Search results

This paper highlights the need for researchers to work across disciplinary boundaries in order to capture the complexity that care practitioners have to engage with everyday in care home settings. Drawing on findings from a literature review on the complexity of loss in continuing care institutions for older people, the case is made for less victim blaming and more appreciative approaches to research. The way this thinking informed the development of a further literature review on quality of life in care homes (My Home Life) is discussed. Findings from this second study are shared by illustrating key messages with quotes from older residents, relatives and staff living, visiting and working in care homes. These best practice messages focus on: transition into a care home; working to help residents maintain their identity; creating community within care homes; shared decision‐making; health and health services; end‐of‐life care; keeping the workforce fit for purpose, and promoting positive culture. The importance of collaborative working in both research and practice is discussed. The paper is likely to be of interest to all those concerned with improving and developing evidence‐based practice in the care home sector, including users and service providers, managers, commissioners and inspectors, policy‐makers, researchers and teachers.

The current policy context demands that health service providers demonstrate that services are effective, efficient, value for money and of good quality. Recent Government interest in intermediate care has increased pressure on day hospitals in particular to supply such evidence, because they face competition for their core services (such as rehabilitation care) from other community‐based providers. This review was conducted as part of a small study to evaluate a day hospital service in North London. Findings suggest that the outcomes of day hospital care are especially difficult to appraise because of the highly variable nature of both individual facilities and the needs and capabilities of patients attending. Traditional quantitative methods, such as randomised controlled trials or the use of standardised tools to assess treatment outcomes, face severe methodological problems owing to this variability. Three problems in particular would appear to hamper such research: comparability difficulties, owing to great variations in facilities and patient profiles; defining outcomes, because varying need may result in very different intended treatment outcomes, and determining complete costs, because patients rarely receive day hospital treatment in isolation from other health and social care services. The review suggests therefore that future researchers take a more user‐focused and qualitative research approach to the evaluation of day hospital care, such as by evaluating joint care plans with patients and staff, by assessing costs, by following small numbers of users through treatment and by studying users' and carers' views of (and preferences for) care.

A growing older population with complex care needs, including dementia, are living in care homes. It is important to support researchers in conducting ethical and appropriate work in this complex research environment. The purpose of this paper is to discuss key issues in care homes research including examples of best practice. The intention is to inform researchers across disciplines, leading to more sensitive and meaningful care home research practice.

Experienced care homes researchers were invited to provide methodological insights and details not already reported in their publications. These have been analysed, creating key themes and linked to project publications.

The need for reflexivity was a key finding. In particular, researchers need to: appreciate that the work is complex; see participants as potential research partners; and consider how cognitive and physical frailty of residents, staffing pressures and the unique environments of care homes might impact upon their research. Other challenges include recruitment and consenting people who lack mental capacity.

As the care homes research landscape continues to develop and grow, there still remains limited reflection and discussion of methodological issues with a need for a “safe space” for researchers to discuss challenges.

This review is an updated methodological guide for care homes researchers, also highlighting current gaps in the mechanisms for continuing to share best research practice.

CardioPharm is a public interactive health promotion software for use by customers visiting community pharmacies. The program gives advice on reducing the risk of cardiovascular disease, requiring the user to input various details of their lifestyle, with particular attention to diet. The user is asked questions about their fibre, fruit and vegetables, and fat intake. A brief risk assessment is then provided and further advice given. The user is encouraged to consult health promotion leaflets provided at the side of the computer kiosk, or ask the pharmacist for more detailed information. CardioPharm has been designed and developed in a multimedia format incorporating sound, video and touch screen. This format allows easier access to the information and makes learning easier for the user.

This paper seeks to present findings from a longitudinal action research study aimed at exploring one such innovation. Little is known about the micro‐level impact of health service innovations over time.

The paper shows that action research is a participatory approach ideally suited to monitoring the process and outcomes of change. Over 20 months, an action researcher studied the work of four interprofessional care co‐ordinators (IPCCs), whose role was intended to speed patient through‐put within a London teaching hospital general medical directorate. The action researcher kept regular participant observation field notes and supplemented these data with a profile of IPCC patients (n=407), in‐depth interviews (n=37) and focus groups (n=16) with staff. Throughout the study, findings were regularly fed back to participants to inform practice developments.

The findings in this paper show that, in spite of the original intention for this role to provide clerical support to the multidisciplinary team, over time the role shifted beyond its implementation into practice to take on more complex work from registered nurses. This raised actual and potential governance issues that were not attended to by service managers. A complex and turbulent context disrupted managers' and practitioners' abilities to reflect on and respond to these longer‐term role shifts.

This paper argues that the complex nature of the innovation and the setting in which it operated account for the role shift and the lack of attention to issues of governance. Current innovation literature suggests that implementation into routine practice represents the end‐point of an innovation's journey. These findings suggest that certain innovations may in fact continue to shift in nature even after this “end‐point”. The conclusions drawn are likely to be of global interest to those interested in complex health service innovations.

The purpose of this paper is to examine critically the concept of “leadership transmission”, considering what theoretical and practical value this metaphor brings to the healthcare modernization agenda.

The paper develops understanding of the transmission metaphor, whilst theoretical perspectives on leadership are reviewed, including debates, which shed light on the concept by focusing on the phenomenon of distributed or dispersed leadership.

The transmission metaphor is perhaps misleading, by implying that “leadership can be caught” like a disease. However, defining leadership in terms of influence, a novel typology of transmission processes is introduced; top down (one‐way), inter‐organizational (bi‐lateral), and dispersed (multi‐directional). Recent research suggests that organizational changes are often led by the spontaneous concertive action of staff at all levels, not just by senior élite groups. The way in which dispersed influence processes arise, unfold, and are transmitted into organizational outcomes can be understood through theoretical narratives, which capture event sequences and combinations of factors unfolding over time in a given context. Given the scale and pace of the change agenda, healthcare modernization may indeed depend on widely dispersed leadership.

It is therefore necessary to establish the conditions in which leadership transmission is encouraged, to recognize, support, and develop the “unsung heroes” who assume change leadership positions, and to widen the agenda and coverage of NHS leadership development programmes.

There is currently no other commentary, empirical or theoretical, academic or professional, which examines critically the concept of leadership transmission, while exploring the nature of this perspective, and its theoretical and practical value.