principal beneficiaries will be:
1. The medical industry and healthcare professionals
Representatives from the medical industry will be invited to all three project workshops. This will capitalise on our successful existing collaboration with James Lavan (a member of the project's Advisory Group) and Mark Richardson VP Research and Technology at Smith&Nephew, and we will expand our invitation through the Association of British Healthcare Industries to include both international and local medical manufacturing firms, such as De Puy Synthes and Medasil (Surgical) Ltd., with whom Co-I Stark has previously collaborated through an AHRC Knowledge Transfer Fellowship (2011-12).
We will work closely with our project partner, the National Institute for Health Research WoundTec Healthcare Technology Co-operative (NIHR WoundTec HTC) to help them realise their core goal of 'improving quality of life for patients through the rapid translation of ideas and technologies in wound prevention and treatment' (http://www.woundtec.htc.nihr.ac.uk/about-us). In particular, engaging the NIHR WoundTec HTC in discussions around the historical context of wound care has the potential for impact on current practices in their four key focus areas: diagnostics, infection detection and treatment, wound prevention and support surfaces, and co-design strategies.
2. Patients/service users
There is a growing body of evidence showing a mismatch between the health research that patients want to see happen and the research that is actually being carried out. We will work closely with patients/service users and carers in the design and delivery of this interdisciplinary wound care research project in order to focus the advanced wound care research agenda on the social and clinical outcomes that matter most to them. This network will therefore ensure that future research and professional practice improves patient experience, leaving a lasting impact on everyday wound care.
3. Museum and heritage organisations
The workshops will take place at the Thackray Medical Museum and will use objects and texts from the museum's collection to facilitate discussion. The project therefore has the potential to give added value to the Thackray's collections and provide additional context to their upcoming programme of events through their major HLF project, Healthy Future. Broader impact will be guaranteed for the medical museum community though the Thackray's leading role in the Medical Museum Subject Specialist Network and UK Medical Collections Group. This will ensure that dissemination is as wide as possible and that the project is responsive to the needs and agendas of medical heritage practitioners and audiences.
4. Public audiences
The experience of wound care falls as much in the domain of the domestic and everyday as in that of professional medicine and healthcare. We will therefore work with public audiences in the UK to generate interest in and dialogue around comparative work globally. Wider audiences will be invited to contribute to project discussions and outputs and to explore the public image of wound care. A public panel debate at the project mid-point, as well as ongoing, public digital content arising from the workshops, will allow for two-way exchange and enable major themes emerging from this discussion to feed into planning for the final workshop and subsequent programmes of research. This will ensure that that project's research and impact plans remain flexible and responsive to the needs of the widest possible non-academic community.
1. The medical industry and healthcare professionals
Representatives from the medical industry will be invited to all three project workshops. This will capitalise on our successful existing collaboration with James Lavan (a member of the project's Advisory Group) and Mark Richardson VP Research and Technology at Smith&Nephew, and we will expand our invitation through the Association of British Healthcare Industries to include both international and local medical manufacturing firms, such as De Puy Synthes and Medasil (Surgical) Ltd., with whom Co-I Stark has previously collaborated through an AHRC Knowledge Transfer Fellowship (2011-12).
We will work closely with our project partner, the National Institute for Health Research WoundTec Healthcare Technology Co-operative (NIHR WoundTec HTC) to help them realise their core goal of 'improving quality of life for patients through the rapid translation of ideas and technologies in wound prevention and treatment' (http://www.woundtec.htc.nihr.ac.uk/about-us). In particular, engaging the NIHR WoundTec HTC in discussions around the historical context of wound care has the potential for impact on current practices in their four key focus areas: diagnostics, infection detection and treatment, wound prevention and support surfaces, and co-design strategies.
2. Patients/service users
There is a growing body of evidence showing a mismatch between the health research that patients want to see happen and the research that is actually being carried out. We will work closely with patients/service users and carers in the design and delivery of this interdisciplinary wound care research project in order to focus the advanced wound care research agenda on the social and clinical outcomes that matter most to them. This network will therefore ensure that future research and professional practice improves patient experience, leaving a lasting impact on everyday wound care.
3. Museum and heritage organisations
The workshops will take place at the Thackray Medical Museum and will use objects and texts from the museum's collection to facilitate discussion. The project therefore has the potential to give added value to the Thackray's collections and provide additional context to their upcoming programme of events through their major HLF project, Healthy Future. Broader impact will be guaranteed for the medical museum community though the Thackray's leading role in the Medical Museum Subject Specialist Network and UK Medical Collections Group. This will ensure that dissemination is as wide as possible and that the project is responsive to the needs and agendas of medical heritage practitioners and audiences.
