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  • 1.
    Adams, Mary
    et al.
    King’s College London, UK.
    Maben, Jill
    King’s College London, UK.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). King’s College London, UK.
    ‘It’s sometimes hard to tell what patients are playing at’: How healthcare professionals make sense of why patients and families complain about care2018In: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 22, no 6, p. 603-623Article in journal (Refereed)
    Abstract [en]

    This article draws from sociological and socio-legal studies of dispute between patients and doctors to examine how healthcare professionals made sense of patients’ complaints about healthcare. We analyse 41 discursive interviews with professional healthcare staff working in eight different English National Health Service settings to explore how they made sense of events of complaint and of patients’ (including families’) motives for complaining. We find that for our interviewees, events of patients’ complaining about care were perceived as a breach in fundamental relationships involving patients’ trust or patients’ recognition of their work efforts. We find that interviewees rationalised patients’ motives for complaining in ways that marginalised the content of their concerns. Complaints were most often discussed as coming from patients who were inexpert, distressed or advantage-seeking; accordingly, care professionals hearing their concerns about care positioned themselves as informed decision-makers, empathic listeners or service gate-keepers. We find differences in our interviewees’ rationalisation of patients’ complaining about care to be related to local service contingences rather than to fixed professional differences. We note that it was rare for interviewees to describe complaints raised by patients as grounds for improving the quality of care. Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism exercised contemporary healthcare work.

  • 2.
    Anderson, Janet E.
    et al.
    Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK.
    Nunes, Francisco
    Department of Human Resources and Organizational Behavior, ISCTE-IUL, Lisbon, Portugal.
    Bal, Roland
    Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Netherlands.
    Burnett, Susan
    Faculty of Medicine, Department of Surgery & Cancer, Imperial College, UK.
    Karltun, Anette
    Jönköping University, School of Engineering, JTH, Supply Chain and Operations Management. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Sanne, Johan
    IVL Swedish Environmental Research Institute, Sweden.
    Aase, Karina
    SHARE—Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Norway.
    Wiig, Siri
    SHARE—Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Norway.
    Fulop, Naomi J.
    Department of Applied Health Research, University College London, UK.
    The QUASER Team, ,
    Translating research on quality improvement in five European countries into a reflective guide for hospital leaders: the ‘QUASER Hospital Guide’2019In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to translate the findings of the QUASER study into a reflective, dialogic guide to help senior hospital leaders develop an organization wide QI strategy.

    Design: The QUASER study involved in depth ethnographic research into QI work and practices in two hospitals in each of five European countries. Three translational stakeholder workshops were held to review research findings and advise on the design of the Guide. An extended iterative process involving researchers from each participant country was then used to populate the Guide.

    Setting: The research was carried out in two hospitals in each of five European countries.

    Participants: In total, 389 interviews with healthcare practitioners and 803 hours of observations.

    Intervention: None.

    Main outcome measure: None.

    Results: The QUASER Hospital Guide was designed for leadership teams to diagnose their organization’s strengths and weaknesses in the eight QI challenges. The Guide supports organizational dialogue about QI challenges, enables leaders to share perspectives, and helps teams to develop solutions to their situated problems. The Guide includes extensive examples of QI strategies drawn from the data and is published online and on paper.

    Conclusion: The QUASER Hospital Guide is empirically based, draws on a dialogical approach to Organizational Development and complexity science and can facilitate hospital leadership teams to identify the best solutions for their organization.

  • 3. Blackwell, R. W. N.
    et al.
    Lowton, K.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Grudzen, C.
    Grocott, P.
    Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes2017In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 68, p. 83-94Article in journal (Refereed)
    Abstract [en]

    Background

    Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of − and preferences for – palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting.

    Objectives

    To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work. Setting an Emergency Department in a large teaching hospital in the United Kingdom.

    Methods

    Experience-based Co-design incorporating: 150 h of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members.

    Findings

    The study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the ‘voice’ of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process.

    Conclusion

    Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the ‘accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase. 

  • 4.
    Clarke, David
    et al.
    Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford, United Kingdom.
    Jones, Fiona
    Faculty of Health Social Care and Education, St George's University of London, London, United Kingdom.
    Harris, Ruth
    Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings?: A rapid evidence synthesis2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 7, article id e014650Article in journal (Refereed)
    Abstract [en]

    Background

    Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings.

    Aims

    To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings.

    Design

    Rapid evidence synthesis.

    Data sources

    Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues.

    Study selection

    Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting.

    Findings

    712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made.

    Conclusions

    Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader impacts on the values and behaviours of participants should also be considered. 

  • 5. Desai, A.
    et al.
    Zoccatelli, G.
    Adams, M.
    Allen, D.
    Brearley, S.
    Rafferty, A. M.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, United Kingdom.
    Donetto, S.
    Taking data seriously: The value of actor-network theory in rethinking patient experience data2017In: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 22, no 2, p. 134-136Article in journal (Refereed)
    Abstract [en]

    Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention to patient experience data as having agency in particular hospital interactions allows us to better trace how and in what circumstances data lead (or fail to lead) to quality improvement.

  • 6. Donetto, S.
    et al.
    Malone, M.
    Sayer, L.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing & Midwifery, King's College London, United Kingdom.
    New models to support the professional education of health visitors: A qualitative study of the role of space and place in creating ‘community of learning hubs’2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 54, p. 69-76Article in journal (Refereed)
    Abstract [en]

    Background

    In response to a policy-driven workforce expansion in England new models of preparing health visitors for practice have been implemented. ‘Community of Learning hubs’ (COLHs) are one such model, involving different possible approaches to student support in clinical practice placements (for example, ‘long arm mentoring’ or ‘action learning set’ sessions). Such models present opportunities for studying the possible effects of spatiality on the learning experiences of students and newly qualified health visitors, and on team relationships more broadly.

    Objectives

    To explore a ‘community of learning hub’ model in health visitor education and reflect on the role of space and place in the learning experience and professional identity development of student health visitors.

    Design

    Qualitative research conducted during first year of implementation.

    Settings

    Three ‘community of learning hub’ projects based in two NHS community Trusts in London during the period 2013–2015. Participants Managers and leads (n = 7), practice teachers and mentors (n = 6) and newly qualified and student health visitors (n = 16).

    Methods

    Semi-structured, audio-recorded interviews analysed thematically.

    Results

    Participants had differing views as to what constituted a ‘hub’ in their projects. Two themes emerged around the spaces that shape the learning experience of student and newly qualified health visitors. Firstly, a generalised need for a ‘quiet place’ which allows pause for reflection but also for sharing experiences and relieving common anxieties. Secondly, the role of physical arrangements in open-plan spaces to promote access to support from more experienced practitioners.

    Conclusions

    Attention to spatiality can shed light on important aspects of teaching and learning practices, and on the professional identities these practices shape and support. New configurations of time and space as part of educational initiatives can surface new insights into existing practices and learning models. 

  • 7. Donetto, S.
    et al.
    Penfold, C.
    Anderson, J.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Maben, J.
    Nursing work and sensory experiences of hospital design: A before and after qualitative study following a move to all-single room inpatient accommodation2017In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 46, p. 121-129Article in journal (Refereed)
    Abstract [en]

    The embodied experience of nursing practice is rarely studied. Drawing on data from an internationally relevant larger study conducted in 2013–14, here we explore the sensory dimension of the embodied experiences of nursing staff working on two acute NHS hospital wards before and after a move to all-single room inpatient accommodation. We undertook a secondary analysis of 25 interviews with nursing staff (12 before and 13 after the move with half [13/25] using photographs taken by participants) from a mixed-method before-and-after study. This analysis focused on the sensory dimensions of nursing staff's experiences of their working practices and the effect of the built environment upon these. Drawing on Pallasmaa's theoretocal insights, we report how the all-single room ward design prioritises ‘focused vision’ and hinders peripheral perception, whilst the open ward environment is rich in contextual and preconscious information. We suggest all-single room accommodation may offer staff an impoverished experience of caring for patients and of working with each other. 

  • 8.
    Donetto, Sara
    et al.
    Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom.
    Desai, Amit
    Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom.
    Zoccatelli, Giulia
    Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom.
    Allen, Davina
    School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom.
    Brearley, Sally
    Independent patient and public involvement advisor, Sutton, United Kingdom.
    Rafferty, Anne Marie
    Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom.
    Organisational strategies and practices to improve care using patient experience data in acute NHS hospital trusts: an ethnographic study2019In: Health Services and Delivery Research, ISSN 2050-4349, Vol. 7, no 34Article in journal (Refereed)
    Abstract [en]

    Background

    Although NHS organisations have access to a wealth of patient experience data in various formats (e.g. surveys, complaints and compliments, patient stories and online feedback), not enough attention has been paid to understanding how patient experience data translate into improvements in the quality of care.

