Care planning and co-ordination: imperfect solutions in a complex world

Care planning and co-ordination are central to the delivery of comprehensive mental health care especially where individuals have complex health and social care needs. Although the terms are often used together they clearly imply different sets of processes, practices and ultimately experiences for individuals using and working in services. Care planning involves professionals (nurses, doctors, social workers and others) and the person needing care collaborating on goals, making shared written records and agreeing when to review progress

Impressions of action and critical action learning:exploring the leadership development of senior doctors in an English healthcare organization

This paper aims to explore the influence of one cycle of a learning set experience in a postgraduate medical leadership development programme. It does so from two perspectives: first, from the self-reports of nine senior doctors working in leadership roles in England in the National Health Service; and second from a researcher perspective as we present our research process, findings and perceptions on the use of action learning (AL) and critical action learning (CAL) for leadership development in the complex and unpredictable context of that service. The paper affirms other study findings that CAL in the development of participants’ collective reflexivity has the potential to deal with emotions and power relations in organizational life. An original contribution lies in advancing the idea that CAL can help build resilience in doctor leaders and groups in uncertain conditions such that they are able to challenge current care delivery and effect change in organizational performance

Getting involved in the community—What stops us? Findings from an inclusive research project

© 2019 John Wiley & Sons Ltd Feeling alone and not connected to other people where you live affects many people and especially people with a learning disability. The government and the newspapers are talking a lot about this, they want to understand who is affected and what can be done. Our group did a research project to find out some of the things that stop us getting involved in local places with local people where we can make and keep friends. The people in the research project mainly lived independently and did not use learning disability services, so needed to use local community organisations. Pictorial cards, made by one of the group members, using photographs were used to sort out all the things we talked about into groups. These included transport, fear and anxiety, limits on our choice and control, risks and personal safety. We then talked about what could be done, this included more easy read information, so people know what is available locally, more support to go to places and advocacy to get involved. There also needs to be better community safety including more Safe Places in the community. Abstract: Background Social isolation is an issue that affects many people and especially people with a learning disability. There is an association between social exclusion and feeling lonely, an issue currently highlighted as a growing concern which needs to be addressed both in the media and by the government. Methods The Building Bridges Research Group do inclusive research projects about the issues that are important to them. Over the summer of 2018, the research group undertook an inclusive research project to identify some of the specific barriers that prevent community inclusion and the opportunity to develop friends. The people involved mainly lived independently and did not use learning disability services, with the exception of evening clubs, so needed to use universal services. Results Pictorial cards, made by one of the group, using photographs were used to organise the data into themes. These included transport, fear and anxiety, limits on choice and control, risks and personal safety. Conclusion The inclusive research design enabled people with a learning disability to contribute to all stages of the research project, from identifying the issue, gathering data, the analysis and writing up. They also made suggestions of ways to increase social networks, friendships and well-being and so decrease loneliness. These include more access to easy read information, more support and advocacy and measures to address community safety including a wider roll-out of the Safe Places scheme. There also needs to be further research undertaken with other people with a learning disability in different areas to widen the understanding of the impact of these barriers on people's lives.Published versio

A case study evaluation of implementation of a care pathway to support normal birth in one English birth centre: anticipated benefits and unintended consequences

Background: The policy drive for the UK National Health Service (NHS) has focused on the need for high quality services informed by evidence of best practice. The introduction of care pathways and protocols to standardise care and support implementation of evidence into practice has taken place across the NHS with limited evaluation of their impact. A multi-site case study evaluation was undertaken to assess the impact of use of care pathways and protocols on clinicians, service users and service delivery. One of the five sites was a midwifery-led Birth Centre, where an adapted version of the All Wales Clinical Pathway for Normal Birth had been implemented. Methods: The overarching framework was realistic evaluation. A case study design enabled the capture of data on use of the pathway in the clinical setting, use of multiple methods of data collection and opportunity to study and understand the experiences of clinicians and service users whose care was informed by the pathway. Women attending the Birth Centre were recruited at their 36 week antenatal visit. Episodes of care during labour were observed, following which the woman and the midwife who cared for her were interviewed about use of the pathway. Interviews were also held with other key stakeholders from the study site. Qualitative data were content analysed. Results: Observations were undertaken of four women during labour. Eighteen interviews were conducted with clinicians and women, including the women whose care was observed and the midwives who cared for them, senior midwifery managers and obstetricians. The implementation of the pathway resulted in a number of anticipated benefits, including increased midwifery confidence in skills to support normal birth and promotion of team working. There were also unintended consequences, including concerns about a lack of documentation of labour care and negative impact on working relationships with obstetric and other midwifery colleagues. Women were unaware their care was informed by a care pathway. Conclusion: Care pathways are complex interventions which generate a number of consequences for practice. Those considering introduction of pathways need to ensure all relevant stakeholders are engaged with this and develop robust evaluation strategies to accompany implementation

