Determining the skills needed by frontline NHS staff to deliver quality improvement: findings from six case studies.

BACKGROUND: Previous studies have detailed the technical, learning and soft skills healthcare staff deploy to deliver quality improvement (QI). However, research has mainly focused on management and leadership skills, overlooking the skills frontline staff use to improve care. Our research explored which skills mattered to frontline health practitioners delivering QI projects. STUDY DESIGN: We used a theory-driven approach, informed by communities of practice, knowledge-in-practice-in-context and positive deviance theory. We used case studies to examine skill use in three pseudonymised English hospital Trusts, selected on the basis of Care Quality Commission rating. Seventy-three senior staff orientation interviews led to the selection of two QI projects at each site. Snowball sampling obtained a maximally varied range of 87 staff with whom we held 122 semistructured interviews at different stages of QI delivery, analysed thematically. RESULTS: Six overarching 'Socio-Organisational Functional and Facilitative Tasks' (SOFFTs) were deployed by frontline staff. Several of these had to be enacted to address challenges faced. The SOFFTs included: (1) adopting and promulgating the appropriate organisational environment; (2) managing the QI rollercoaster; (3) getting the problem right; (4) getting the right message to the right people; (5) enabling learning to occur; and (6) contextualising experience. Each task had its own inherent skills. CONCLUSION: Our case studies provide a nuanced understanding of the skills used by healthcare staff. While technical skills are important, the ability to judge when and how to use wider skills was paramount. The provision of QI training and fidelity to the improvement programme may be less of a priority than the deployment of SOFFT skills used to overcome barriers. QI projects will fail if such skills and resources are not accessed

Uncovering the processes of knowledge transformation: the example of local evidence-informed policy-making in United Kingdom healthcare.

BACKGROUND: Healthcare policy-makers are expected to develop 'evidence-based' policies. Yet, studies have consistently shown that, like clinical practitioners, they need to combine many varied kinds of evidence and information derived from divergent sources. Working in the complex environment of healthcare decision-making, they have to rely on forms of (practical, contextual) knowledge quite different from that produced by researchers. It is therefore important to understand how and why they transform research-based evidence into the knowledge they ultimately use. METHODS: We purposively selected four healthcare-commissioning organisations working with external agencies that provided research-based evidence to assist with commissioning; we interviewed a total of 52 people involved in that work. This entailed 92 interviews in total, each lasting 20-60 minutes, including 47 with policy-making commissioners, 36 with staff of external agencies, and 9 with freelance specialists, lay representatives and local-authority professionals. We observed 25 meetings (14 within the commissioning organisations) and reviewed relevant documents. We analysed the data thematically using a constant comparison method with a coding framework and developed structured summaries consisting of 20-50 pages for each case-study site. We iteratively discussed and refined emerging findings, including cross-case analyses, in regular research team meetings with facilitated analysis. Further details of the study and other results have been described elsewhere. RESULTS: The commissioners' role was to assess the available care provision options, develop justifiable arguments for the preferred alternatives, and navigate them through a tortuous decision-making system with often-conflicting internal and external opinion. In a multi-transactional environment characterised by interactive, pressurised, under-determined decisions, this required repeated, contested sensemaking through negotiation of many sources of evidence. Commissioners therefore had to subject research-based knowledge to multiple 'knowledge behaviours'/manipulations as they repeatedly re-interpreted and recrafted the available evidence while carrying out their many roles. Two key 'incorporative processes' underpinned these activities, namely contextualisation of evidence and engagement of stakeholders. We describe five Active Channels of Knowledge Transformation - Interpersonal Relationships, People Placement, Product Deployment, Copy, Adapt and Paste, and Governance and Procedure - that provided the organisational spaces and the mechanisms for commissioners to constantly reshape research-based knowledge while incorporating it into the eventual policies that configured local health services. CONCLUSIONS: Our new insights into the ways in which policy-makers and practitioners inevitably transform research-based knowledge, rather than simply translate it, could foster more realistic and productive expectations for the conduct and evaluation of research-informed healthcare provision

Embracing complexity and uncertainty to create impact: Exploring the processes and transformative potential of co-produced research through development of a social impact model

