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Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

The initial purpose of this study was to examine the educational needs and perceptions of students and clinicians in Canadian legal clinics.

The author conducted a literature review of leading educational materials in Canada and the United States focusing on required or preferred competencies for law students. The author then interviewed law students, clinicians, social workers, and community legal workers from across Ontario, Canada, all of whom were working or studying at law school-affiliated legal clinics. Interview subjects were asked a series of questions about their learning experiences in hopes of informing the creation of clinical teaching and learning materials.

The data revealed an under-reliance of the affective elements of teaching, learning, and practice in both existing literature and current teaching practices. The data also revealed deep structural divides between doctrinal and clinical teaching and learning approaches.

Without further integration between these two approaches, students and, ultimately, communities and clients will not reap the benefits possible from an integrated curriculum.

Purpose – This chapter provides the reader with an overview of a reflective video pedagogy for use within a literacy center or within professional development contexts. The conceptual overview is followed by two-case examples that reveal how literacy centers can serve as rich, productive research sites for the use and study of reflective video pedagogy.

Methodology/approach – The authors describe their ongoing work to develop and integrate a reflective video pedagogy within a literacy center during a 15-week practicum for literacy-specialists-in-training. The reflective video pedagogy is not only used by the clinicians who work with struggling readers twice a week, but it is also used by the researchers at the literacy center who study the reflective video pedagogy through the same video the clinicians use.

Practical implications – Literacy centers are dynamic sites where children, families, pre/in-service teachers, and teacher educators work together around literacy development. Reflective video pedagogies can be used to closely examine learning and teaching for adult students (i.e., clinicians) and for youth (i.e., children in elementary, middle, and high school) and also for parents who want their children to find success with literacy.

Research implications – In recent years “scaling up” and “scientific research” have come to dominate much of the literacy research landscape. While we see the value and necessity of large-scale experimental studies, we also posit that literacy centers have a unique role to play. Given that resources are scarce, literacy scholars must maximize the affordances of literacy centers as rich, productive research sites for the use and study of a reflective video pedagogy.

Many mental health clinicians have delivered services digitally in response to the COVID-19 pandemic. Emerging research suggests that, despite some initial discomfort, therapists appear to adjust to remote working. The purpose of this study is to explore the views of clinicians working within a fully digital organisation towards digital service provision.

Clinicians (N = 52) providing digital mental health assessments and treatments at Healios anonymously completed a mixed-methods questionnaire.

In all, 85% of participants enjoyed working remotely and 71% thought they would continue to work online over the next 5–10 years. Of the participants, 40% reported low confidence in online work’s efficacy before working remotely, but 96% reported confidence at the time of questionnaire completion: suggesting confidence increased with experience. An exploratory “inverted” factor analysis generated a two-factor solution, grouping clinicians into two factors based on key views. Factor 1 was predominantly characterised by satisfaction with training received and factor 2 by quality of technical experiences (encountering problems less often and greater personal confidence in resolving them). Qualitative feedback described some benefits of, and barriers to, digital service provision. Clinicians reflected on a perceived change in cultural norms, with more openness to digital services following the COVID-19 pandemic. On a personal level, teletherapy was viewed more favourably with increased personal experience.

Clinicians’ confidence in providing services digitally is discussed, with reference to how this may be affected by extent of remote working experience and availability of technical support. Staff well-being within the digital workspace is also discussed.

Virtual care is any interaction between a patient and clinician or clinicians, occurring remotely using information technologies. Like many international services, United Kingdom (UK) ambulance services use paramedics and nurses to undertake telephone assessments of patients calling the 999 emergency service line. Using their clinical knowledge, experience, and, at times, computer decision support software, these clinicians assess patients from a range of clinical acuities to confirm the need for an emergency response or identify and support those patients who can be cared for with remote treatment advice and referral. The Covid-19 pandemic saw UK ambulance services change and adapt their operating models to meet social distancing requirements, increase clinical staff numbers and mitigate staff becoming unavailable for work due to self-isolation. One such strategy was moving clinicians from Emergency Operations Centres (EOCs) to working at home. Staff utilised digital phone systems, remote computer-aided dispatch modules, remote clinical decision support software and video platforms, which allowed close to full functionality compared to inside typical EOCs. There is a dearth of literature exploring the comparative practice of clinicians from home rather than from EOCs. Therefore, this study reports the findings of a qualitative analysis of these effects from the clinician's perspective. The authors hope that the findings from this study will inform the operating, education and leadership practices of those delivering such services.

