RESTORE

Realist evaluations of professional support and remediation
Illustration of one person helping another for the RESTORE project

RESTORE

Realist evaluations of professional support and remediation
RESTORE Logo

What is RESTORE? 

RESTORE (Realist evaluations of professional support and remediation) is an interdisciplinary research programme that aims to optimise the delivery of professional support (including remediation) for health professionals, across specialties and career stages, and make informed recommendations to improve practice.
The RESTORE programme of research comprises four projects, details on which are provided below.
 

RESTORE 1

Long title:
Funded by:
Funding amount: £185,107.26
Location: University of Plymouth
Dates: April 2018 – January 2020 
University of Plymouth PI: Dr Nicola Brennan 
University of Plymouth staff: Professor Tom Gale, Dr Tristan Price, Dr Lyndsey Withers, Dr Marie Bryce, Ms Amanda Wanner
Project partners: Dr Geoff Wong, University of Oxford; Dr Linda Prescott-Clements, Royal College of Veterinary Surgeons; Professor Julian Archer, Monash University, Australia; Professor Jennifer Cleland, Nanyang Technological University, Singapore 
 

Overview

The human cost of a failing doctor is difficult to measure, but it is estimated that nearly 12,000 patients die in England each year as a result of preventable medical errors. All of us, as patients, expect our doctors to be competent. If they are not, we expect the doctors to be stopped from practising.
The General Medical Council has powers to do this. However, there is a wider problem that is more difficult to address: doctors who underperform. For this group of doctors, they do not need to stop practising but, to keep patients safe, they need help. This could be through retraining in a certain area, or perhaps addressing underlying physical or mental health problems. Bringing a doctor’s performance back up to an acceptable standard is called remediation.

Objectives

  1. To conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent do remediation programmes for practising doctors work to restore patient safety.
  2. To provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.

Publications

Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J & Bryce M (2021), 'Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review', Health Services and Delivery Research 9, (11) 1-116,
Price T, Wong G, Withers L, Wanner A, Cleland J, Gale T, Prescott-Clements L, Archer J, Bryce M & Brennan N (2021), 'Optimising the delivery of remediation programmes for doctors: A realist review', Medical Education, 55 (9).
Price T, Brennan N, Cleland J, Prescott-Clements L, Wanner A, Withers L, Wong G & Archer J (2018), 'Remediating doctors' performance to restore patient safety: a realist review protocol', BMJ Open 8, (10) e025943-e025943, 1-7.
 

RESTORE 2

Long title:  
Funded by:
Funding amount: £742,620.24
Location: University of Plymouth
Dates: July 2021 – June 2025
University of Plymouth PI: Dr Nicola Brennan 
Project partners:  Dr Geoff Wong, University of Oxford; Professor Jennifer Cleland, Nanyang Technological University, Singapore 
 

Overview

The optimal performance of doctors is essential to the provision of high-quality and safe care for patients. Professional support services exist to provide help, guidance and access to additional training and support for doctors in difficulty, to remedy problems and to help with career development. 
Our realist review of the literature (RESTORE 1) found that remediation interventions work when they develop doctors' insight and motivation, and reinforce behaviour change. However, our review also identified significant knowledge gaps. Most studies were from North America; few focused on the UK NHS setting. There was also a lack of detailed high-quality data to effectively test the programme theory and, in particular, the potential contextual impacts on intervention effectiveness.

Objectives

  1. To use a participatory co-design approach to help NHS organisations incorporate evidence-based recommendations to optimise the delivery of existing professional support interventions for doctors
  2. To use a realist approach to evaluate how NHS professional support programmes produce their effects 
  3. To develop:
    • NHS-specific 'recommendations' for the optimisation of professional support programmes 
    • an 'implementation toolkit' for professional support programme leads in the NHS that helps them to improve their professional support programmes based on the NHS-specific 'recommendations'.

Publications

Reynolds E, Lloyd H, Cleland J, Wong G, Withers L, Price T, Gale T, Brennan N (2025), 'Implementing recommendations to optimise professional support in the medical workplace: A participatory co-design approach', Medical Education, 1–12.
Brennan N (2021), 'Emotions, psychological safety and recommendations for designing remediation programmes', Medical Education, 56 (2) 141-143.  
Brennan N, Reynolds E, Price T, Wong G, Withers L, Cleland J, Lloyd H, Gale T (2025), A Guide to Optimise the Delivery of Professional Support in the NHS. University of Plymouth, Plymouth.
 

RESTORE 3 

Long title: The remediation of professionalism in undergraduate medical students: a realist evaluation
Funded by: Peninsula Medical School Studentship
Location: University of Plymouth
Dates: April 2024 – March 2028
PhD candidate: Ross Raymond-Jones 
Director of studies: Dr Tristan Price 

Objective

To identify how, why, for whom, in what context and to what extent professionalism remediation interventions work for undergraduate medical students
 

RESTORE 4 

Long title: Professional support services for dentists: a modified realist approach
Funded by: Faculty of Health Studentship
Location: University of Plymouth
Dates: October 2025 – September 2029
PhD candidate: Aya Al-Harbawee 
Director of studies: Dr Marie Bryce 

Objective

To identify why, how, for whom and to what extent professional support programmes work to enable dentists in difficulty to continue to practise safely.
 

University of Plymouth researchers

 
 
 

Collaborative partners

Department of Health and Social Care disclaimer

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. 
The Hoe

Contact Dr Nicola Brennan

+44 1752 586835

CAMERA, University of Plymouth, C521, Portland Square, Drake Circus, Plymouth, Devon, PL4 8AA