Research into practice : collaboration for leadership in applied health research and care (CLAHRC) for Nottinghamshire, Derbyshire, Lincolnshire (NDL)

To address the problem of translation from research-based evidence to routine healthcare practice, the Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire, and Lincolnshire (CLAHRC-NDL) was funded by the National Institute for Health Research as one of nine CLAHRCs across England. This paper outlines the underlying theory and its application that CLAHRC-NDL has adopted, as a case example that might be generalised to practice outside the CLAHRC, in comparison to alternative models of implementation

Translating research findings into practice: example of treatment services for adolescents in managed care.

An important question in the alcoholism treatment field is how research findings can be translated into real-world clinical practice. Researchers have developed a new research-practice integration (RPI) model that can both drive the formulation of studies and new research questions and promote improvements in treatment quality. The hallmark of this model is a collaborative relationship between the key stakeholders in both alcohol and other drug (AOD) treatment and research, including health plan administrators and clinicians, treatment program administrators, psychiatry and primary care departments, patients and their families, purchasers, and researchers. The issue of technology transfer is especially relevant in the realm of adolescent AOD treatment. The implementation and feasibility of the RPI model are illustrated by a case study of a managed health care plan's treatment services for adolescents with AOD dependence. In this setting, key research findings are being used to shape the plan's adolescent health services

Mental health nurses' encounters with occupational health services

This is a pre-copyedited, author-produced version of an article accepted for publication in Occupational Medicine following peer review. Under embargo until 16 June 2019. The version of recordJ. Oates, J. Jones, and N. Drey, ‘Mental health nurses’ encounters with occupational health services’, Occupational Medicine, kqy084, (2018), is available online at: https://doi.org/10.1093/occmed/kqy084.Background: Staff wellbeing is vital to the functioning of the UK National Health Service (NHS). Mental health nurses with personal experience of mental illness can offer a professionally and personally informed insight into the occupational health service offered by their employer. Aims: To investigate mental health nurses’ views of occupational health provision in the NHS, based on their personal experience. Methods: A qualitative interview study using a purposive sample of mental health nurses with personal experience of mental illness. Results: Twenty-seven mental health nurses met the inclusion criteria. Thematic analysis identified three themes: comparisons of ‘relative expertise’ between the mental health nurse and the occupational health clinician; concerns about ‘being treated’ by a service at their work; and ‘returning to work’. Conclusion: Occupational health provision in mental health settings must take account of the expertise of its staff. Further research, looking at NHS occupational health provision from the provider perspective is warranted.Peer reviewe

What can a participatory approach to evaluation contribute to the field of integrated care?

© 2017 BMJ Publishing Group. All rights reserved. Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground. In this paper we present a methodological approach, based on the principles of participatory research, that attempts to address this challenge. Participatory approaches are characterised by a desire to use social science methods to solve practical problems and a commitment on the part of researchers to substantive and sustained collaboration with relevant stakeholders. We describe how we applied an emerging practical model of participatory research, the researcher-in-residence model, to evaluate a large-scale integrated care programme in the UK. We propose that the approach added value to the programme in a number of ways: by engaging stakeholders in using established evidence and with the benefits of rigorously evaluating their work, by providing insights for local stakeholders that they were either not familiar with or had not fully considered in relation to the development and implementation of the programme and by challenging established mindsets and norms. While there is still much to learn about the benefits and challenges of applying participatory approaches in the health sector, we demonstrate how using such approaches have the potential to help practitioners integrate care more effectively in their daily practice and help progress the academic study of integrated care

Evaluating empowerment and control of HE e-learning in a secure environment

With the increased spread of HE distance learning into a wide variety of contexts it is important for us to understand the factors involved in its successful deployment for students. E-learning has a great potential to support effective and empowering HE distance learning (Wilson, 2007; Adams, 2005; Hughes, 2005). However, within two secure environments, prisons and health service, the factors involved are complex. This paper reviews HE e-learning technology perceptions within these two contrasting contexts from 225 students' and stakeholders' perspectives. Previous research has detailed literature limitations on obtaining students' perspectives of e-learning (Conole et al, 2006). These limitations are compounded when other stakeholder perceptions are not integrated (Sun et al, 2007; Adams et al, 2005; Millen at al, 2002). This paper developed and applied an e-learning framework for student and stakeholder perceptions. This social psychological framework, is based on previous practice based e-learning studies and is used here to synthesise two large-scale case studies. The framework focuses on three concepts learner Access (e.g. learning design, technology design, physical access), Awareness (e.g. of resources, their usage and support for e-learning tasks) and Acceptability (e.g. trust, privacy, aesthetics, engagement). Students' and stakeholders' perceptions identified high levels of students' empowerment through e-learning whilst still requiring a further pedagogical tailoring and an awareness of support. However, serious problems within these contexts have identified blocks to e-learning through stakeholders perceptions and fears of acceptability (i.e. issues of risk and trust). Ultimately, through understanding competing perceptions and needs within these complex environments we can support the effective technological development, pedagogical design and deployment of e-learning systems

Bringing genetics into primary care: findings from a national evaluation of pilots in England

Objectives: Developments in genetic knowledge and clinical applications are seen as rendering traditional modes of organizing genetics provision increasingly inappropriate. In common with a number of developed world countries the UK has sought to increase the role of primary care in delivering such services. However, efforts to reconfigure service delivery face multiple challenges associated with divergent policy objectives, organizational boundaries and professional cultures. This paper presents findings from an evaluation of an English initiative to integrate genetics into 'mainstream' clinical provision in the National Health Service. Methods: Qualitative research in 11 case-study sites focusing on attempts by pilots funded by the initiative to embed knowledge and provision within primary care illustrating barriers faced and the ways in which these were surmounted. Results: Lack of intrinsic interest in clinical genetics among primary care staff was compounded by national targets that focused their attention elsewhere and by service structures that rendered genetics a peripheral concern demanding minimal engagement. Established divisions between the commissioning of mainstream and specialist services, along with the pressures of shorter-term targets, impeded ongoing funding. Conclusions: More wide-ranging policy and organizational support is required if the aim of entrenching genetics knowledge and practice across the Health Service is to be realized

Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

BACKGROUND: The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners. METHODS: The aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation. RESULTS: A continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a 'positive narration' of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals' levels. CONCLUSIONS: The PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours

Healthcare services managers: what information do they need and use?

Objectives: To gain insight into the information behaviour of healthcare services managers as they draw on information while engaged in decision making unrelated to individual patient care. Objectives – The purpose of this research project was to gain insight into the information behaviour of healthcare services managers as they use information while engaged in decision-making unrelated to individual patient care. Methods – This small-scale, exploratory, multiple case study used the critical incident technique in nineteen semi-structured interviews. Responses were analyzed using ‘Framework,’ a matrix-based content analysis system. Results – This paper presents findings related to the internal information that healthcare services managers need and use. Their decisions are influenced by a wide variety of factors. They must often make decisions without all of the information they would prefer to have. Internal information and practical experience set the context for new research-based information, so they are generally considered first. Conclusions – Healthcare services managers support decisions with both facts and value-based information. These results may inform both delivery of health library services delivery and strategic health information management planning. They may also support librarians who extend their skills beyond managing library collections and teaching published information retrieval skills, to managing internal and external information, teaching information literacy, and supporting information sharing

Growing Up Healthy in Minnesota

An evaluation of the Blue Cross and Blue Shield of Minnesota Foundation's Growing Up Healthy Program. In spring 2002, the Blue Cross and Blue Shield of Minnesota Foundation made grants to nine organizations around the state to improve access to and use of preventive medical and dental services for children and teens. Focused particularly on the needs of immigrant communities and communities of color, the $1.4 million Growing Up Healthy program aimed ultimately to improve the health of Minnesotans at highest risk for lifelong health disparities.In keeping with the goals of the initiative, over 90 percent of children who received or were connected with a preventive health or dental exam were in communities of color. Growing Up Healthy reached an estimated 17,500 people in two years