    Objectives

    The main aim was to explore and enhance the organisational strategies and practices through which patient experience data are collected, interpreted and translated into quality improvements in acute NHS hospital trusts in England. The secondary aim was to understand and optimise the involvement and responsibilities of nurses in senior managerial and front-line roles with respect to such data.

    Design

    The study comprised two phases. Phase 1 consisted of an actor–network theory-informed ethnographic study of the ‘journeys’ of patient experience data in five acute NHS hospital trusts, particularly in cancer and dementia services. Phase 2 comprised a series of Joint Interpretive Forums (one cross-site and one at each trust) bringing together different stakeholders (e.g. members of staff, national policy-makers, patient/carer representatives) to distil generalisable principles to optimise the use of patient experience data.

    Setting

    Five purposively sampled acute NHS hospital trusts in England.

    Results

    The analysis points to five key themes: (1) each type of data takes multiple forms and can generate improvements in care at different stages in its complex ‘journey’ through an organisation; (2) where patient experience data participate in interactions (with human and/or non-human actors) characterised by the qualities of autonomy (to act/trigger action), authority (to ensure that action is seen as legitimate) and contextualisation (to act meaningfully in a given situation), quality improvements can take place in response to the data; (3) nurses largely have ultimate responsibility for the way in which data are collected, interpreted and used to improve care, but other professionals also have important roles that could be explored further; (4) formalised quality improvement can confer authority to patient experience data work, but the data also lead to action for improvement in ways that are not formally identified as quality improvement; (5) sense-making exercises with study participants can support organisational learning.

    Limitations

    Patient experience data practices at trusts performing ‘worse than others’ on the Care Quality Commission scores were not examined. Although attention was paid to the views of patients and carers, the study focused largely on organisational processes and practices. Finally, the processes and practices around other types of data were not examined, such as patient safety and clinical outcomes data, or how these interact with patient experience data.

    Conclusions

    NHS organisations may find it useful to identify the local roles and processes that bring about autonomy, authority and contextualisation in patient experience data work. The composition and expertise of patient experience teams could better complement the largely invisible nursing work that currently accounts for a large part of the translation of data into care improvements.

    Future work

    To date, future work has not been planned.

  • 9.
    Hanna, Esmée
    et al.
    Institute of Allied Health Sciences, De Montfort University, Leicester, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Adult Nursing, King’s College London, London, United Kingdom.
    Ethics of limb disposal: Dignity and the medical waste stockpiling scandal2019In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 45, no 9, p. 575-578Article in journal (Refereed)
    Abstract [en]

    We draw on the concept of dignity to consider the ethics of the disposal of amputated limbs. The ethics of the management and disposal of human tissue has been subject to greater scrutiny and discussion in recent years, although the disposal of the limbs often remains absent from such discourses. In light of the recent UK controversy regarding failures in the medical waste disposal and the stockpiling of waste (including body parts), the appropriate handling of human tissue has been subject to further scrutiny. Although this scandal has evoked concern regarding procurement and supply chain issues, as well as possible health and safety risks from such a stockpile', the dignity of those patients' implicated in this controversy has been less widely discussed. Drawing at Foster's (2014) work, we argue that a dignity framework provides a useful lens to frame consideration of the disposal of limbs after amputation. Such a framework may be difficult to reconcile with the logic of business and the biovalue' of the medical waste, but would we argue afford more patient-centred approaches towards disposal. It may also facilitate better practices to help mitigate future stockpiling incidences. 

  • 10.
    Harlock, Jenny
    et al.
    Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
    Williams, Iestyn
    Health Services Management Centre, University of Birmingham, Birmingham, UK.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK.
    Hall, Kelly
    Department of Social Policy and Social Work, University of Birmingham, UK.
    Mannion, Russell
    Health Services Management Centre, University of Birmingham, UK.
    Brearley, Sally
    The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK.
    Doing more with less in health care: Findings from a multi-method study of decommissioning in the English National Health Service2018In: Journal of Social Policy, ISSN 0047-2794, E-ISSN 1469-7823, Vol. 47, no 3, p. 543-564Article in journal (Refereed)
    Abstract [en]

    In the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to ‘successfully’ implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what ‘success’ looks like in terms of a decommissioning process. 

