Examining hybrid nurse managers as a case of identity transition in healthcare : developing a balanced research agenda

This research note synthesizes sociology of work and organization studies literatures, to outline a research agenda examining the identity transition of nurses. Academic studies suggest that nurses face a greater challenge to enact, and are more likely to be marginalized within, hybrid manager roles. Further research is encouraged that has a comparative professional dimension, focused upon social position and power and which takes account of the gendered nature of policy reform and professions

Moving from rational to normative ideologies of control over public involvement : a case of continued managerial dominance

Public Involvement (PI) is a strategic priority in global healthcare settings, yet can be seen as peripheral during decision making processes. Whilst extant research acknowledges variations in how policy is translated into practice, the majority attribute it to the limiting influence of professional hierarchies on the perceived ‘legitimacy’ of PI. Drawing on examples of three commissioning organisations within the English NHS, we outline how the variance in policy implementation for PI can be attributed to influence from the managers rather than professionals. In doing so we explore how rational ideologies of managerial control negatively impact PI. However, we also illustrate how PI alluded to in policy can be more successfully realised when organisational managers enact normative ideologies of control. Notwithstanding this assertion, we argue managerial domination exists even in the case of normative ideologies of control, to the detriment of more radical PI in service development

The impact of emotionally important social identities on the construction of a managerial leader identity : a challenge for nurses in the English National Health Service

The ability of individuals to accommodate the emotional transition into roles requiring the construction of a leader identity is an under-researched phenomenon. To address this research gap we consider the experience of 32 nurse managers undergoing a leadership development programme, exploring how an emotional attachment to their professional group identity may cause identity conflict during the construction of a managerial leader identity. We consider how competing desired identities can result in negative emotional experiences, calling into question existing work, which assumes that desired group identities are congruent with leader identities. Our work suggests that identity work can mitigate identity conflict at the individual level, enabling nurse managers to function in their role, but emotional distress will continue due to a perceived loss of professional identity and group influence. We contend it is only by eschewing an emotional attachment to a professional group identity that nurse managers will be able to overcome this negative emotional experience

Improvisation during a crisis : hidden innovation in healthcare systems

Background Crises, such as the COVID-19 pandemic, risk overwhelming health and social care systems. As part of their responses to a critical situation, healthcare professionals necessarily improvise. Some of these local improvisations have the potential to contribute to important innovations for health and social care systems with relevance beyond the particular service area and crisis in which they were developed. Findings This paper explores some key drivers of improvised innovation that may arise in response to a crisis. We highlight how services that are not considered immediate priorities may also emerge as especially fertile areas in this respect. Conclusion Health managers and policymakers should monitor crisis-induced improvisations to counteract the potential deterioration of non-prioritised services and to identify and share useful innovations. This will be crucial as health and social care systems around the world recover from the COVID-19 pandemic and head into another potential crisis: a global economic recession

Realizing policy aspirations of voluntary sector involvement in integrated care provision : insights from the English National Health Service

Integrating voluntary sector organizations (VSOs) into complex health and social care provision is a priority in global healthcare policy. However, realization of these policy aspirations in practice is limited, as VSOs struggle to collaborate with health and social care professionals, or influence the wider healthcare system, undermining their potential involvement in care provision. This paper aims to increase understandings of how the policy implementation gap could be addressed, by asking: how do new workforce roles support VSO involvement in delivering integrated care? Drawing on 40 interviews with VSO workers, healthcare commissioners, and healthcare professionals, conducted over 18 months in the English NHS, we outline how workforce capacity development through the introduction of coordinating roles, coupled with increasing regulatory control of VSO involvement, resulted in enhanced VSO integration in service provision. However, we also warn against the potential for exploitation of VSOs whereby they become replacements for health and social care provision, rather than a complementary service within an integrated team, resulting in patient harm. Our findings have important implications for policy makers, practitioners, VSO leaders and healthcare commissioners. We conclude that policy realization is dependent on the development of coordinating roles, coupled with levels of regulation which protect against exploitation without becoming normatively restrictive, thereby losing the important flexibility of VSOs

The capacity of health service commissioners to use evidence: a case study

Clinical Commissioning Groups (CCGs) lead a network of organisations that plan and make decisions about what services to provide through the NHS. By examining decision-making about service interventions designed to reduce potentially avoidable elderly care admissions into acute hospitals, our study explores the capacity of CCG-led commissioning networks to make decisions that are based on evidence. Empirically, we study 13 cases of representative (region, size, urban/rural) commissioning networks in England, drawing on interviews with commissioning managers, general practitioners (GPs), patient and public involvement (PPI) representatives and other relevant stakeholders. CCGs can not only draw on evidence about what is most clinically effective or cost-effective, but can also consider patient experience and local knowledge held by doctors. However, the inclusion of GPs and PPI representatives is limited, so the local knowledge of doctors and the patient experience are not considered as fully as they might be in commissioning decisions. CCGs can use government agencies, such as commissioning support units, that provide external information about local population and existing service provision, but they fail to do so adequately. The voluntary sector can play a key role in providing local knowledge about individual patients and their needs. Finally, given the need for health and social care organisations to collaborate to support older people so that they do not experience potentially avoidable admissions to acute hospitals, there is a need for organisations to develop joint evidence-based strategies and work together in real time to exchange information. From our research, in collaboration with a PPI reference group, a self-assessment questionnaire for CCG-led commissioning networks was developed, which allows CCGs to assess and develop their capacity to acquire and use different types of evidence in their decision-making.questionnaire for CCG-led commissioning networks was developed, which allows CCGs to assess and develop their capacity to acquire and use different types of evidence in their decision-making