A convenience sample of telephone nurses and paramedics from one UK ambulance service in which home working had been implemented were contacted. 15 clinicians with recent home working experience responded to the invite out of a possible 31 (48%). All participants had previously practised remote assessment from within an EOC. Semi-structured interviews took place via video conferencing software and were recorded, transcribed and thematically analysed. An inductive approach was taken to generating codes and both researchers separately reading the transcripts before re-reading them, assigning initial themes and determining frequency.

Four main themes were identified with further associated sub-themes: (1) performance, (2) support, (3) distractions and interruptions and (4) confidence in decision-making.

There are very few studies exploring the practice of remote clinicians in emergency EOCs. This study identified that home working clinicians felt their productivity had increased, making them more satisfied in their practice. However, there were mixed feelings over the level of support they perceived they now received, despite the mechanisms of support being largely the same. Supervisors found it especially challenging to provide support to practitioners; and employers might need to clarify the support mechanisms they provide to homeworkers. The elimination of distractions and interruptions was seen as a largely positive result of homeworking; however, these interruptions were not seen as inappropriate, thus, identifying a need for role clarity and task coordination rather than interruption elimination. Finally, clinicians felt that they become more confident when working from home, researching more, trusting themselves more and relying less on others to reach safe outcomes. However, there were missed opportunities to learn from listening to others' clinical practice.

This paper aims to evaluate service user (SU) and clinician acceptability of video care, including future preferences to inform mental health practice during COVID-19, and beyond.

Structured questionnaires were co-developed with SUs and clinicians. The SU online experience questionnaire was built into video consultations (VCs) via the Attend Anywhere platform, completed between July 2020 and March 2021. A Trust-wide clinician experience survey was conducted between July and October 2020. Chi-squared test was performed for any differences in clinician VC rating by mental health difficulties, with the content analysis used for free-text data.

Of 1,275 SUs completing the questionnaire following VC, most felt supported (93.4%), and their needs were met (90%). For future appointments, 51.8% of SUs preferred video, followed by face-to-face (33%), with COVID-related and practical reasons given. Of 249 clinicians, 161 (64.7%) had used VCs. Most felt the therapeutic relationship (76.4%) and privacy (78.7%) were maintained. Clinicians felt confident about clinical assessment and management using video. However, they were less confident in assessing psychotic symptoms and initiating psychotropic medications. There were no significant differences in clinician VC rating by mental health difficulties. For future, more SUs preferred using video, with a quarter providing practical reasons.

The study provides a real-world example of video care implementation. In addition to highlighting clinician needs, support at the wider system/policy level, with a focus on addressing inequalities, can inform mental health care beyond COVID-19.

Virtual reality (VR) is a novel technology that could be used in the assessment and/or treatment of deliberate firesetting. This study aims to develop an understanding of clinicians’ views of VR for deliberate firesetting, to identify areas where VR could potentially add value to current practice and any particular barriers to using VR in this context.

Through an online survey, 73 clinicians rated their agreement with nine potential benefits of using VR for firesetting and 11 potential barriers to using it. They also provided free text responses detailing the greatest perceived potential benefit and the greatest perceived barrier. Factors related to intent to use VR for firesetting in the future were explored.

Clinicians perceived the ability to safely expose clients to fire-related stimuli to be highly beneficial. However, clinicians were concerned about the possibility of re-traumatisation and logistic barriers. Previous experience of using VR with individuals who have set fires was significantly related to using it in the future.

Further research establishing the feasibility and effectiveness of using VR with individuals who have set fires may help alleviate clinicians’ concerns. Increasing opportunities for clinicians to experience a firesetting VR programme may widen the implementation of firesetting VR.

Previous research has only focused on clinicians’ perceptions of VR in the general field of forensic mental health and has failed to consider offence-specific applications.

The Department of Health and the National Health Service (NHS) Future Focused Finance (FFF) programme promotes effective engagement between clinical and finance staff. Surveys undertaken by the Department of Health between 2013 and 2015 found few NHS Trusts reported high levels of engagement. The purpose of this paper is to gain a better understanding of current working relationships between NHS clinical and finance professionals and how they might be supported to become more effective.

Ipsos MORI were commissioned by the NHS FFF programme to undertake an online survey of NHS clinical and finance staff between June and August 2015.

The majority of clinicians had a member of a finance team linked to their speciality or directorate. Clinical and finance professionals have a positive view of joint working preferring face-to-face contact. Clinician’s confidence in their understanding of finance was generally good and finance staff felt they had a good understanding of clinical issues. Effective working relationships were facilitated by face-to-face contact, a professional relationship, and the availability of clear, well presented finance and activity data.

Data protection issues limited the accessibility of the survey team to NHS staff resulting in a relatively low-response rate. Other forms of communication, including social media, were utilised to increase access to the survey.

The FFF programme is a unique programme aimed at making the NHS finance profession fit for the future. The close partnering work stream brings together the finance and clinical perspective to share knowledge, evidence, training, and to develop good practice and engagement.

Although the benefits of clinician researchers for health services are now more clearly recognised, their career development is not well understood. Hence, the purpose of this paper, a scoping review, is to determine what has been discussed in the literature about career opportunities for allied health (AH) clinician researchers in health services.

A structured literature search was completed in December 2020 for literature published 2010–2020 in English. A total of 2,171 unique abstracts were found and screened by two reviewers and 206 articles progressed to full text screening.

Forty-six studies were ultimately included; however, only two of these had aims directly related to AH clinician researcher careers, with the remainder containing only incidental data on this topic. Over half (56.5%) of the included studies were conducted in Australia, with a variety of AH professions represented. In terms of research design, 52.2% used cross-sectional survey designs, while case studies and qualitative research designs were also common. Key observations were that varying terminology and definitions were used, and there was little information about the inclusion of research in clinical positions or opportunities for formal clinical researcher positions in health services. There was some evidence to support that there are limited career opportunities after PhD completion, and that current career pathways are insufficient. There was conflicting evidence on whether engagement in research is beneficial for clinical career progression.

This review highlights a lack of research on this topic and outlines future directions to better support career pathways for AH clinician researchers.

The purpose of this paper is to examine how knowledge exchange between academics and clinicians in Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) is influenced by their social position based on their symbolic and social capitals, that is, their personal professional status and connections to high-status professional peers, knowledge brokers, and unfamiliar professional peers.

Using an online survey, the author triangulates the cross-sectional measurement of the effects of academic and clinicians’ social position in the initial and later phases of CLAHRCs with the longitudinal measurement of these effects over a two-year period.

First, academics and clinicians with a higher personal professional status are more likely to develop joint networks and decision making both in the early and later phases of a CLAHRC. Second, academics and clinicians who are more connected to higher status occupational peers are more likely to develop joint networks in the early phase of a knowledge exchange partnership but are less likely to become engaged in joint networks over time. Third, involvement of knowledge brokers in the networks of academics and clinicians is likely to facilitate their inter-professional networking only in the later partnership phase.

Academics and clinicians’ capitals have a distinctive influence on knowledge exchange in the early and later phases of CLAHRCs and on a change in knowledge exchange over a two-year period.

Prior research on CLAHRCs has examined how knowledge exchange between academics and clinicians can be encouraged by the creation of shared governance mechanisms. The author advances this research by highlighting the role of their social position in facilitating knowledge exchange.