ENGAGING STAFF AND ALIGNING INCENTIVES TO ACHIEVE HIGHER LEVELS OF PERFORMANCE

The Nuffield Trust is a charitable trust carrying out research and policy analysis on health services. Its focus is on the reform of health services to increase the efficiency, effectiveness, equality and responsiveness of care. Published b

“You don't know what you are saying ‘Yes’ and what you are saying ‘No’ to”: hospital experiences of older people from minority ethnic communities

ABSTRACTImproving responsiveness to the needs of older people from minority ethnic communities has been emphasised as a goal in England since the publication of the National Service Framework for Older People in 2001. Despite this, people from minority ethnic groups consistently give poorer ratings of their health services than ‘majority’ populations, both in England and across many other health-care systems. Language barriers have been shown to play a particularly important role, and appear to be a stronger predictor of perceived quality of care than ethnic origin per se. This paper reports findings from a larger study exploring older people's experiences of care transitions, focusing on the findings from one case study area which explored the hospital and discharge experiences of older people from minority ethnic communities. A participatory approach was adopted, with older people from the local area collaborating in the design, delivery and analysis of the research as ‘co-researchers’. Twenty-four in-depth narrative interviews were carried out with people who had experienced a recent hospital stay as a patient or a family member providing care and support. Our findings show that many aspects of the hospital experience, including the desire for personalised and humanistic approaches to care, are important to older people irrespective of ethnic background. However, older people from minority ethnic communities can also face language and cultural barriers which negatively affect the quality and experience of care. People who had limited English proficiency struggled to understand, communicate and participate in their care. Where professional services were not available or requested, interpreting was provided informally by other patients, family members, hospital staff in clinical and domestic roles, or not at all. We conclude that targeted strategies are required to ensure appropriate and effective hospital services for a multicultural population.</jats:p

Is bureaucracy being busted in research ethics and governance for health services research in the UK?:Experiences and perspectives reported by stakeholders through an online survey

Acknowledgements: We would like to thank the Board of Trustees of HSRUK for support and advice throughout study. Thank you to all respondents to the survey for contributing their data and views. The HRA and NIHR are also warmly acknowledged for their continued support throughout the study.Peer reviewedPublisher PD

Understanding and improving transitions of older people: a user and carer centred approach

This project focuses on older people and their transition between different services and agencies in health and social care. Research studies and reports from inspectors have shown that older people experience many problems before, during and after transitions. This project will be conducted in four local areas and has two key aims. First, it will explore what information, support and care is needed by older people (and their carers) as they go through a transition. Second, the project team will work with people and organisations in the four local areas to put the findings into practice.It is increasingly recognised that older people should be involved in improving the quality of services for their use. In this project, older people who are service users and carers will be recruited, trained and supported to participate in the research. They will work with academic researchers to conduct in-depth interviews in order to find out about older people's experiences of a recent care transition. Analysis of the data and presentation of the findings will be carried out jointly by academic and user/carer researchers.The project team will feed back the findings of the interviews in each of the local areas. It will also provide support to people and organisations in these areas to put the findings into practice, in order to improve transitions for older people. In each area, a local advisory group, which include service users and carers, will lead this process. The findings from the in-depth interviews and the local implementation activities will be shared with NHS, social care and other organisations nationally

Staff experiences of training and delivery of remote home monitoring services for patients diagnosed with COVID-19 in England: A mixed-methods study

OBJECTIVES: Remote home monitoring services for patients at risk of rapid deterioration introduced during the COVID-19 pandemic had important implications for the health workforce. This study explored the nature of 'work' that health care staff in England undertook to manage patients with COVID-19 remotely, how they were supported to deliver these new services, and the factors that influenced delivery of COVID-19 remote home monitoring services for staff. METHODS: We conducted a rapid mixed-methods evaluation of COVID-19 remote home monitoring services during November 2020 to July 2021 using a cross-sectional survey of a purposive sample of staff involved in delivering the service (clinical leads, frontline delivery staff and those involved in data collection and management) from 28 sites across England. We also conducted interviews with 58 staff in a subsample of 17 sites. Data collection and analysis were carried out in parallel. We used thematic analysis to analyse qualitative data while quantitative survey data were analysed using descriptive statistics. RESULTS: A total of 292 staff responded to the surveys (39% response rate). We found that prior experience of remote monitoring had some, albeit limited benefit for delivering similar services for patients diagnosed with COVID-19. Staff received a range of locally specific training and clinical oversight along with bespoke materials and resources. Staff reported feeling uncertain about using their own judgement and being reliant on seeking clinical oversight. The experience of transitioning from face-to-face to remote service delivery led some frontline delivery staff to reconsider their professional role, as well as their beliefs around their own capabilities. There was a general perception of staff being able to adapt, acquire new skills and knowledge and they demonstrated a commitment to continuity of care for patients, although there were reports of struggling with the increased accountability and responsibility attached to their adapted roles at times. CONCLUSIONS: Remote home monitoring models can play an important role in managing a large number of patients for COVID-19 and possibly a range of other conditions. Successful delivery of such service models depends on staff competency and the nature of training received to facilitate effective care and patient engagement