4. Public audiences
The experience of wound care falls as much in the domain of the domestic and everyday as in that of professional medicine and healthcare. We will therefore work with public audiences in the UK to generate interest in and dialogue around comparative work globally. Wider audiences will be invited to contribute to project discussions and outputs and to explore the public image of wound care. A public panel debate at the project mid-point, as well as ongoing, public digital content arising from the workshops, will allow for two-way exchange and enable major themes emerging from this discussion to feed into planning for the final workshop and subsequent programmes of research. This will ensure that that project's research and impact plans remain flexible and responsive to the needs of the widest possible non-academic community.
Publications
Madden M
(2019)
Understanding the development of advanced wound care in the UK: Interdisciplinary perspectives on care, cure and innovation.
in Journal of tissue viability
| Title | Design and wound care |
| Description | 'Design and Wound care' introduces 'Wound Care for All', the work of Jessie White our designer in residence and asks whether we neglect patient centred design in wound care, highlighting functionality but adding gloss through marketing. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2017 |
| Impact | Just produced |
| URL | https://youtu.be/uZ280Tbmnxc |
| Title | Illustrations |
| Description | Tom Bailey acted as a graphic recorder at each of three research networking workshops at the Thackray Medical Museum. He has added colour after the event and provided digital copies for dissemination purposes. |
| Type Of Art | Artwork |
| Year Produced | 2017 |
| Impact | To date these have been used on the website and in conference presentations at the European Wound Management Conference in Amsterdam 2017, 3rd Transatlantic Wound Science and Podiatric Medicine Conference, Galway 2017 and BSA Conference Manchester 2017. |
| URL | http://wounds.leeds.ac.uk/ |
| Title | Object Handling |
| Description | 'Object Handling' shows how the use of objects can bring out important aspects of the history of wound care including the relationship between medicine and commercial interests. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2017 |
| Impact | Just produced |
| URL | https://youtu.be/JbV9mcXwoPg |
| Title | Project Story |
| Description | 'Project Story' explains what we set out to do and the benefit of bringing together different perspectives and media to throw new light on a field. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2017 |
| Impact | Just produced |
| URL | https://youtu.be/sJc4q3sgttA |
| Title | Wound Care for All |
| Description | A series of images created by our designer in residence. Photographs of a model holding an impractical dressing/plaster. Wound Care for All, is a collection of ten images that represent the designer's response to the workshops and the research she did into the wound care industry. She found the marketing often used to promote wound care products to be excessive and sometimes irrelevant to the products themselves. The images are glamorous and bright, mirroring the advertising you often see in the fashion and cosmetic industry. The hands holding the objects are black drawing attention to the politics of skin tone/colour in plasters and dressings. |
| Type Of Art | Artwork |
| Year Produced | 2017 |
| Impact | Just produced, will update |
| Title | Wounds Undressed (short animation) |
| Description | 'Wounds Undressed' is a short animation with illustrations by Tom Bailey. It seeks to highlight the importance of wound care for those affected and for all of us. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2017 |
| Impact | Just created. Shown as part of an exhibition at University of Leeds 17th November 2017. Circulated to Materialities of Care and AsSIST UK group lists. |
| URL | https://youtu.be/SUgAm1r611A |
| Description | This cross-disciplinary research-networking project connected academics from a broad range of disciplines with patient and industry representatives to explore what we can learn from current and past developments in advanced wound care. Advanced wound care deals with chronic, complex wounds, including leg ulcers, pressure ulcers, diabetic foot ulcers and dehisced surgical wounds. The aim was to explore innovation in 'advanced' wound care in the wider context of the history and sociology of wound care. Although a fundamental part of everyday health care, technologies of wound care are often considered mundane and are overlooked by both researchers and practitioners, with important consequences for service users. We held three workshops at the Thackray Medical Musem in Leeds between June 2016 and May 2017 at which papers and short 'provocations' were combined with object handling to produce discussion which was captured in graphics and video. A 'designer in residence' produced some images as another output from the discussions. Workshop 1 focused on which health professions, patients and industries have been involved in the development of wound care in the UK and their field of interaction. The nursing/doctor division, the development of materials, the role of industry, the changing demographic of patients and the introduction and development of the NHS were all important factors in the discussion. The workshop started with an exploration of the Thackray museums artifacts relating to woundcare throughout history. Workshop 2 focused on the science, technologies/materials and techniques used in wound care and our relationships with these. We discussed changing and persisting technologies, ideas and approaches; how 'good' innovations have been distinguished from 'bad' innovations and what the 'advance' in advanced wound care actually means. Workshop 3 focused on regulation, evidence and marketing in wound care. In particular, we asked whether health professionals and service users have the information to distinguish grounded claims for products from irrelevant truths and misinformation.Based on our discussions we would argue that key to understanding advanced wound care in the UK is not only the paradigm shift from dry to moist wound healing, but how this connects with the history of the professional development of nursing and its interaction with industry marketing and evidence informed healthcare. |