The relationship between perceived organisational threat and compassion for others: Implications for the NHS

© 2017 John Wiley & Sons, Ltd. The National Health Service (NHS) is known to be a challenging place to work, with financial and performance targets placing increasing pressure on the organisation. This study aimed to investigate whether these pressures and threats might be detrimental to the quality of care and the compassion that the NHS strives to deliver. Quantitative data were collected via self-report questionnaires from healthcare professionals across 3 NHS trusts in England in order to measure Self-compassion; Compassion for Others; Perceived Organisational Threat; and Perceived Organisational Compassion. Qualitative data were also collected to explore the threats considered most pertinent to healthcare professionals at present. The key findings suggest that an increase in Perceived Organisational Threat may reduce an individual's ability to give compassion to others; however, Self-compassion and Perceived Organisational Compassion were better predictors of Compassion for Others. This highlights the need to consider compassion at a systemic level, providing interventions and training not only to cultivate self-compassion in healthcare professionals, but also to encourage compassion across the NHS more generally. In promoting self-compassion and increasing the level of compassion that employees feel they receive at work, healthcare professionals may be better able to maintain or improve their level of compassion for service users and colleagues. Key Practitioner Message: Increases in Perceived Organisational Threat were found to be related to a decrease in healthcare professionals' level of Compassion for Others. However, Self-compassion and Perceived Organisational Compassion were significantly better predictors of level of Compassion for Others than was Perceived Organisational Threat; an increase in Self-compassion and Perceived Organisational Compassion related to an increase in Compassion for Others. Healthcare service development and staff interventions may benefit from greater focus on cultivating and promoting self-compassion and on systemic interventions promoting compassion across all levels of an organisation. Future research should examine the feasibility and effectiveness of compassion-focussed interventions amongst professionals in healthcare organisations and would benefit from further investigation into the impact this may have for service users

A cross-sectional survey of mental health service users’, carers’ and professionals’ priorities for patient safety in the United Kingdom

Background: Establishing patient safety priorities in psychiatry has received less international attention than in other areas of health care. This study aimed to identify safety issues as described by people in the United Kingdom identifying as mental health service users, carers and professionals. Methods: A cross-sectional online survey was distributed via social media. Identified safety issues were mapped onto the Yorkshire Contributory Factors Framework (YCFF) which categorizes factors that contribute to patient safety incidents in general hospital settings. Service user and carer responses were described separately from professional responses using descriptive statistics. Results: One hundred and eighty-five responses from 95 service users and carers and 90 professionals were analysed. Seventy different safety issues were identified. These were mapped onto the 17 existing categories of the YCFF and two additional categories created to form the YCFF-MH. Most frequently identified issues were as follows: “Individual characteristics” (of staff) which included competence and listening skills; “Service process” that contained concerns about waiting times; “Management of staff and staffing levels” dominated by staffing levels; and “External policy context” which included the overall resourcing of services. Professionals identified staffing levels and inadequate community provision more frequently than service users and carers, who in turn identified crisis care more frequently. Conclusions: This study updates knowledge on stakeholder perceived safety issues across mental health care. It shows a far broader range of issues relating to safety than has previously been described. The YCFF was successfully modified to describe these issues and areas for further coproduced research are suggested

Understanding the health and wellbeing challenges of the food banking system: A qualitative study of food bank users, providers and referrers in London.

In the UK, food poverty has been associated with conditions such as obesity, malnutrition, hypertension, iron deficiency, and impaired liver function. Food banks, the primary response to food poverty on the ground, typically rely on community referral and distribution systems that involve health and social care professionals and local authority public health teams. The perspectives of these key stakeholders remain underexplored. This paper reports on a qualitative study of the health and wellbeing challenges of food poverty and food banking in London. An ethnographic investigation of food bank staff and users was carried out alongside a series of healthcare stakeholder interviews. A total of 42 participants were interviewed. A Critical Grounded Theory (CGT) analysis revealed that contemporary lived experiences of food poverty are embedded within and symptomatic of extreme marginalisation, which in turn impacts upon health. Specifically, food poverty was conceptualised by participants to: firstly, be a barrier to providing adequate care and nutrition for young children; secondly, be exacerbated by lack of access to adequate fresh food, food storage and cooking facilities; and thirdly, amplify existing health and social problems. Further investigation of the local government structures and professional roles that both rely upon and serve to further embed the food banking system is necessary in order to understand the politics of changing welfare landscapes