Going for growth : improvement in the infrastructural and management support for clinical academic research

Our objective was to implement a Directorate Research Strategy to improve and grow clinical academic capacity and capability and ensure that the organisational systems and processes enabled clinical staff and managers to increase grant capture, undertake clinically relevant research including the adoption of NIHR portfolio sites and established a culture in which research was an accepted part of professional practice. An initial evaluation of senior and middle manager attitudes and understanding of the research infrastructure and benefits of research identified that the Directorate had a deeply segmented view of research and only a partial view of how research could benefit patients and improve their services. A significant number of staff claimed to be research active but this activity was not contributing to the service knowledge or being translated into grant capture, leading to income that could be used to invest in patient -facing research. Few managers had appreciated the challenge of implementing the research strategy or the potential of enabling research active staff to generate clinical academic careers. An improvement approach was adopted, based on the 'Discipline of Improvement' (Penny 2003) recognising the need to embed research activity as a sustained activity that would involve all staff across the Directorate and deliver to the performance targets agree with the organisation. The interventions were introduced to assist key managers in each professional group to champion research and undertake the organisational change that would be needed. The Discipline of Improvement suggests an equal and proportional range of activity to engage staff, amend and adapt processes and systems, carry out organisational change and 'make it a habit'. The four cycles of improvement over 14 months were focused on the aim of inclusion of clinical staff in the delivery of the research strategy and this has resulted in 'academic status' being awarded in 2015. A clinical academic infrastructure, Public and Patient involvement and participation of clinical academic staff (10%) in grant capture and income has sustained the investment in research growth.</p

Locating assistive technology research in a clinical setting : an occupational perspective

Peer research was used to identify the experience and perceptions of assistive technology and telecare adoption in a UK healthcare context. A narrative account of participation and learning is intended to provoke further dialogue. There have been a range of policy and implementation initiatives that are within the direct experience of organisational actors over the last 15 years and this engagement allows for specific reflection on the service achievements and some of the barriers to implementation of technology changes in rehabilitation practice and service design. Insights are presented that suggest a reification of research priorities and a need to align technology, through patient and public engagement, to provider priorities. In addition, an improvement in adoption would be based on sustained capacity building within the Occupational Therapy workforce and a re-focus on specific knowledge sharing and learning about technology. Given the shared desire to promote the sustained adoption of appropriate technology for assistance and rehabilitation it is suggested the voice of practitioners is strengthened through research and knowledge exchange in the clinical setting

Complex programme evaluation of a ‘New Care Model’ Vanguard: a shared commitment to quality improvement in an integrated health and care context

NHS Vanguards, under-pressure to perform, required better contracting and data management arrangements with evaluation teams, to ensure that integrated service outcomes could be reported effectively. This communication reflects the experience of evaluating an NHS Vanguard and suggests how academic teams can improve capacity for complex programme evaluation of rapid improvements in integrated services. This should be based on a shared commitment to data collection and management. Also, robust knowledge exchange processes can enable systems change and sustainability. The identifying features of the particular site have been withheld

Complex programme evaluation of a ‘New Care Model’ Vanguard: a shared commitment to quality improvement in an integrated health and care context

NHS Vanguards, under-pressure to perform, required better contracting and data management arrangements with evaluation teams, to ensure that integrated service outcomes could be reported effectively. This communication reflects the experience of evaluating an NHS Vanguard and suggests how academic teams can improve capacity for complex programme evaluation of rapid improvements in integrated services. This should be based on a shared commitment to data collection and management. Also, robust knowledge exchange processes can enable systems change and sustainability. The identifying features of the particular site have been withheld

Development of a Dysphagia Management Protocol for Older Residents in a Care Home Setting. (abstract only)

Purpose: The aim of this study is to develop a co-designed dysphagia management protocol for older residents living in a care home setting. Method: A qualitative study is being conducted within four care homes in a region in the North of England; these were purposively selected to ensure representation of a range of care models across the care home sector. A literature search was conducted to establish good practice in the management of dysphagia in care homes. The findings from the literature review informed the development of semi-structured interview/focus group guides. Eight focus groups have been conducted with 40 members of the nursing and care assistant team and semi-structured interviews conducted with four nursing home managers. These have explored the assessment and management of dysphagia and the barriers and opportunities for improvement in dysphagia management. Interviews will also be conducted with residents (n=16) and nominated relatives, and quality managers (n=4). The interview and focus group data are being analyzed using the Framework Approach. Results: The literature review and preliminary data analysis suggest the following emerging themes: Lack of integrated approaches to education and training; Enablers and barriers to effective dysphagia management; Impact of relationship with other health care professionals on dysphagia management. Conclusion: These findings will lead to the co-design of a protocol for optimizing nutrition and hydration which is based on evidence and best practice principles and which can be adopted in the care home setting. This protocol will be produced by January 2018. The study has been funded by the Abbeyfield Foundation

Knowledge exchange at York St John: Building capacity in a small university.

Government policy and Higher Education (HE) sector strategy has promoted increased external engagement and participation in the knowledge economy on the part of universities. These drivers have sought to encourage academics to become engaged in the economic, social and cultural issues of society and to address problems in such a way as to demonstrate a knowledge contribution from the academy. Universities, as knowledge intensive organizations respond by changing their organizational structures and processes to support knowledge exchange and to encourage the involvement of academics in this endeavour. This thesis demonstrates how the concept of absorptive capacity (Cohen & Levinthal 2000) was used to understand knowledge exchange capacity at York St John University; a learning and teaching organization with newly acquired University status and a key strategic aim associated with increasing enterprise and knowledge exchange. The action research revealed a very limited development of knowledge exchange strategy and planning and limited ability to 'assimilate' and therefore 'exploit' new knowledge. Academic individualism and managerial control inhibited participation in the action research process and whilst the diagnosis was partly shared with the academic community further actions were not achieved. However a subsequent re-structuring of the University and a very senior appointment to lead external facing activity, suggested that a structural commitment to external engagement was made. Following a critical reflection on the research process and the systems theory of absorptive capacity, the contribution to practice-knowledge a conceptual framework was devised to explain the outcomes of the action research. The framework 'Knowledge Exchange Leadership in High and Low Absorptive Capacity Settings' articulates how academic leadership mindsets differ in high and low absorptive capacity settings. The framework is based on observed experience and individual interpretation of individual and corporate leadership in low capacity settings and an induction about the same domains in high absorptive capacity settings. The framework will help evaluate HE leadership behaviours and facilitate strategic planning for academic knowledge exchange and organizational knowledge productivity. The framework requires further application in other university contexts, to validate it as a practice tool for individual and organizational development. Through epistemological reflection, the functionalist approach (Burrell & Morgan 1979) through action research is questioned. The practitioner-inquiry experience leads to a more critical and interpretive understanding about the barriers to university based organizational change. Further consideration is given to managing action research using more participative methods. I suggest some key questions to engage the academic community in knowledge exchange and 'engaged scholarship' (Van de Ven 2010) as a means to improve engagement with knowledge and to improve assimilation and capacity for knowledge exchange

Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units

Objectives This report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision. Design Cohort study and survey data. Setting OOH appointments offered in four units in one region in England (October 2015 to November 2016). Methods Unidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available. Results There were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular—93% selecting ‘extremely likely’ or ‘likely’ to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service. Conclusions The users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs