Shaping the future for primary care education and training project. Finding the evidence for education & training to deliver integrated health and social care: the primary care workforce perspective

This report is one of a series of outputs from the Shaping the Future in Primary Care Education and Training project (www.pcet.org.uk) funded by the North West Development Agency (NWDA). It is the result of a collaborative initiative between the NWDA, the North West Universities Association and seven Higher Education Institutions in the North West of England. The report presents an evidence base drawn from the analysis of the experiences and aspirations of integrated health and social care, as reported by members of the current primary health and social care workforce working in or with Primary Care Trusts (PCTs) in the North West region

Evaluation of the organisation and delivery of patient-centred acute nursing care

In 2002, a team of researchers from the School of Nursing, University of Salford were commissioned by Bolton Hospitals NHS Trust to evaluate the delivery and organisation of patient-centred nursing care across the acute nursing wards within the Royal Bolton Hospital. The key driver for the commissioning of this study arose from two serious untoward incidents that occurred in the year 2000. Following investigation of both these events the Director of Nursing in post at that time believed that poor organisation and delivery of care may have been a contributory factor. Senior nurses in the Trust had also expressed their concern that care may not be organised in a way that made best use of the skills available

Therapists’ experiences and perceptions of teamwork in neurological rehabilitation: Critical happenings in effective and ineffective teamwork

This article reports the second part of an exploratory study into occupational therapists` and physiotherapists` perceptions and experiences of team-work in neurological rehabilitation: the factors that were thought to influence effective and ineffective team-work, and the meaning behind effective and ineffective team work in neurological rehabilitation. The study was undertaken through semi-structured interviews of 10 therapists from three different neurological rehabilitation teams based in the United Kingdom, and used the critical incident technique. Through analysis of the data, several main themes emerged regarding the perceived critical happenings in effective and ineffective team work. These were: team events and characteristics, team members` characteristics, shared and collaborative working practices, communication, specific organisational structures, environmental, external, and patient and family related factors. Effective and ineffective team-work was perceived to impact on a number of levels: having implications for the team, the patient, individual team members, and the neurological rehabilitation service. The study supported the perceived value of team work within neurological rehabilitation. It also indicated the extensive and variable factors that may influence the team working process as well as the complex and diverse nature of the process

Opportunities, challenges and learnings from qualitative research with stakeholders in frailty in three European countries

The aims of this paper are to reflect upon the experiences of researchers involved in a cross-national qualitative study with stakeholders in three European countries (Italy, Poland and UK), within the context of the FOCUS project on frailty management and optimisation (see http://focus-aha.eu/en/home). Six researchers’ reflections were gathered using open-ended questions. Responses were thematically analysed. We report on our team diversity including cultural differences in epistemological stances and describe how working remotely challenged clear communication. We comment on linguistic issues, our data collection approaches and methods of analysis. However, we also reflect upon the ability of such projects to build knowledge, generate capacity and promote the value of qualitative research in healthcare across Europe. Finally, we advocate an approach to cross-national research that is as much about building a cohesive knowledge exchange network as it is about understanding the lives, perspectives and experiences of our stakeholders

Disease Surveillance Networks Initiative Africa: Final Evaluation

The overall objective of the Foundation's Disease Surveillance Networks (DSN) Initiative is to strengthen technical capacity at the country level for disease surveillance and to bolster response to outbreaks through the sharing of technical information and expertise. It supports formalizing collaboration, information sharing and best practices among established networks as well as trans-national, interdisciplinary and multi-sectoral efforts, and is experienced in developing and fostering innovative partnerships. In order to more effectively address disease threats, the DSN has four key outcome areas:(1) forming and sustaining trans-boundary DSN;(2) strengthening and applying technical and communication skills by local experts and institutions;(3) increasing access and use of improved tools and methods on information sharing, reporting and monitoring; and(4) emphasizing One Health and transdisciplinary approaches to policy and practice at global, regional and local levels

Integrating Students into Interdisciplinary Health and Health Disparities Research Teams

Major initiatives by the U.S. Department of Health and Human Services as well as the World Health Organization have produced a large and compelling body of evidence on how to reduce health disparities, which entails having a clear understanding of how social factors shape health and healthcare outcomes. Specifically, there is a need for healthcare professionals to understand social determinants of health (e.g., low socioeconomic status, lack of health insurance, and poor education) and how these lead to disparities in health for people of minority racial and ethnic groups. Little is known about how students are developed as health disparities researchers or how their research experiences impact their views about addressing social determinants of health as a career goal. The purpose of this paper is to describe how health and human sciences students were integrated into three minority HIV prevention and testing projects using the lifelong learning for health professionals (LLHP) principles and activities framework, which entails a focus on: (a) education, (b) community, and (c) organization in the planning, development, implementation, and evaluation of interdisciplinary research

Drawing a line in the sand: Autism diagnosis as social process

This PhD explored how clinicians make diagnostic decisions about autism in secondary care. Symptoms of autism are considered to be widely heterogeneous, meaning that decisions about where the diagnostic threshold lies can be challenging. Diagnosis in the UK is usually undertaken by multi-disciplinary teams (MDTs) and can involve numerous stages of decision-making in different contexts across an extended time period. The process of diagnosis is complex and multi-faceted, and can be particularly challenging when cases are considered ‘borderline’ or where there are coexisting conditions. A qualitative approach was used in four studies. A narrative review of twenty-one clinical guidelines was conducted (study one); observation of eighteen assessment team meetings on four sites was undertaken (studies two and three); and sixteen interviews were conducted with clinicians engaged in autism diagnosis (study four). The narrative review found that guidelines varied in recommendations for assessment procedures and provided no guidance as to how MDT meetings should be facilitated. Guidelines highlighted utilising clinical judgement, valuing experience and dealing with contradiction and uncertainty. A thematic analysis of observation data found that clinicians produce objective accounts through their situated practices and perform diagnosis as an act of interpretation, affect and evaluation to meet the institutional demands of the diagnostic setting. A discursive psychology analysis explored interaction in the team meetings and found a four-part narrative structure utilised to account for and explain potential contradictory evidence and manage uncertainty. A preliminary thematic analysis of the interview study found that clinicians value working collectively to enable them to feel confident about difficult decisions. Clinicians appear to be engaged in a ‘push/pull relationship’ with diagnostic decision-making which involves resisting or accepting patient and family wishes; working within time and resource constraints; and consideration of the potential positive and negative consequences of the diagnosis. This PhD offers an empirical contribution to the nature of practical uncertainty work in healthcare. Diagnosticians are charged with the burden of uncertainty in autism diagnosis, and find strategies to manage this dilemma to find the best outcomes for their patients. Uncertainty is readily displayed in inter-clinician discussion, however, clinicians are compelled to deliver a clear and certain diagnostic outcome for patients, families and other professionals. The result of this translation from uncertainty to certainty is the construction of a condition whereby it is possible to be both part of a spectrum as well as categorically defined. Overall, this PhD contributes to a growing field of scholarship on autism diagnosis and provides insight into our understanding of diagnosis as a social process.Wellcome Trus

Business schools inside the academy: What are the prospects for interdepartmental research collaboration?

Established literature about the role of business schools tends towards more parochial concerns, such as their need for a more pluralist and socially reflexive mode of knowledge production (Starkey and Tiratsoo 2007; Starkey et al 2009) or the failure of management’s professionalism project expressed through the business school movement (Khurana 2007). When casting their gaze otherwise, academic commentators examine business schools’ weakening links with management practice (Bennis and O’Toole 2005). Our theme makes a novel contribution to the business school literature through exploring prospects for research collaborations with other university departments. We draw upon the case of UK business schools, which are typically university-based (unlike some of their European counterparts), and provide illustrations relating to collaboration with medical schools to make our analytical points. We might expect that business schools and medical schools effectively collaborate given their similar vocational underpinnings, but at the same time, there are significant differences, such as differing paradigms of research and the extent to which the practice fields are professionalised. This means collaboration may prove challenging. In short, the case of collaboration between business schools and medical schools is likely to illuminate the challenges for business schools ‘reaching out’ to other university departments