Implementing person-centred outcome measures in palliative care: An exploratory qualitative study using Normalisation Process Theory to understand processes and context

Background: Despite evidence demonstrating the utility of using Person-Centred Outcome Measures within palliative care settings, implementing them into routine practice is challenging. Most research has described barriers to, without explaining the causal mechanisms underpinning, implementation. Implementation theories explain how, why, and in which contexts specific relationships between barriers/enablers might improve implementation effectiveness but have rarely been used in palliative care outcomes research. Aim: To use Normalisation Process Theory to understand and explain the causal mechanisms that underpin successful implementation of Person-Centred Outcome Measures within palliative care. Design: Exploratory qualitative study. Data collected through semi-structured interviews and analysed using a Framework approach. Setting/participants: 63 healthcare professionals, across 11 specialist palliative care services, were purposefully sampled by role, experience, seniority, and settings (inpatient, outpatient/day therapy, home-based/community). Results: Seven main themes were developed, representing the causal mechanisms and relationships underpinning successful implementation of outcome measures into routine practice. Themes were: Subjectivity of measures; Frequency and version of Integrated Palliative care Outcome Scale; Training, education, and peer support; Building and sustaining community engagement; Electronic system readiness; The art of communication; Reinforcing use through demonstrating value. Conclusions: Relationships influencing implementation resided at individual and organisational levels. Addressing these factors is key to driving the implementation of outcome measures into routine practice so that those using palliative care services can benefit from the systematic identification, management, and measurement of their symptoms and concerns. We provide key questions that are essential for those implementing and using outcome measures to consider in order to facilitate the integration of outcome measures into routine palliative care practice

'Getting people on board': Discursive leadership for consensus building in team meetings

Meetings are increasingly seen as sites where organizing and strategic change take place, but the role of specific discursive strategies and related linguistic-pragmatic and argumentative devices, employed by meeting chairs, is little understood. The purpose of this article is to address the range of behaviours of chairs in business organizations by comparing strategies employed by the same chief executive officer (CEO) in two key meeting genres: regular management team meetings and ‘away-days’. While drawing on research from organization studies on the role of leadership in meetings and studies of language in the workplace from (socio)linguistics and discourse studies, we abductively identified five salient discursive strategies which meeting chairs employ in driving decision making: (1) Bonding; (2) Encouraging; (3) Directing; (4) Modulating; and (5) Re/Committing. We investigate the leadership styles of the CEO in both meeting genres via a multi-level approach using empirical data drawn from meetings of a single management team in a multinational defence corporation. Our key findings are, first, that the chair of the meetings (and leading manager) influences the outcome of the meetings in both negative and positive ways, through the choice of discursive strategies. Second, it becomes apparent that the specific context and related meeting genre mediate participation and the ability of the chair to control interactions within the team. Third, a more hierarchical authoritarian or a more interpersonal egalitarian leadership style can be identified via specific combinations of these five discursive strategies. The article concludes that the egalitarian leadership style increases the likelihood of achieving a durable consensus. Several related avenues for research are outlined

Surviving rather than thriving: Understanding the experiences of women coaches using a theory of gendered social well-being

In shifting our gaze to the sociological impact of being in the minority, the purpose of this study was to substantiate a model of gendered social well-being to appraise women coaches’ circumstances, experiences and challenges as embedded within the social structures and relations of their profession. This is drawn on indepth interviews with a sample of head women coaches within the UK. The findings demonstrate that personal lives, relationships, social and family commitments were sidelined by many of the participants in order to meet the expectations of being a (woman) coach. We locate these experiences in the organisational practices of high performance sport which hinder women coaches from having meaningful control over their lives. The complexities of identity are also revealed through the interplay of gender with (dis)ability, age and whiteness as evidence of hegemonic femininity within the coaching profession. Consequently, for many women, coaching is experienced as a ‘developmental dead-end’

The impact of an "equal opportunities" ideological framework on coaches’ knowledge and practice

This study focuses upon UK professional coaches’ experiences of equity training and the impact of the conceptualisation of equity as a matter of equal opportunities on this education and subsequent coaching practice. The research employs a critical feminist approach to connect the ideological framing of gender equity by sporting organisations to coaches’ ability to understand, identify and manage issues of gender equity, equality and diversity. The discussions are based on interviews with four coaches, Jack, Peter, Charlotte and Tony, who had all recently undertaken equity training, and all of whom represented sports and different stages of the coaching pathway. The data highlights that seeing gender equity through an “equal opportunities” lens results in a narrow conceptualisation of such issues by coaches, fails to challenge dominant and discriminative ideologies, and does not enable coaches to address equity within their practices. Consequently, coaches struggle to understand the importance of and manage such issues. The participants’ experiences reveal that gender relations, intersected principally with religion and ethnicity, underpinned their everyday coaching practices. The findings illustrate the need for sporting organisations to redefine how they approach equality and equity and for a more sophisticated sociocultural educational programme for coaches

Critical discourse studies: Where to from here?

This paper surveys critical discourse studies to the present and claims that, to avoid lapsing into comfortable orthodoxy in its mature phase, CDS needs to reassert its transformative radical teleology. The initial part of the paper reasserts the need for a strong social theory given the materialist and context-bound nature of discourse in daily activity. From this basis, the paper then characterizes the “new times” in which contemporary discourse occurs, and briefly surveys those issues typically analyzed, namely political economy, race and gender, and critical literacy. By considering people's ordinary lives, the paper then suggests that subject and agency, and calculative technologies of management deserve, and new modalities need, more research. Transdisciplinarity is encouraged, particularly with social psychology and critical management studies

Trust and ethics in local journalism: a distinctive orientation towards responsible journalism and ethical practices

This chapter compares the perceptions and experiences of local journalists with those of other types of journalists in six European countries to advance our understanding of ethics in local journalism in different journalism cultures and contexts. As cross-national insights are rare, the interviews with 31 journalists shed light on journalists’ ethical practices in these contexts. We find that local journalists are united by a shared identification with a distinctive set of values regarding their responsibilities to the public. A commitment to creating and defending the community differentiates them from other types of journalists, indicating that journalistic specialism is a more prominent definer of role perceptions than country context. Local journalists describe having a particularly close relationship with their audience due to geographical proximity, a co-dependence on the community and notions of a shared sense of place. Coupled with the heightened accountability that comes with the greater visibility of local journalists within communities, it is incumbent upon them to strive for high ethical standards. Our findings add to existing evidence that the culture of the newsroom and the news organisation is at least as important (and possibly more) as formal codes of ethics in influencing ethical practices