The case for collaborative learning: Introducing opportunities in the higher education setting

Public Health England and the Department of Health (2015) have documented that parents are requesting consistent professional advice throughout pregnancy and the early weeks following birth, as their care is transferred from midwives to health visitors. In addition, commissioners are increasingly seeking to integrate services to provide joined-up care and improve health outcomes for parents and families. This paper discusses the benefits, to both parents and health professionals, of collaborative working, together with the challenges faced by midwives and health visitors in the current climate. It explores the benefits of collaborative learning between the two disciplines in the higher education setting, with an example of a successful collaboration at the University of Central Lancashire

A systematic review of the effectiveness of universal Health Visitor led Child Health Clinics

This paper presents the findings of a systematic review undertaken to assess how effectively health visitor led child health clinics (‘baby clinics’) contribute to the promotion of pre-school child health and the reduction of health inequalities.Despite the widespread presence of baby clinics across the UK, there is little published research about the service model, its purpose or effectiveness. The initial search produced 559 articles, after removing duplicates, 175 abstracts were assessed against the inclusion criteria and 24 qualitative studies were identified as relevant to the review. No studies were excluded based on quality issues, however the quality of studies was variable. Thematic analysis was used to organise and interpret the data. Although the review presents a synthesis of research over the last 30 years, there is a lack of evaluative research about the structure, process and outcomes of baby clinics, which makes it impossible to draw any conclusions about the effectiveness of the service offer. Findings suggest research on the value and purpose of baby clinics is now needed and whilst good evaluation studies with clear outcome measures are sought, it is clear that the theoretical processes through which positive outcomes are promoted need to be established first

Women's views of continuity of information provided during and after pregnancy: A qualitative interview study

Straightforward transfer of care from pregnancy to the postpartum period is associated with health benefits and is desired by women worldwide. Underpinning this transfer of care is the sharing of information between healthcare professionals and the provision of consistent information to women. In this qualitative study, two aspects of continuity of information were examined; first the information passed on from midwife to health visitor regarding a woman and her baby before the health visitor meets the woman postnatally and second, the consistency of information received by women from these two healthcare professionals (the main healthcare providers during and after pregnancy in England). To be eligible for the study, women had to have had a baby in England within 12 months prior to the interview. Participants also needed to be able to read and speak English and be over 18 years old. Recruitment of participants was via word of mouth and social media. Twenty-nine mothers were interviewed of whom 19 were first time mothers. The interviews took place in the summer and autumn of 2016 and were transcribed verbatim and analysed using Framework Analysis. Two overarching themes were identified: not feeling listened to and information inconsistencies. Women reported little experience of midwives and health visitors sharing information about their care, forcing women to repeat information. This made women feel not listened to and participants recommended that healthcare professionals share information; prioritising information about labour, mental health, and chronic conditions. Women had mixed experiences regarding receiving information from midwives and health visitors, with examples of both consistent and inconsistent information received. To avoid inconsistent information, joint appointments were recommended. Findings from this study clearly suggest that better communication pathways need to be developed and effectively implemented for midwives and health visitors to improve the care that they provide to women

Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration

Background Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign. Objective To explore citizens’ involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements. Design A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions. Setting and participants A two‐day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations. Intervention studied Eight case studies working with vulnerable and disadvantaged populations in three countries. Results We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre‐specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations. Discussion and conclusions Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User‐centred evaluations of codesigned public services are needed

Organisational strategies and practices to improve care using patient experience data in acute NHS hospital trusts: an ethnographic study

