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Mulvale, G., Moll, S., Miatello, A., Robert, G., Larkin, M., Palmer, V. J., . . . Girling, M. (2019). Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration. Health Expectations, 22(3), 284-297
Open this publication in new window or tab >>Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration
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2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, no 3, p. 284-297Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign.

OBJECTIVE: To explore citizens' involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements.

DESIGN: A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions.

SETTING AND PARTICIPANTS: A two-day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations.

INTERVENTION STUDIED: Eight case studies working with vulnerable and disadvantaged populations in three countries.

RESULTS: We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre-specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations.

DISCUSSION AND CONCLUSIONS: Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User-centred evaluations of codesigned public services are needed.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
codesign, public services, vulnerable populations
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42600 (URN)10.1111/hex.12864 (DOI)000470930200003 ()30604580 (PubMedID)2-s2.0-85066507115 (Scopus ID)GOA HHJ 2019;HHJIMPROVEIS (Local ID)GOA HHJ 2019;HHJIMPROVEIS (Archive number)GOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-07-14Bibliographically approved
Jones, L., Pomeroy, L., Robert, G., Burnett, S., Anderson, J. E., Morris, S., . . . Fulop, N. J. (2019). Explaining organisational responses to a board-level quality improvement intervention: Findings from an evaluation in six providers in the English National Health Service. BMJ Quality and Safety, 28(3), 198-204
Open this publication in new window or tab >>Explaining organisational responses to a board-level quality improvement intervention: Findings from an evaluation in six providers in the English National Health Service
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2019 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, no 3, p. 198-204Article in journal (Refereed) Published
Abstract [en]

Background: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis' typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Methods: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents.

Results: Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of 'slack' - expressed by participants as the 'space to think' and 'someone to do the doing' - and the presence of a functioning board.

Conclusions: Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
governance, organizational theory, quality improvement, adult, article, England, female, field work, health care personnel, human, interview, major clinical study, male, national health service, public sector, total quality management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42577 (URN)10.1136/bmjqs-2018-008291 (DOI)30381330 (PubMedID)2-s2.0-85056110523 (Scopus ID)GOA HHJ 2019;HHJIMPROVEIS (Local ID)GOA HHJ 2019;HHJIMPROVEIS (Archive number)GOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-03-22Bibliographically approved
Robert, G., Kjellström, S., Areskoug Josefsson, K., Andersson-Gäre, B., Andersson, A.-C., Ockander, M., . . . Donetto, S. (2019). Exploring, measuring and enhancing the co-production of health and wellbeing at the national, regional and local levels through comparative case studies in Sweden and England: The 'Samskapa' research programme (study protocol). In: : . Paper presented at 14th ESA Conference, Europe and Beyond: Boundaries, Barriers and Belonging, 20-23 August 2019, Manchester, UK.
Open this publication in new window or tab >>Exploring, measuring and enhancing the co-production of health and wellbeing at the national, regional and local levels through comparative case studies in Sweden and England: The 'Samskapa' research programme (study protocol)
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2019 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45081 (URN)
Conference
14th ESA Conference, Europe and Beyond: Boundaries, Barriers and Belonging, 20-23 August 2019, Manchester, UK
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-06-25Bibliographically approved
Locock, L., Kirkpatrick, S., Brading, L., Sturmey, G., Cornwell, J., Churchill, N. & Robert, G. (2019). Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement. Research in Social Science and Disability, 5(1)
Open this publication in new window or tab >>Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement
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2019 (English)In: Research in Social Science and Disability, ISSN 1479-3547, E-ISSN 2056-7529, Vol. 5, no 1Article in journal (Refereed) Published
Abstract [en]