  • 11. Jones, L.
    et al.
    Pomeroy, L.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, United Kingdom.
    Burnett, S.
    Anderson, J. E.
    Fulop, N. J.
    How do hospital boards govern for quality improvement?: A mixed methods study of 15 organisations in England2017In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 26, no 12, p. 978-986Article in journal (Refereed)
    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. 

  • 12.
    Jones, Lorelei
    et al.
    School of Health Sciences, Bangor University, G-Bangor, United Kingdom.
    Pomeroy, Linda
    Department of Applied Health Research, University College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
    Burnett, Susan
    Centre for Patient Safety and Service Quality, Imperial College London, London, United Kingdom.
    Anderson, Janet E.
    Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
    Morris, Stephen
    Department of Applied Health Research, University College London, London, United Kingdom.
    Capelas Barbosa, Estela
    Department of Applied Health Research, University College London, London, United Kingdom.
    Fulop, Naomi J.
    Department of Applied Health Research, University College London, London, United Kingdom.
    Explaining organisational responses to a board-level quality improvement intervention: Findings from an evaluation in six providers in the English National Health Service2019In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, no 3, p. 198-204Article in journal (Refereed)
    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.

  • 13.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Ockander, Marlene
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Käll, Jacob
    Djursdala samhällsförening, Djursdala, Sweden, Sweden.
    McGrath, Jane
    London, United Kingdom.
    Donetto, Sara
    Florence Nightingale Faculty of Nursing, King's College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, King's College London, London, United Kingdom.
    Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the 'Samskapa' research programme protocol2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e029723Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Cocreation, coproduction and codesign are advocated as effective ways of involving citizens in the design, management, provision and evaluation of health and social care services. Although numerous case studies describe the nature and level of coproduction in individual projects, there remain three significant gaps in the evidence base: (1) measures of coproduction processes and their outcomes, (2) mechanisms that enable inclusivity and reciprocity and (3) management systems and styles. By focusing on these issues, we aim to explore, enhance and measure the value of coproduction for improving the health and well-being of citizens.

    METHODS AND ANALYSIS:

    Nine ongoing coproduction projects form the core of an interactive research programme ('Samskapa') during a 6-year period (2019-2024). Six of these will take place in Sweden and three will be undertaken in England to enable knowledge exchange and cross-cultural comparison. The programme has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sensemaking process will generate relevant lessons both for those participating in the projects and researchers. Based on the findings, we will develop explanatory models and other outputs to increase the sustained value (and values) of future coproduction initiatives in these sectors.

    ETHICS AND DISSEMINATION:

    All necessary ethical approvals will be obtained from the regional Ethical Board in Sweden and from relevant authorities in England. All data and personal data will be handled in accordance with General Data Protection Regulations. Given the interactive nature of the research programme, knowledge dissemination to participants and stakeholders in the nine projects will be ongoing throughout the 6 years. External workshops-facilitated in collaboration with participating case studies and citizens-both during and at the end of the programme will provide an additional dissemination mechanism and involve health and social care practitioners, policymakers and third-sector organisations. 

  • 14.
    Leamy, Mary
    et al.
    Department of Mental Health Nursing, Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
    Reynolds, Ellie
    Adult Nursing Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Adult Nursing Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
    Taylor, Cath
    School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
    Maben, Jill
    School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
    The origins and implementation of an intervention to support healthcare staff to deliver compassionate care: exploring fidelity and adaptation in the transfer of Schwartz Center Rounds® from the United States to the United Kingdom.2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 457Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Schwartz Center Rounds® (henceforce Rounds) were developed in the United States (US) in 1995 to provide a regular, structured time and safe place for staff to meet to share the emotional, psychological and social challenges of working in healthcare. Rounds were adopted in the United Kingdom (UK) in 2009 and have been subsequently implemented in over 180 healthcare organisations. Using Rounds as a case study, we aim to inform current debates around maintaining fidelity when an intervention developed in one country is transferred and implemented in another.

    METHODS: Interpretive design using nine qualitative interviews (UK = 3, US = 6) and four focus groups (UK: Focus group 1 (4 participants), Focus group 2 (5 participants; US: focus group 1 (5 participants) focus group 2 (2 participants) with participants involved in Rounds design and implementation, for example, programme architects, senior leaders, mentors and trainers. We also conducted non-participant observations of Rounds (UK = 42: USA = 2) and training days (UK = 2). Data were analysed using thematic analysis.