The NHS collects a lot of information about patients’ experiences of care; however, it is not clear how this information is used to achieve quality improvements. This study had two main aims: one was to explore how this information, also called patient experience data, translates into quality improvements in NHS hospitals, and the other was to understand the role of nurses in collecting, making sense of and using these data for improving care. The study had two phases. In phase 1, we observed practices in five NHS hospitals in England and interviewed key participants (including NHS staff and patient/carer representatives) to study what happened to patient experience data, especially in the areas of cancer and dementia care. In phase 2, we held a series of workshops (the first with participants from all five trusts and policy-makers, and then one workshop at each trust) to discuss how the early findings from our research may be relevant to NHS trusts. We found that (1) each type of data, for example a survey, goes through several transformations – from a paper questionnaire, to an electronic database, to a report – which can lead to care improvements at different stages of this transformation process; (2) when data are part of interactions – either with members of staff or with certain processes in the organisation – characterised by authority and autonomy, and context-awareness, it often leads to care improvements; (3) nurses are largely responsible for how data are collected, made sense of and used to improve care, but other roles – including those of clerical staff and other clinicians – are also important and may need more attention; (4) official quality improvement work may not take into account the less documented ‘everyday quality improvement’ work that happens in the organisation; and (5) holding workshops with participants can help organisational learning

Nursing work and sensory experiences of hospital design: A before and after qualitative study following a move to all-single room inpatient accommodation

The embodied experience of nursing practice is rarely studied. Drawing on data from an internationally relevant larger study conducted in 2013–14, here we explore the sensory dimension of the embodied experiences of nursing staff working on two acute NHS hospital wards before and after a move to all-single room inpatient accommodation. We undertook a secondary analysis of 25 interviews with nursing staff (12 before and 13 after the move with half [13/25] using photographs taken by participants) from a mixed-method before-and-after study. This analysis focused on the sensory dimensions of nursing staff's experiences of their working practices and the effect of the built environment upon these. Drawing on Pallasmaa's theoretocal insights, we report how the all-single room ward design prioritises ‘focused vision’ and hinders peripheral perception, whilst the open ward environment is rich in contextual and preconscious information. We suggest all-single room accommodation may offer staff an impoverished experience of caring for patients and of working with each other

Exploring liminality in the co-design of rehabilitation environments: The case of one acute stroke unit.

This paper describes an Experience-based Co-design (EBCD) project that aimed to increase patient activity within an acute stroke unit. We apply the concept of liminality to explore ways in which the EBCD process, a form of Participatory Action Research, may dilute or even dissolve social hierarchies and challenge assumptions about practices and constraints in this care setting, thereby opening up possibilities for transformation that enhances the therapeutic value of the space for patients and care providers alike. By occasioning a liminal phase of possibility for change, the work of one co-design group explored in detail here suggests that, in this process, the sociomaterial interactions involving patients, family members, staff, and the physical space are refashioned and re-inscribed in transformed 'emplaced' relationships of care

Patient experience feedback in UK hospitals : What types are available and what are their potential roles in quality improvement (QI)?

BACKGROUND & OBJECTIVES: The comparative uses of different types of patient experience (PE) feedback as data within quality improvement (QI) are poorly understood. This paper reviews what types are currently available and categorizes them by their characteristics in order to better understand their roles in QI. METHODS: A scoping review of types of feedback currently available to hospital staff in the UK was undertaken. This comprised academic database searches for "measures of PE outcomes" (2000-2016), and grey literature and websites for all types of "PE feedback" potentially available (2005-2016). Through an iterative consensus process, we developed a list of characteristics and used this to present categories of similar types. MAIN RESULTS: The scoping review returned 37 feedback types. A list of 12 characteristics was developed and applied, enabling identification of 4 categories that help understand potential use within QI-(1) Hospital-initiated (validated) quantitative surveys: for example the NHS Adult Inpatient Survey; (2) Patient-initiated qualitative feedback: for example complaints or twitter comments; (3) Hospital-initiated qualitative feedback: for example Experience Based Co-Design; (4) Other: for example Friends & Family Test. Of those routinely collected, few elicit "ready-to-use" data and those that do elicit data most suitable for measuring accountability, not for informing ward-based improvement. Guidance does exist for linking collection of feedback to QI for some feedback types in Category 3 but these types are not routinely used. CONCLUSION: If feedback is to be used more frequently within QI, more attention must be paid to obtaining and making available the most appropriate types