Micro-volunteering at scale can help health systems respond to emergencies, such as the Covid-19 pandemic

One of the unprecedented challenges of the Covid-19 pandemic has been to support millions of clinically high-risk individuals who were advised to self-isolate for long periods to reduce the likelihood of infection. The NHS in England issued a mass call for volunteers in March 2020 to help support people who were shielding or vulnerable for other reasons during the lockdown. Three quarters of a million people came forward to aid the health at home experience for these vulnerable individuals by providing friendly telephone calls, help with shopping or collection of medicines or transport to essential hospital appointments. Hospitals also used to scheme to replace older volunteers who had been stood down after Covid-19 risk assessments and to help patients avoid unnecessary trips into their services. As we gained experience of running the scheme, additional tasks were added, such as support for Covid-19 research trials. The approach to ‘micro-volunteering’ at scale has been hugely beneficial and has significantly increased the number and diversity of volunteers supporting the health system. This article describes the scheme and provides an account of achievements over the first wave of Covid-19 in England. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Patients’ experiences in the UK: Future strategic directions

Over the last decade policy has emphasised the importance of a good patient experience as a cornerstone of high quality health and social care in the UK, with many initiatives attempting to develop patient-centred practice. More recently, the Francis Inquiry has addressed the significant failings in care identified at Mid Staffordshire NHS Foundation Trust in England and has been pivotal in raising the importance of patient experience.1 The Francis report made 290 recommendations, with many emphasizing the importance of patient experience through their focus on specific ways in which the quality of experiences can be enhanced, for example, by improving support for compassionate, caring and committed care, achieved through stronger healthcare leadership. The linkages between experience, patient safety and clinical effectiveness have also been emphasized more recently.2 For the first time commissioners in England are working together to set a national level of ambition to improve experiences of care.3 Yet while policy has attempted to place patient experiences at the heart of care, significant challenges still remain before patient experience is fully integrated conceptually and organisationally. We review some of the key challenges in relation to research and consider ways forward

Building national consensus on experiences of care

The NHS in England is measured against specific indicators that focus on ‘ensuring that people have a positive experience of care,’ yet there was a lack of organisational alignment across the new national health and care organisations regarding their understanding of what constitutes a positive experience of care. This represents a major barrier to achieving an aligned and consistent system-wide approach to improving experiences. To address the need to create national alignment in definition and approach, we worked with the Patient Experience Sub-group of the National Quality Board to develop consensus on how national organisations define ‘experience of care’ and what constitutes a good experience of care, drawing on relevant evidence and guidance. Working in collaboration, we developed a ‘Narrative’ to describe this consensus and highlight resources and examples of good practice on improving experiences of care for the wider system, including commissioners and providers, to support broader improvement and implementation efforts

Depictions of power in the imperial art of the early Macedonian Emperors: Basil I, Leo VI and Alexander

The last comprehensive study of Byzantine imperial art was published in 1936 and there have been surprisingly few investigations of the art of the Macedonian Dynasty, despite their reputation as active propagandists. Most studies of imperial art have taken a centuries-long perspective, identifying major patterns but overlooking choices made by or on behalf of individual emperors. This thesis considers imperial in the reigns of the first three Macedonain Emperors: Basil (867 - 886) and his sons Leo (886 - 912) and Alexander (912 - 913). It seeks to understand how they constructed images of their power and what imperial art says about the power dynamics at Constatinople. Chapter 1 considers imperial portraits. It concludes that although elements of the imperial image were unchanging, there were nevertheless important differences in the public images put forward by each emperor. Basil’s physical power was often depicted, whilst Leo was depicted as a wise ruler. Aspects of emperor’s private lives are also visible in their art. Chapter 2 charts the changing iconography between reigns. It studies the emergence and development of the motif of an emperor being crowned by a heavenly figure, which signified the idea of anointing, and its assimilation into imperial art. The chief innovator in terms of imperial iconography, however, was Alexander, and not Basil. Chapter 3 considers Basil and Leo’s records as builders and renovators of churches, monasteries, palaces and other buildings. Whilst multiple motives were at work, Basil and Leo acted in different ways. Basil’s activity, it is argued, partly reflected his response to the earthquake of 869, which might have jeopardised the perceived legitimacy of his seizure of power in 867. Chapter 4 considers power relations between the emperor and other members of the imperial household. It finds evidence of tension, for example between Basil and his surviving sons Leo and Alexander, as well as examples when imperial behaviour was not dynastic in character. Chapter 5 examines the relationship bwteen emperor and patriarch, at a time when there may have been ideological differences about the extent of imperial power. It suggests that patriarchal art presented a potential challenge to unfettered imperial power, which Basil was prepared to accept but which ran counter to the way that Leo saw his own authority. The study of imperial art in these decades supports that interpretation that art was evolutionary and adaptive in character. Yet it was more grounded in the ideas, chaacter and preferences of individual emperors than has often been recognised and did, on occasion, respond to topical concerns, hopes and fears

Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement

Economic and Social Research Council (ES/L01338X/1). Locock, L., Kirkpatrick, S., Brading, L. et al. Response to “comments on: involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement. Res Involv Engagem 5, 26 (2019). https://doi.org/10.1186/s40900-019-0158-yPeer reviewedPublisher PD

Funcons for HGMP:the fundamental constructs of homogeneous generative meta-programming

The PLanCompS project proposes a component-based approach to programming-language development in which fundamental constructs (funcons) are reused across language definitions. Homogeneous Generative Meta-Programming (HGMP) enables writing programs that generate code as data, at run-time or compile-time, for manipulation and staged evaluation. Building on existing formalisations of HGMP, this paper introduces funcons for HGMP and demonstrates their usage in component-based semantics

A modular structural operational semantics for delimited continuations

It has been an open question as to whether the Modular Structural Operational Semantics framework can express the dynamic semantics of call/cc. This paper shows that it can, and furthermore, demonstrates that it can express the more general delimited control operators control and shift

Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation

Background and aim: The NHS collects a large number of data on patient experience, but there are concerns that it does not use this information to improve care. This study explored whether or not and how front-line staff use patient experience data for service improvement. Methods: Phase 1 – secondary analysis of existing national survey data, and a new survey of NHS trust patient experience leads. Phase 2 – case studies in six medical wards using ethnographic observations and interviews. A baseline and a follow-up patient experience survey were conducted on each ward, supplemented by in-depth interviews. Following an initial learning community to discuss approaches to learning from and improving patient experience, teams developed and implemented their own interventions. Emerging findings from the ethnographic research were shared formatively. Phase 3 – dissemination, including an online guide for NHS staff. Key findings: Phase 1 – an analysis of staff and inpatient survey results for all 153 acute trusts in England was undertaken, and 57 completed surveys were obtained from patient experience leads. The most commonly cited barrier to using patient experience data was a lack of staff time to examine the data (75%), followed by cost (35%), lack of staff interest/support (21%) and too many data (21%). Trusts were grouped in a matrix of high, medium and low performance across several indices to inform case study selection. Phase 2 – in every site, staff undertook quality improvement projects using a range of data sources. The number and scale of these varied, as did the extent to which they drew directly on patient experience data, and the extent of involvement of patients. Before-and-after surveys of patient experience showed little statistically significant change. Making sense of patient experience ‘data’ Staff were engaged in a process of sense-making from a range of formal and informal sources of intelligence. Survey data remain the most commonly recognised and used form of data. ‘Soft’ intelligence, such as patient stories, informal comments and daily ward experiences of staff, patients and family, also fed into staff’s improvement plans, but they and the wider organisation may not recognise these as ‘data’. Staff may lack confidence in using them for improvement. Staff could not always point to a specific source of patient experience ‘data’ that led to a particular project, and sometimes reported acting on what they felt they already knew needed changing. Staff experience as a route to improving patient experience Some sites focused on staff motivation and experience on the assumption that this would improve patient experience through indirect cultural and attitudinal change, and by making staff feel empowered and supported. Staff participants identified several potential interlinked mechanisms: (1) motivated staff provide better care, (2) staff who feel taken seriously are more likely to be motivated, (3) involvement in quality improvement is itself motivating and (4) improving patient experience can directly improve staff experience. ‘Team-based capital’ in NHS settings We propose ‘team-based capital’ in NHS settings as a key mechanism between the contexts in our case studies and observed outcomes. ‘Capital’ is the extent to which staff command varied practical, organisational and social resources that enable them to set agendas, drive process and implement change. These include not just material or economic resources, but also status, time, space, relational networks and influence. Teams involving a range of clinical and non-clinical staff from multiple disciplines and levels of seniority could assemble a greater range of capital; progress was generally greater when the team included individuals from the patient experience office. Phase 3 – an online guide for NHS staff was produced in collaboration with The Point of Care Foundation. Limitations: This was an ethnographic study of how and why NHS front-line staff do or do not use patient experience data for quality improvement. It was not designed to demonstrate whether particular types of patient experience data or quality improvement approaches are more effective than others. Future research: Developing and testing interventions focused specifically on staff but with patient experience as the outcome, with a health economics component. Studies focusing on the effect of team composition and diversity on the impact and scope of patient-centred quality improvement. Research into using unstructured feedback and soft intelligence