Search results

Worldwide, healthcare systems struggle to sustain the delivery of services at a time of increasing demand, limited resources and growing expectations from users, coupled with dealing with the aftermath of the Covid-19 pandemic and the threat of other outbreaks. There has never been a more important time to sustain innovation and improvements. Using an illustrative case, the authors assess the application of two existing frameworks to identify the key propositions and dimensions required to deliver sustainable services.

This illustrative case study focuses on a service provided by a chronic disease, multidisciplinary community healthcare team in the UK. Experienced-based interviews were conducted with health professionals, patients and relatives to provide a rich account of a care pathway design. A high-level process map is used to visualise the key touch points.

The authors identify all seven propositions of the SERVICE framework being present along with additional dimensions relating to sustaining innovation and improvement.

This research is limited to a chronic disease care pathway. However, the authors believe the results could be applicable to other medical conditions, which are supported by a similar multi-disciplinary service delivery model.

The authors provide a sustainable public service operations SERVICES framework for health professionals and managers to consider when (re)designing care pathways.

This research contributes to the emerging discipline of public service operations research by empirically testing for the first time the SERVICE framework within healthcare. The authors have included additional factors associated with innovation and improvement and recommended further development of the framework to include factors, such as economic sustainability, highly relevant to the context of universal healthcare systems.

Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes. However, these tasks are not systematically managed and are often extended due to missing information or equipment or staff unavailability. This research aims to assess whether ward rounds can be structured more efficiently and effectively from the perspective of patients and staff.

This mixed-method approach examines the ward rounds conducted in three units within a haematology department of a major Danish hospital. Baseline measures were collected to capture the value of the ward round described by patients and staff. The information on patient and equipment flows associated with a typical ward round was mapped with recommendations for improvement.

Staff aspired to deliver a good-quality ward round, but what this meant was never articulated and there were no established standards. The duration of the ward round was unpredictable and could take 6 hours to complete. Improvements identified by the team allow the ward rounds to be completed by mid-day with much more certainty.

This research provides an insight as to how ward rounds are conducted within a Danish haematology department.

The research has implications for those involved in ward rounds to reduce the time taken whilst maintaining quality and safety of patient care.

This research has implications for patients and their families who wish to spend time with consultants.

Previous research has focused on the interactions between doctors and nurses. This research focuses on the operational process of the ward round and presents a structured approach to support multi-disciplinary teams with a focus on value from the patient’s perspective.

One overlooked determinant of interprofessional teamwork is the mobilisation of professional identity. Taking a health or social care practitioner out of their professional silo and placing them in an interprofessional team setting will challenge their professional identity. The theory of signature pedagogy was used to investigate the challenges and what is needed to support practitioners to mobilise their professional identity to maximise teamwork.

A cross-sectional mixed methods study was undertaken in the form of three focus groups, with members of health and social care teams in Wales, UK. Using nominal group technique, participants explored and ranked the challenges and benefits of mobilising their professional identity within an interprofessional setting.

Findings on mobilising professional identity were found to be aligned closely with the three signature pedagogy apprenticeships of learning to think and to perform like others in their profession and to act with moral integrity. The biggest challenge facing practitioners was thinking like others in their profession while in an interprofessional team.

The focus of this study is health and social care teams within Wales, UK, which may limit the results to teams that have a similar representation of professionals.

Healthcare leaders should be aware of the opportunities to promote mobilisation of professional identity to maximise teamwork. For example, at induction, by introducing the different roles and shared responsibilities. Such practical implications do have consequences for policy as regards interprofessional team development and organisational commitments to adult learning and evaluation.

This is the first study of professional identity of interprofessional healthcare and social professionals using signature pedagogy to gain a better understanding of teamwork.

It has become accepted practice to include an evaluation alongside learning programmes that take place at work, as a means of judging their effectiveness. There is a tendency to focus such evaluations on the relevance of the intervention and the amount of learning achieved by the individual. The aim of this review is to examine existing evaluation frameworks that have been used to evaluate education interventions and, in particular, assess how these have been used and the outcomes of such activity.

A scoping review using Arskey and O’Malley’s five stage framework was undertaken to examine existing evaluation frameworks claiming to evaluate education interventions.

Forty five articles were included in the review. A majority of papers concentrate on learner satisfaction and/or learning achieved. Rarely is a structured framework mentioned, or detail of the approach to analysis cited. Typically, evaluations lacked baseline data, control groups, longitudinal observations and contextual awareness.

This review has implications for those involved in designing and evaluating work-related education programmes, as it identifies areas where evaluations need to be strengthened and recommends how existing frameworks can be combined to improve how evaluations are conducted.

This scoping review is novel in its assessment and critique of evaluation frameworks employed to evaluate work-related education programmes.

This research examines how knowledge and information are managed within two care networks. We develop a conceptual framework drawing on the notion of brokering and the 3T framework, which is used to describe the relative complexity of boundaries (referred to in the framework as syntactic, semantic and pragmatic) as well as capabilities and processes required to exchange information within the network. Previous research on brokering has focused on healthcare managers and professionals, but this research extends to patients and caregivers. Understanding knowledge exchange and brokering practices in healthcare is critical to the delivery of effective services.

For this case research, non-participant observation and experienced-based interviews were undertaken with healthcare professionals, patients and caregivers within two care networks.