© 2018 The Author(s). The potential use, influence and impact of health research is seldom fully realised. This stubborn problem has caused burgeoning global interest in research aiming to address the implementation 'gap' and factors inhibiting the uptake of scientific evidence. Scholars and practitioners have questioned the nature of evidence used and required for healthcare, highlighting the complex ways in which knowledge is formed, shared and modified in practice and policy. This has led to rapid expansion, expertise and innovation in the field of knowledge mobilisation and funding for experimentation into the effectiveness of different knowledge mobilisation models. One approach gaining prominence involves stakeholders (e.g. researchers, practitioners, service users, policy-makers, managers and carers) in the co-production, and application, of knowledge for practice, policy and research (frequently termed integrated knowledge translation in Canada). Its popularity stems largely from its potential to address dilemmas inherent in the implementation of knowledge generated using more reductionist methods. However, despite increasing recognition, demands for co-produced research to illustrate its worth are becoming pressing while the means to do so remain challenging. This is due not only to the diversity of approaches to co-production and their application, but also to the ways through which different stakeholders conceptualise, measure, reward and use research. While research co-production can lead to demonstrable benefits such as policy or practice change, it may also have more diffuse and subtle impact on relationships, knowledge sharing, and in engendering culture shifts and research capacity-building. These relatively intangible outcomes are harder to measure and require new emphases and tools. This opinion paper uses six Canadian and United Kingdom case studies to explore the principles and practice of co-production and illustrate how it can influence interactions between research, policy and practice, and benefit diverse stakeholders. In doing so, we identify a continuum of co-production processes. We propose and illustrate the use of a new 'social model of impact' and framework to capture multi-layered and potentially transformative impacts of co-produced research. We make recommendations for future directions in research co-production and impact measurement

Review: The dissemination and uptake of competency frameworks

Clinical competencies are increasingly being used to structure career and clinical progression in post-registration nursing. Competency framework documents have been proposed as a way of supporting competence development. One major national initiative in this respect is the NHS Education for Scotland (NES) competency frameworks which have seen development of over 26 such frameworks dealing with a wide range of nursing specialties. Utilising an initial scoping study followed by a stakeholder evaluation the dissemination and uptake of a selected number of competency frameworks was investigated. Participants in the scoping study (n = 18) and in the main stakeholder survey ( n = 24) from a sample of Health Boards and Higher Education Institutions were recruited. Data were collected by telephone and face-to-face interviews. Within the NHS and HEI's the specified framework documents have a variable penetration. Documents are used to support CPD at the individual and organisational levels. They also inform, albeit in a very limited way, curricular developments in HEIs. The success of framework documents is linked to their timeliness in relation to local and national developments such as service redesign and to whether or not documents were 'championed' by committed practitioners or professional groups. Competency framework documents are recognised and utilised by clinicians, NHS managers and Education providers. Information providers and users need to co-ordinate their initiatives in order that staff development links with service redesign

Building rapport through non-verbal communications

Andrée le May discusses ways in which signs and signals, such as touch and facial expression, can strengthen relationships with older people and improve their quality of life

Communicating care

Communication is vital to care; however, the ability to communicate can alter in old age

Communities of practice in health and social care

Communities of Practice in Health and Social Care highlights how communities of practice (CoPs) can make service development and quality improvement in health and social care easier to initiate and more sustainable. Using a series of case studies from the UK and Australia the book demonstrates how the theory of CoPs is implemented in the delivery of health and social care and highlights the associated potential, complexities, advantages and disadvantages. <br/

A new year, a new commission: the commission for patient and public involvement in health

Since its first term in office the Government has sought to modernise the ways in which patients and the public are involved in decisions about their individual care and the development of health services at a local level. The new year saw the birth of the latest mechanism for implementing the patient-centred service envisioned in the NHS plan: the Commission for Patient and Public Involvement in Health (CPPIH). CPPIH as the Health Minister, David Lammy, emphasised has the potential to bring about a cultural change in the ways in which the NHS deals with patients and the public. This change should result in shifting the balance of power in their favour and so give patients and the public real influence and power ensuring that their voices are heard, supported, encouraged and, where necessary, enforced. The Commission will champion and promote the involvement of the public in decisions that affect their health, putting them at the heart of decision-making, at both local and national levels and will establish local networks to support existing patient forums. Initially the Commission will work towards: ! Empowering the public to have their say by training them with the skills they need to get involved; ! Supporting patients and the public to make sure their voices are heard; ! Working with traditionally marginalised groups to ensure that getting involved is as easy as possible; ! Encouraging patient forums to use modern technology and alternative approaches to meetings to generate as much interest as possible; ! Training older people to promote the idea of getting involved to fellow older people; and ! Ensuring any consultation suits the patients and public and not just the organisers. Sharon Grant, supported by Laura McMurtrie as Chief Executive, together with ten commissioners appointed by the NHS Appointments Commission, chairs the Commission. Whilst the CPPIH has become the latest step in the Government ?s movement towards closer patient and public involvement in the NHS, it has a firm bedrock of local and national participation and a wealth of patient forums on which to draw. We will all - both from a professional or consumer viewpoint - monitor its progress and impact with interest