Patient or user involvement in health research is well-established but is often limited to advising on research questions and design, leaving researchers to collect and analyse ‘data’ (which in this paper means written copies of interviews with patients about their experiences). We were working with sets of interviews with 1) young people with depression and 2) people with experiences of stroke. We were looking for key themes that it would be useful for the NHS to know about, and we developed short films which healthcare staff can use to think about how to make care more patient-centred. We wanted to see what user involvement in this analysis would bring, and how best to achieve it practically.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Patient and public involvement; User involvement; Patient experience; Experience-based co-design; Qualitative analysis; Qualitative interviews; Quality improvement; Health research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42599 (URN)10.1186/s40900-018-0133-z (DOI)HHJIMPROVEIS (Local ID)HHJIMPROVEIS (Archive number)HHJIMPROVEIS (OAI)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-01-11Bibliographically approved
Wright, R. J., Lowton, K., Robert, G., Grudzen, C. R. & Grocott, P. (2018). Emergency department staff priorities for improving palliative care provision for older people: A qualitative study. Palliative Medicine: A Multiprofessional Journal, 32(2), 417-425
Open this publication in new window or tab >>Emergency department staff priorities for improving palliative care provision for older people: A qualitative study
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2018 (English)In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 32, no 2, p. 417-425Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Emergency department-based palliative care services are increasing, but research to develop these services rarely includes input from emergency clinicians, jeopardizing the effectiveness of subsequent palliative care interventions.

AIM: To collaboratively identify with emergency clinicians' improvement priorities for emergency department-based palliative care for older people.

DESIGN: This was one component of an experience-based co-design project, conducted using semi-structured interviews and feedback sessions.

SETTING/PARTICIPANTS: In-depth interviews with 15 emergency clinicians (nurses and doctors) at a large teaching hospital emergency department in the United Kingdom exploring experiences of palliative care delivery for older people. A thematic analysis identified core challenges that were presented to 64 clinicians over five feedback sessions, validating interview findings, and identifying shared priorities for improving palliative care delivery.

RESULTS: Eight challenges emerged: patient age; access to information; communication with patients, family members, and clinicians; understanding of palliative care; role uncertainty; complex systems and processes; time constraints; and limited training and education. Through feedback sessions, clinicians selected four challenges as improvement priorities: time constraints; communication and information; systems and processes; and understanding of palliative care. As resulting improvement plans evolved, "training and education" replaced "time constraints" as a priority.

CONCLUSION: Clinician priorities for improving emergency department-based palliative care were identified through collaborative, iterative processes. Though generally aware of older palliative patients' needs, clinicians struggled to provide high-quality care due to a range of complex factors. Further research should identify whether priorities are shared across other emergency departments, and develop, implement, and evaluate strategies developed by clinicians.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Palliative care, emergency department, frail older adults
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38567 (URN)10.1177/0269216317705789 (DOI)000423322000013 ()28429643 (PubMedID)2-s2.0-85041137526 (Scopus ID)HHJIMPROVEIS (Local ID)HHJIMPROVEIS (Archive number)HHJIMPROVEIS (OAI)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-08-20Bibliographically approved
Robert, G., Cornwell, J. & Black, N. (2018). Friends and family test should no longer be mandatory. BMJ. British Medical Journal (International Ed.), 360, Article ID k367.
Open this publication in new window or tab >>Friends and family test should no longer be mandatory
2018 (English)In: BMJ. British Medical Journal (International Ed.), ISSN 0959-8146, E-ISSN 0959-535X, Vol. 360, article id k367Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
England, family, follow up, friend, health care policy, health care quality, health service, hospital patient, human, national health service, priority journal, public opinion, questionnaire, Review, total quality management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42579 (URN)10.1136/bmj.k367 (DOI)000423844600004 ()29378693 (PubMedID)2-s2.0-85041233254 (Scopus ID)HHJIMPROVEIS (Local ID)HHJIMPROVEIS (Archive number)HHJIMPROVEIS (OAI)
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-02-05Bibliographically approved
Palmer, V. J., Weavell, W., Callander, R., Piper, D., Richard, L., Maher, L., . . . Robert, G. (2018). The Participatory Zeitgeist: An explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement. Medical Humanities
Open this publication in new window or tab >>The Participatory Zeitgeist: An explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement
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2018 (English)In: Medical Humanities, ISSN 1468-215X, E-ISSN 1473-4265Article in journal (Refereed) Epub ahead of print
Abstract [en]

