For more than 25 years my research interests have focused on how to improve the quality of health services and patient care in the health sector, in particular in primary care and at the interface between primary care and other services. I started my interest by developing specific indicators of quality, particularly for use in general practice. I then explored how these metrics are used by clinical practitioners, managers and people using health services, in particular on the implications of putting comparative information about quality into the public domain. I have also researched the decision making process in health care organisations and the role of organisational culture in facilitating service improvement. This has led to a wider interest in context and the relationship between specific improvement interventions, implementation methods and the wider environment within which care is provided. All of my work has attempted to explore the interaction between macro (e.g. policy), meso (e.g. teams and organisations) and micro (e.g patient level) elements of care.

In recent years I have become increasingly interested in the interface between academia and the health service and in developing new approaches to optimising the use of research evidence in practice.