The findings reveal brokering roles occupied by healthcare professionals, patients and caregivers support the transfer, translation and transformation of knowledge and information across functional and organisational boundaries. Enablers and disablers to brokering and the exchange of knowledge and information are also identified.

The study is limited to two care networks for long-term conditions within the UK. Further research opportunities exist to examine similar care networks that extend across professional and organisational boundaries.

This research informs healthcare professionals of the brokering capabilities that occur within networks and the enabling and disabling factors to managing knowledge across boundaries.

This paper provides a conceptual framework that categorises how increased levels of knowledge and information exchange and brokering practices are managed within care networks.

Integrated care has been identified as essential to delivering the reforms required in health and social care across the UK and other healthcare systems. Given this suggests new ways of working for health and social care professionals, little research has considered how different professions manage and mobilise their professional identity (PI) whilst working in an integrated team. The paper aims to discuss these issues.

A qualitative cross-sectional study was designed using eight focus groups with community-based health and social care practitioners from across Wales in the UK during 2017.

Participants reported key factors influencing practice were communication, goal congruence and training. The key characteristics of PI for that enabled integrated working were open mindedness, professional trust, scope of practice and uniqueness. Blurring of boundaries was found to enable and hinder integrated working.

This research was conducted in the UK which limits the geographic coverage of the study. Nevertheless, the insight provided on PI and integrated teams is relevant to other healthcare systems.

This study codifies for health and social care practitioners the enabling and inhibiting factors that influence PI when working in integrated teams.

Recommendations in terms of how healthcare professionals manage and mobilise their PI when working in integrated teams are somewhat scarce. This paper identifies the key factors that influence PI which could impact the performance of integrated teams and ultimately, patient care.

The purpose of this paper is to investigate patient perspectives on attending pulmonary rehabilitation (PR). This qualitative case study identifies the benefits and challenges to attending PR and presents areas of improvements as recommended by patients.

A qualitative case study of a UK case study based on a PR programme based on undertaking focus groups (n=3) and interviews (n=15) with current and former patients.

The findings report patient perspectives of the challenges and benefits of attending a PR programme along with recommendations on how the service could be improved.

The authors focussed solely on a UK PR programme, so the findings might not be applicable to other countries if PR is organised and provided in a unique way or setting.

This paper provides valuable insights to patient perspectives offrom patients attending PR programmes, which are useful to those running and designing these services.

The findings identify the benefits and challenges for patients attending PR programmes and suggest areas where improvements can be made.

Globally, healthcare managers continue to struggle with increasing demands for their services being delivered with limited or shrinking resources. It is, therefore, clear that systems, processes and practices need to change to meet these challenges. The purpose of this paper is to assess how integrating two improvement technologies, Lean and integrated care pathways (ICP) might help.

Lean and ICP in healthcare provide a platform to develop conceptual frameworks for integrating two approaches.

A conceptual integrated framework is provided to assist care pathway designers and implementers to consider the synergistic benefits of combining approaches to improvement.

The authors provide a conceptual framework that requires empirically testing.

This research provides a conceptual framework to aid practitioners to improve healthcare design and delivery.

For the first time, the authors bring together two approaches to improving patient care pathway design and consider how these are linked in relation to improving healthcare delivery.

Quality improvement collaboratives (QICs) are a popular approach to improving healthcare services and patient outcomes. This paper evaluates a QIC implemented by a large, integrated healthcare organisation in Wales in the UK.

This evaluation study draws on two well-established evaluation frameworks: Kirkpatrick's approach to gather data on participant satisfaction and learning and Stake's approach to gather data and form judgements about the impact of the intervention. A mixed methods approach was taken which included documentary analysis, surveys, semi-structured interviews, and observation of the QIC programme.

Together the two frameworks provide a rounded interpretation of the extent to which the QIC intervention was fit-for-purpose. Broadly the evaluation of the QIC was positive with some areas of improvement identified.

This study is limited to a QIC conducted within one organisation. Further testing of the hybrid framework is needed that extends to different designs of QICs.

A hybrid framework is provided to assist those charged with designing and evaluating QICs.

Evaluation studies are limited on QICs and if present tend to adopt one framework. Given the complexities of undertaking quality improvement within healthcare, this study uniquely takes a hybrid approach.

The purpose of this paper is to describe current care pathways for children with autism including enablers and barriers, as experienced by health professionals, education professionals and families in South Wales, UK.

This study is based on a mixed-methods approach using focus group discussions, creative writing workshops and visualisation using rich pictures.

The experiences of the care pathways differed significantly across the three groups. Health professionals described the most rigidly structured pathways, with clear entry points and outcomes. Education professionals and parents described more complex and confusing pathways, with parents assuming the responsibility of coordinating the health and education activity in a bid to link the two independent pathways. All three groups identified enablers, although these differed across the groups. The barriers were more consistent across the groups (e.g. poor communication, missing information, lack of transparency, limited post-diagnosis services and access to services based on diagnosis rather than need).

This research could inform the design of new services which are premised on multi-agency and multi-disciplinary working to ensure children with Autism spectrum disorders (ASD) receive joined up services and support.

Although this study did not represent all professional groups or all experiences of autism, the authors examined three different perspectives of the ASD pathway. In addition, the authors triangulated high-level process maps with rich pictures and creative writing exercises, which allowed the authors to identify specific recommendations to improve integration and reduce duplication and gaps in provision.