Healthcare systems redesign and service improvement approaches are adopting participatory tools, techniques and mindsets. Participatory methods increasingly used in healthcare improvement coalesce around the concept of coproduction, and related practices of cocreation, codesign and coinnovation. These participatory methods have become the new Zeitgeist - the spirit of our times in quality improvement. The rationale for this new spirit of participation relates to voice and engagement (those with lived experience should be engaged in processes of development, redesign and improvements), empowerment (engagement in codesign and coproduction has positive individual and societal benefits) and advancement (quality of life and other health outcomes and experiences of services for everyone involved should improve as a result). This paper introduces Mental Health Experience Co-design (MH ECO), a peer designed and led adapted form of Experience-based Co-design (EBCD) developed in Australia. MH ECO is said to facilitate empowerment, foster trust, develop autonomy, self-determination and choice for people living with mental illnesses and their carers, including staff at mental health services. Little information exists about the underlying mechanisms of change; the entities, processes and structures that underpin MH ECO and similar EBCD studies. To address this, we identified eight possible mechanisms from an assessment of the activities and outcomes of MH ECO and a review of existing published evaluations. The eight mechanisms, recognition, dialogue, cooperation, accountability, mobilisation, enactment, creativity and attainment, are discussed within an 'explanatory theoretical model of change' that details these and ideal relational transitions that might be observed or not with MH ECO or other EBCD studies. We critically appraise the sociocultural and political movement in coproduction and draw on interdisciplinary theories from the humanities - narrative theory, dialogical ethics, cooperative and empowerment theory. The model advances theoretical thinking in coproduction beyond motivations and towards identifying underlying processes and entities that might impact on process and outcome. Trial registration number: The Australian and New Zealand Clinical Trials Registry, ACTRN12614000457640 (results). 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
medical humanities, mental health care, philosophy of medicine/health care, social science
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42578 (URN)10.1136/medhum-2017-011398 (DOI)29954854 (PubMedID)2-s2.0-85049352550 (Scopus ID)HHJIMPROVEIS (Local ID)HHJIMPROVEIS (Archive number)HHJIMPROVEIS (OAI)
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-01-10
Robert, G. & Macdonald, A. S. (2017). Co-design, organisational creativity and quality improvement in the healthcare sector: 'designerly' or 'design-like'?. In: D. Sangiorgi & A. Prendiville (Ed.), Designing for service: key issues and new directions. London: Bloomsbury Academic
Open this publication in new window or tab >>Co-design, organisational creativity and quality improvement in the healthcare sector: 'designerly' or 'design-like'?
2017 (English)In: Designing for service: key issues and new directions / [ed] D. Sangiorgi & A. Prendiville, London: Bloomsbury Academic, 2017Chapter in book (Refereed)
Place, publisher, year, edition, pages
London: Bloomsbury Academic, 2017
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38566 (URN)978-1-4742-5012-2 (ISBN)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-08-20Bibliographically approved
Robert, G., Philippou, J., Leamy, M., Reynolds, E., Ross, S., Bennett, L., . . . Maben, J. (2017). Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009-2015. BMJ Open, 7(1), Article ID e014326.
Open this publication in new window or tab >>Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009-2015
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 1, article id e014326Article in journal (Refereed) Published
Abstract [en]

Objectives: Schwartz Center Rounds ('Rounds') are a multidisciplinary forum in which healthcare staff within an organisation discuss the psychological, emotional and social challenges associated with their work in a confidential and safe environment. Implemented in over 375 North American organisations, since 2009, they have been increasingly adopted in England. This study aimed to establish how many and what types of organisations have adopted Rounds in England, and to explore why they did so.

Setting: Public healthcare organisations in England.

Participants: Secondary data analysis was used to map and profile all 116 public healthcare organisations that had adopted Rounds in England by July 2015. Semistructured telephone interviews were conducted with 45 Round coordinators within adopting organisations.