    RESULTS: We identified four core and seven sub-core Rounds components, based upon the US design, and seven peripheral components, based on our US and UK fieldwork. We found high core component fidelity and examples of UK adaptations. We identified six strategies used to maintain high fidelity during Rounds transfer and implementation from the US to UK settings: i) having a legal contract between the two national bodies overseeing implementation, ii) requiring adopting UK healthcare organisations to sign a contract with the national body, iii) piloting the intervention in the UK context, iv) emphasising the credibility of the intervention, v) promoting and evaluating Rounds, and vi) providing implementation support and infrastructure.

    CONCLUSIONS: This study identifies how fidelity to the core components of a particular intervention was maintained during transfer from one country to another by identifying six strategies which participants argued had enhanced fidelity during transfer of Rounds to a different country, with contractual agreements and legitimacy of intervention sources key. Potential disadvantages include limitations to further innovation and adaptation.

  • 15.
    Locock, Louise
    et al.
    Health Services Research Unit, University of Aberdeen (Formerly University of Oxford), Health Sciences Building, Foresterhill, Aberdeen, Scotland.
    Kirkpatrick, Susan
    Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England.
    Brading, Lucy
    Institute of Psychology Health and Society/North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, England.
    Sturmey, Gordon
    Aberdeen, Scotland.
    Cornwell, Jocelyn
    Point of Care Foundation, London, England.
    Churchill, Neil
    Experience, Participation and Equalities, Leeds, England.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, England.
    Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement2019In: Research in Social Science and Disability, ISSN 1479-3547, E-ISSN 2056-7529, Vol. 5, no 1Article in journal (Refereed)
    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.

  • 16.
    Locock, Louise
    et al.
    University of Aberdeen, Scotland.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). King's College, London, United Kingdom.
    Meier, Ninna
    Aalborg University, Denmark.
    Patients, families, and care settings2019In: Context in action and how to study it: Illustrations from health care / [ed] N. Meier & S. Dopson, Oxford: Oxford University Press, 2019, p. 155-165Chapter in book (Refereed)
  • 17.
    McAllister, Sarah
    et al.
    Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
    Tsianakas, Vicki
    Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
    McCrae, Niall
    Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
    Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 93, p. 106-118Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The review aimed to 1) explore the constituents of nurse-patient therapeutic engagement on acute mental health wards; 2) map factors that influence engagement to the Theoretical Domains Framework and 3) integrate results into a conceptual model of engagement to inform the development of interventions to improve engagement.

    DESIGN: A systematic integrative review using an established framework specific to the integrative review methodology.

    DATA SOURCES: Database searches (CINAHL, PsycINFO, BNI and Cochrane Library) and hand searching identified 3414 articles. After screening, applying eligibility criteria, and quality appraisal, 37 articles were included: n = 27 empirical research studies, n = 10 expert opinion pieces, n = 1 case study and n = 1 theoretical report.

    REVIEW METHODS: Peer-reviewed empirical studies, theoretical reports or expert opinion pieces that explored therapeutic engagement as a stated aim and were conducted in acute mental health inpatient settings from the patient or nurse perspective were included. Data were extracted from the introduction, results and discussion sections of empirical research, and the complete article of theoretical and expert opinion pieces. Data were coded then grouped into subthemes and themes. Data relating to influencing factors were further categorised according to the Theoretical Domains Framework. Results were synthesised into a conceptual model of engagement.

    RESULTS: Five conceptually distinct, but closely related constructs of engagement - called the "Principles of Engagement" - emerged: 1) Understanding the person and their experiences; 2) Facilitating growth; 3) Therapeutic use of self; 4) Choosing the right approach and 5) Authoritative vs. emotional containment. Influences on engagement ranged across all 14 theoretical domains of the Theoretical Domains Framework.

    CONCLUSION: A holistic understanding of the essential components of engagement may make it easier for nurses to recognise what they do, and to do it well. The model can be used to generate testable hypotheses about how and where to target behavioural change interventions. The Principles of Engagement must be reflected in the development of interventions to improve engagement.

  • 18.
    Metz, Allison
    et al.
    University of North Carolina at Chapel Hill, United States.
    Boaz, Annette
    Kingston University London, St. George’s University of London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). King’s College London, United Kingdom.
    Co-creative approaches to knowledge production: What next for bridging the research to practice gap?2019In: Evidence & Policy: A Journal of Research, Debate and Practice, ISSN 1744-2648, E-ISSN 1744-2656, Vol. 15, no 3, p. 331-337Article in journal (Other academic)
  • 19.
    Mulvale, Gillian
    et al.
    McMaster University, Burlington, Ontario, Canada.
    Moll, Sandra
    McMaster University, Burlington, Ontario, Canada.
    Miatello, Ashleigh
    McMaster University, Burlington, Ontario, Canada.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). King's College London, London, UK.
    Larkin, Michael
    Aston University, Birmingham, UK.
    Palmer, Victoria J.
    The University of Melbourne, Parkville, Victoria, Australia.
    Powell, Alicia
    McMaster University, Burlington, Ontario, Canada.
    Gable, Chelsea
    McMaster University, Burlington, Ontario, Canada.
    Girling, Melissa
    Newcastle University, Newcastle upon Tyne, UK.
    Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration2019In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, no 3, p. 284-297Article in journal (Refereed)
    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.

  • 20.
    Palmer, Victoria J.
    et al.
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Weavell, Wayne
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Callander, Rosemary
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Piper, Donella
    Business School, University of New England, Armidale, NSW, Australia.
    Richard, Lauralie
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Maher, Lynne
    Ko Awatea Health System Innovation and Improvement, Counties Manukau Health, Auckland, New Zealand.
    Boyd, Hilary
    Strategy, Participation and Improvement Group, Auckland District Health Board, Auckland, New Zealand.
    Herrman, Helen
    Orygen, National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
    Furler, John
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Gunn, Jane
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Iedema, Rick
    Centre for Team Based Practice and Learning in Health Care, Health Schools, King's College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    The Participatory Zeitgeist: An explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement2019In: Medical Humanities, ISSN 1468-215X, E-ISSN 1473-4265, Vol. 45, no 3, p. 247-257Article in journal (Refereed)
    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). 

  • 21.
    Robert, Glenn
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
    Cornwell, Jocelyn
    Point of Care Foundation, London, United Kingdom.
    Black, Nick
    London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Friends and family test should no longer be mandatory2018In: BMJ. British Medical Journal (International Ed.), ISSN 0959-8146, E-ISSN 0959-535X, Vol. 360, article id k367Article in journal (Other academic)
  • 22.
    Robert, Glenn
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). King's College, London, UK.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Ockander, Marlene
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Käll, Jacob
    McGrath, Jane
    Donetto, Sara
    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)2019Conference paper (Refereed)
  • 23.
    Robert, Glenn
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, United Kingdom.
    Macdonald, Alastair S.
    School of Design, Glasgow School of Art, Glasgow, United Kingdom.
    Co-design, organisational creativity and quality improvement in the healthcare sector: 'designerly' or 'design-like'?2017In: Designing for service: key issues and new directions / [ed] D. Sangiorgi & A. Prendiville, London: Bloomsbury Academic, 2017Chapter in book (Refereed)
  • 24.
    Robert, Glenn
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale, Faculty of Nursing and Midwifery, King's College, London, London, United Kingdom.
    Philippou, J.
    Leamy, M.
    Reynolds, E.
    Ross, S.
    Bennett, L.
    Taylor, C.
    Shuldham, C.
    Maben, J.
    Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009-20152017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 1, article id e014326Article in journal (Refereed)
    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.

  • 25.
    Robert, Glenn
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
    Sarre, Sophie
    Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
    Maben, Jill
    School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Unuted Kingdom.
    Griffiths, Peter
    Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
    Chable, Rosemary
    Training, Development & Workforce, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the 'Productive Ward2020In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 29, p. 31-40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The 'Productive Ward: Releasing Time to Care' programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) Increase time nurses spend in direct patient care. (2) Improve safety and reliability of care. (3) Improve experience for staff and patients. (4) Make changes to physical environments to improve efficiency.

    OBJECTIVE: To explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention.

    DESIGN: Multiple methods within six hospitals including 88 interviews (with Productive Ward leads, ward staff, Patient and Public Involvement representatives and senior managers), 10 ward manager questionnaires and structured observations on 12 randomly selected wards.

    RESULTS: Resource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward towards a range of implementation 'short cuts'. Nonetheless, material legacies (eg, displaying metrics data; storage systems) have remained in place for up to a decade after initial implementation as have some specific practices (eg, protected mealtimes). Variations in timing of adoption, local implementation strategies and contextual changes influenced assimilation into routine practice and subsequent legacies. Productive Ward has informed wider organisational QI strategies that remain in place today and developed lasting QI capabilities among those meaningfully involved in its implementation.

    CONCLUSIONS: As an ongoing QI approach Productive Ward has not been sustained but has informed contemporary organisational QI practices and strategies. Judgements about the long-term sustainability of QI interventions should consider the evolutionary and adaptive nature of change processes.

  • 26.
    Sarre, Sophie
    et al.
    Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, United Kingdom.
    Maben, Jill
    School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
    Griffiths, Peter
    Health Sciences, University of Southampton, Southampton, United Kingdom.
    Chable, Rosemary
    Training, Development & Workforce, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, United Kingdom.
    The 10-year impact of a ward-level quality improvement intervention in acute hospitals: a multiple methods study2019In: Health Services and Delivery Research, ISSN 2050-4349, Vol. 7, no 28Article in journal (Refereed)
    Abstract [en]

    Background

    The ‘Productive Ward: Releasing Time to Care’™ programme (Productive Ward; PW) was introduced in English NHS acute hospitals in 2007 to give ward staff the tools, skills and time needed to implement local improvements to (1) increase the time nurses spend on direct patient care, (2) improve the safety and reliability of care, (3) improve staff and patient experience and (4) make structural changes on wards to improve efficiency. Evidence of whether or not these goals were met and sustained is very limited.

    Objective

    To explore if PW had a sustained impact over the past decade.

    Design

    Multiple methods, comprising two online national surveys, six acute trust case studies (including a secondary analysis of local audit data) and telephone interviews.

    Data sources

    Surveys of 56 directors of nursing and 35 current PW leads; 88 staff and patient and public involvement representative interviews; 10 ward manager questionnaires; structured observations of 12 randomly selected wards and documentary analysis in case studies; and 14 telephone interviews with former PW leads.

    Results

    Trusts typically adopted PW in 2008–9 on their wards using a phased implementation approach. The average length of PW use was 3 years (range < 1 to 7 years). Financial and management support for PW has disappeared in the majority of trusts. The most commonly cited reason for PW’s cessation was a change in quality improvement (QI) approach. Nonetheless, PW has influenced wider QI strategies in around half of the trusts. Around one-third of trusts had impact data relating specifically to PW; the same proportion did not. Early adopters of PW had access to more resources for supporting implementation. Some elements of local implementation strategies were common. However, there were variations that had consequences for the assimilation of PW into routine practice and, subsequently, for the legacies and sustainability of the programme. In all case study sites, material legacies (e.g. display of metrics data; storage systems) remained, as did some processes (e.g. protected mealtimes). Only one case study site had sufficiently robust data collection systems to allow an objective assessment of PW’s impact; in that site, care processes had improved initially (in terms of patient observations and direct care time). Experience of leading PW had benefited the careers of the majority of interviewees. Starting with little or no QI experience, many went on to work on other initiatives within their trusts, or to work in QI at regional or national level within the NHS or in the private sector.

    Limitations

    The research draws on participant recall over a lengthy period characterised by evolving QI approaches and system-level change.

    Conclusions

    Little robust evidence remains of PW leading to a sustained increase in the time nurses spend on direct patient care or improvements in the experiences of staff and/or patients. PW has had a lasting impact on some ward practices. As an ongoing QI approach continually used to make ongoing improvements, PW has not been sustained, but it has informed current organisational QI practices and strategies in many trusts. The design and delivery of future large-scale QI programmes could usefully draw on the lessons learnt from this study of the PW in England over the period 2008–18.

  • 27.
    Wright, Rebecca J.
    et al.
    Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
    Lowton, Karen
    Department of Sociology, University of Sussex, Brighton, UK.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
    Grudzen, Corita R
    Ronald O. Perelman Department of Emergency Medicine, School of Medicine, New York University, New York, NY, USA.
    Grocott, Patricia
    Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
    Emergency department staff priorities for improving palliative care provision for older people: A qualitative study2018In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 32, no 2, p. 417-425Article in journal (Refereed)
    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.

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