Neutralized, enhanced, tokenistic: The influence of formal employment of service-users on processes of co-production

Can formally employing service-users in co-production roles redress the problematic power imbalances inhibiting co-production in the public sector? In this paper we analyze service-users formally employed in co-production roles. Through semi-structured interviews we illustrate how actors use their voice, experience and identity to respond to different power imbalances. First, through the process of ‘inverting professionalism’ structural limitations resulted in neutralized co-production. Second, through the process of ‘embedding expertise’ formally employed service-users challenged collective expectations of their role and meditated power imbalances, resulting in enhanced co-production. Finally, through the process of ‘perpetuating rejection’ a new exacerbated power imbalance emerged when their employment became a negative resource, resulting in tokenistic co-production. We extend understandings of how formally employing service-users has potential to redress power imbalances. However, we caution against policy taking this for granted, and argue that more consideration of the influence of different forms of power is needed

Realist evaluation of the use of patient experience data to improve the quality of inpatient mental health care (EURIPIDES) in England : study protocol

Introduction Inpatient mental healthcare continues to be an area of high risk and where patients report negative experiences. To ensure the patient voice is heard, National Health Service (NHS) Trusts are required to collect feedback from patients routinely. We do not know what kinds of feedback are most important or what management processes are needed to translate this into effective action plans. Further, we do not know if this makes any difference to the patients themselves. This study seeks to explore which of the many different approaches to collecting and using patient experience data are the most useful for supporting improvements in inpatient mental healthcare. The overarching aim of the study is to arrive at recommendations for best practice in the collection and use of patient experience data in NHS England adult inpatient mental health settings. We present the protocol for Realist Evaluation of the Use of Patient Experience Data to Improve the Quality of Inpatient Mental Health Care study (EURIPIDES). Methods and analysis The study is composed of five work packages (WPs), including a systematic review of patient experiences (WP1); a telephone survey to assist the selection of case sites (WP2); six in depth case studies involving interviews with service users, carers and staff to enable a realist evaluation of the use of patient experience to improve quality in adult inpatient mental health services (WP3); an economic evaluation of patient experience feedback activity (WP5); and a consensus conference (WP4). We discuss the methodological rationale for the five WPs. Ethics and dissemination This study has received approval from West Midlands/South Birmingham NHS Research Ethics Committee. The outcome of the consensus conference meeting (WP4) will form the basis of the outputs to be disseminated to NHS providers. Dissemination will also take place through publications and presentations at relevant conferences

Using patient experience data to support improvements in inpatient mental health care: the EURIPIDES multimethod study

Background All NHS providers collect data on patient experience, although there is limited evidence about what to measure or how to collect and use data to improve services. We studied inpatient mental health services, as these are important, costly and often unpopular services within which serious incidents occur. Aims To identify which approaches to collecting and using patient experience data are most useful for supporting improvements in inpatient mental health care. Design The study comprised five work packages: a systematic review to identify evidence-based patient experience themes relevant to inpatient mental health care (work package 1); a survey of patient experience leads in NHS mental health trusts in England to describe current approaches to collecting and using patient experience data in inpatient mental health services, and to populate the sampling frame for work package 3 (work package 2); in-depth case studies at sites selected using the work package 2 findings, analysed using a realist approach (work package 3); a consensus conference to agree on recommendations about best practice (work package 4); and health economic modelling to estimate resource requirements and potential benefits arising from the adoption of best practice (work package 5). Using a realist methodology, we analysed and presented our findings using a framework based on four stages of the patient experience data pathway, for which we coined the term CRAICh (collecting and giving, receiving and listening, analysing, and quality improvement and change). The project was supported by a patient and public involvement team that contributed to work package 1 and the development of programme theories (work package 3). Two employed survivor researchers worked on work packages 2, 3 and 4. Setting The study was conducted in 57 NHS providers of inpatient mental health care in England. Participants In work package 2, 47 NHS patient experience leads took part and, in work package 3, 62 service users, 19 carers and 101 NHS staff participated, across six trusts. Forty-four individuals attended the work package 4 consensus conference. Results The patient experience feedback cycle was rarely completed and, even when improvements were implemented, these tended to be environmental rather than cultural. There were few examples of triangulation with patient safety or outcomes data. We identified 18 rules for best practice in collecting and using inpatient mental health experience data, and 154 realist context–mechanism–outcome configurations that underpin and explain these. Limitations The study was cross-sectional in design and we relied on examples of historical service improvement. Our health economic models (in work package 5) were therefore limited in the estimation and modelling of prospective benefits associated with the collection and use of patient experience data. Conclusions Patient experience work is insufficiently embedded in most mental health trusts. More attention to analysis and interpretation of patient experience data is needed, particularly to ways of triangulating these with outcomes and safety data. Future work Further evaluative research is needed to develop and evaluate a locally adapted intervention based on the 18 rules for best practice. Study registration The systematic review (work package 1) is registered as PROSPERO CRD42016033556