| Exploitation Route | We conducted a public panel debate at the British Science Festival 2016 and, after the grant ended, we also raised further funds for a cross-disciplinary day of events, papers and discussion in honour of Nellie Spindler during stop pressure ulcer week on Friday 17th November 2017 at The University of Leeds. The event was organised in partnership with Leeds Teaching Hospitals NHS Trust and was supported by funds from the Leeds Teaching Hospitals Charitable Trust and Gateways to the First World War. It included nurses, historians, sociologists, members of the public, actors and students from nursing, history and drama. It used outputs from the project including a range of creative visual outputs. We have also made available video outputs. A short animation 'Wounds Undressed' seeks to highlight the importance of wound care for those affected and for all of us. 'Project Story' which explains what we set out to do and the benefit of bringing together different perspectives and media to throw new light on a field. 'Object Handling' shows how the use of objects can bring out important aspects of the history of wound care including the relationship between medicine and commercial interests. 'Design and Wound care' introduces 'Wound Care for All', the work of Jessie White our designer in residence and asks whether we neglect patient centred design in wound care, highlighting functionality but adding gloss through marketing. Graphic recordings will be put on display at the next Tissue Viability conference. The Tissue Viability Society are interested in using our visual outputs in their work. An article and conference presentation are in preparation. A book proposal has been reviewed but contracts have not yet been signed because the investigators currently have full time research and teaching commitments elsewhere. Using historical and sociological lenses to bring together usually disparate perspectives, these outputs will provide valuable reflective material for professionals, researchers, educators and service users interested and engaged in contemporary and future practice in the field. An important aspect of these outputs lies in drawing attention to the maginalisation of perspectives from a new demographic of older patients and others for whom wounds are a manifestation of an underlying long term condition or a consequence of immobility. We have supported the digitisation of several of Dame Kathleen Raven's notebooks from her training. The history of nursing itself has remained a largely neglected area in wider histories of medicine. This is at odds with the historical importance of nursing in healthcare, and the critical role played by nurses in the modern clinic and in the community. By making available primary sources such as these we hope that nursing histories - a key aspect of wound care - and histories of medical education and specialisation might become increasing objects of focus for future research. |
| Sectors | Healthcare,Culture, Heritage, Museums and Collections |
| URL | http://wounds.leeds.ac.uk |
| Description | Dr. Una Adderley who is leading the UK National Wound Care Strategy took part in our workshops and has been circulating our article in their networks. The strategy is to develop recommendations about the care of people with leg or foot ulcers in England https://www.ahsnnetwork.com/about-academic-health-science-networks/national-programmes-priorities/national-wound-care-strategy-programme. Prof Trish Greenhalgh is using the article as an entry level case study on the new MSc in Translational Health Sciences at Oxford University. This is a new course which takes an interdisciplinary and applied approach to the challenges of implementing innovations and research discoveries in a healthcare setting. Students will read the paper and watch an interview with Dr. Mary Madden explaining why we wrote the paper etc as part of a case study where they consider the multiple influences, at different levels and from different sectors, on the adoption of wound management products in health care;. Appreciate the value of the narrative case study for illuminating how the different influences on the adoption of new technologies interact; Use sources such as the Cochrane Database of Systematic Reviews to assess the evidence base for the effectiveness of a health technology. |
| First Year Of Impact | 2019 |
| Sector | Education,Healthcare |
| Impact Types | Policy & public services |
| Description | Inclusion as case study in Trish Greenhalgh's MSc in Translational Health Sciences University of Oxford 2020 |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| URL | https://www.conted.ox.ac.uk/about/msc-in-translational-health-sciences |