Results: The rate of adoption increased after a major national report in 2013. Rounds were typically adopted in order to improve staff well-being. Adopting organisations scored better on staff engagement than non-adopters; among adopting organisations, those performing better on patient experience were more likely to adopt earlier. Most adoption decision-making processes were straightforward. A confluence of factors-a generally favourable set of innovation attributes (including low cost), advocacy from opinion leaders in different professional networks, active dissemination by change agents and a felt need to be seen to be addressing staff well-being-initially led to Rounds being seen as 'an idea whose time had come'. More recent adoption patterns have been shaped by the timing of charitable and other agency funding in specific geographical areas and sectors, as well as several forms of 'mimetic pressure'.

Conclusions: The innate attributes of Rounds, favourable circumstances and the cumulative impact of a sequence of distinct informal and formal social processes have shaped the pattern of their adoption in England.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
Keywords
adoption, data analysis, England, funding, health care organization, human, human experiment, leadership, organization, staff, telephone interview, wellbeing, emotion, empathy, group process, health care delivery, health care personnel, health personnel attitude, health service, interview, psychology, public relations, social support, Attitude of Health Personnel, Delivery of Health Care, Emotions, Group Processes, Health Personnel, Health Services, Health Services Administration, Humans, Interprofessional Relations, Interviews as Topic, Organizational Innovation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38563 (URN)10.1136/bmjopen-2016-014326 (DOI)000395590300173 ()2-s2.0-85009088568 (Scopus ID)GOA HHJ 2017;HHJIMPROVEIS (Local ID)GOA HHJ 2017;HHJIMPROVEIS (Archive number)GOA HHJ 2017;HHJIMPROVEIS (OAI)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2019-06-05Bibliographically approved
Jones, L., Pomeroy, L., Robert, G., Burnett, S., Anderson, J. E. & Fulop, N. J. (2017). How do hospital boards govern for quality improvement?: A mixed methods study of 15 organisations in England. BMJ Quality and Safety, 26(12), 978-986
Open this publication in new window or tab >>How do hospital boards govern for quality improvement?: A mixed methods study of 15 organisations in England
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2017 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 26, no 12, p. 978-986Article in journal (Refereed) Published
Abstract [en]

Background

Health systems worldwide are increasingly holding boards of healthcare organisations accountable for the quality of care that they provide. Previous empirical research has found associations between certain board practices and higher quality patient care; however, little is known about how boards govern for quality improvement (QI).

Methods

We conducted fieldwork over a 30-month period in 15 healthcare provider organisations in England as part of a wider evaluation of a board-level organisational development intervention. Our data comprised board member interviews (n=65), board meeting observations (60 hours) and documents (30 sets of board meeting papers, 15 board minutes and 15 Quality Accounts). We analysed the data using a framework developed from existing evidence of links between board practices and quality of care. We mapped the variation in how boards enacted governance of QI and constructed a measure of QI governance maturity. We then compared organisations to identify the characteristics of those with mature QI governance.

Results

We found that boards with higher levels of maturity in relation to governing for QI had the following characteristics: explicitly prioritising QI; balancing short-term (external) priorities with long-term (internal) investment in QI; using data for QI, not just quality assurance; engaging staff and patients in QI; and encouraging a culture of continuous improvement. These characteristics appeared to be particularly enabled and facilitated by board-level clinical leaders.

Conclusions

This study contributes to a deeper understanding of how boards govern for QI. The identified characteristics of organisations with mature QI governance seemed to be enabled by active clinical leadership. Future research should explore the biographies, identities and work practices of board-level clinical leaders and their role in organisation-wide QI. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
Keywords
Governance, Leadership, Quality Improvement, adult, board of trustees, England, female, field work, health care personnel, human, identity, interview, investment, literature, major clinical study, male, maturity, organizational development, staff, total quality management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38559 (URN)10.1136/bmjqs-2016-006433 (DOI)000415980200007 ()28689191 (PubMedID)2-s2.0-85037066130 (Scopus ID)GOA HHJ 2017;HHJIMPROVEIS (Local ID)GOA HHJ 2017;HHJIMPROVEIS (Archive number)GOA HHJ 2017;HHJIMPROVEIS (OAI)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2019-06-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8781-6675

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