| Description | Ludwig Boltzmann Gesellschaft/LBG (lbg.ac.at) |
| Organisation | Ludwig Boltzmann Society |
| Country | Austria |
| Sector | Academic/University |
| PI Contribution | LBG is an Austrian research institution that operates research centers in cooperation with partner institutions. Following a priority setting initiative in the field of accidental injuries (https://tell-us.online), LBG decided to sponsor a new research group investigating the role of senescent cells in non-healing wounds, in collaboration with an already existing trauma research institute (trauma.lbg.ac.at). Raffael Himmelsbach was hired as co-director with responsibilities for open innovation and operational management, alongside the scientific director, Heinz Redl. In addition to the biomedical research arm, they also earmarked budget for at least one predoc social science position, in addition to more applied subprojects related to open innovation. Raffael contacted me to discuss my experience as a social scientist in the wound healing field, including my experience with the James Lind Alliance. |
| Collaborator Contribution | I had a lengthy discussion with Raffael about the dearth of social science in this area. As I am no longer in this field of study (due to employment change) I had to turn down his request to join their advisory panel |
| Impact | sociology and health sciences |
| Start Year | 2020 |
| Description | Cross disciplinary workshops |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was an AHRC Cross-Disciplinary Research Network Grant. It's core function was to connect academics from a broad range of disciplines with patient and industry representatives to explore what we can learn from current and past developments in advanced wound care. We hosted three workshops at the Thackray Medical Museum between June 2016 and May 2017 to discuss the challenges associated with innovation in chronic wound care. |
| Year(s) Of Engagement Activity | 2016,2017 |
| URL | https://wounds.leeds.ac.uk |
| Description | Nurses on the Frontline of Wound Care: from Passchendaele to pressure ulcers |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Other audiences |
| Results and Impact | This was a day of events and does not fit neatly into the categories provided. Funds for the event were raised from Gateways to the First World War and Leeds Teaching Hospitals NHS Trust (LTHT) charitable fund in collaboration with Professor Alison Fell and colleagues at LTHT. From the drama of WW1 to the hidden contemporary domestic epidemic of chronic wounds - the Parkinson building at the University of Leeds provided a 'stage' for linked events with people in costume, lots to see, themed food, presentations, discussions, object handling, archive viewing and performance. The first part of the day was a conference aimed at nurses and historians, the second part a series of public engagement events including performance and a panel discussion. The whole day was accompanied by exhibitions of historical items relating to wound care, academic research posters on wound care past and present, artworks and videos from 'exploring histories and futures of wound care' and stalls on contemporary wound care (linked to stop pressure ulcer day and a new leg ulcer awareness campaign). More information here https://wounds.leeds.ac.uk/news/history-meets-healthcare-at-our-nurses-on-the-frontline-of-wound-care-event-17-11-207/ and here https://wounds.leeds.ac.uk/news/nurses-on-the-frontline-of-wound-care-from-passchendaele-to-pressure-ulcers-2/ Professor Fell has a record of numbers attending and comments made. |
| Year(s) Of Engagement Activity | 2017 |
| URL | https://wounds.leeds.ac.uk/news/history-meets-healthcare-at-our-nurses-on-the-frontline-of-wound-car... |
| Description | Panel discussion British Science Festival, Swansea |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | PI Mary Madden, Andrea Nelson and Gwyn Tudor CEO of MediWales discussed how new products in wound care are developed and whether they really meet our needs as part of the Dressed to Impress: Caring for Wounds panel at The British Science Festival, Swansea, 9th September 2016. The panel was chaired by co-I James Stark. Andrea Nelson was nominated as the President of the Medical Section by the British Science Association. Mary Madden was interviewed by Richard Hollingham for the festival X-change show. The panel debate consisted of 5-minute introductions from three panellists followed by open discussion of the role of everyday medical devices. The panellists addressed three themes: (i) the historical development of wound care devices, (ii) how new products are devised, tested and brought to market, and (iii) how these devices are affecting medical practice and patient experience.An audience of approx. 40 attended the discussion. The interview was broadcast in Swansea city centre. The panel discussion took place at the start of our award. The aim was to generate interest in a field which is often overlooked because it is seen as mundane or 'ordinary'. We use medical "devices" more often than we might think. A simple plaster or dressing might not seem very technical compared to the complex equipment more commonly associated with medical practice. The topic showed how medical devices - from simple dressings to the latest devices in wound care technology - are brought to market and how they affect patients, highlighting the central place of medical, scientific and technical themes in our everyday lives. |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://www.britishscienceassociation.org/medical-sciences-section |