Shepherding knowledge : a case study of social interactions that support knowledge mobilisation for sepsis care in Scotland

This thesis is about knowledge that interconnects across different domains, and the social interactions that support the mobilisation of such knowledge for clinical practice. These issues are explored in the context of sepsis care in Scotland. Sepsis claims the lives of at least 52,000 people in the UK each year, more than breast, bowel and prostate cancer combined. While Hippocrates observed the dangers of sepsis well over two thousand years ago, only in the last 25 years has a coordinated research strategy been established to guide modern therapeutic efforts. Yet despite a mounting clinical evidence base, the cause(s), progression, treatment and even the very definition of sepsis remain often unclear and sometimes contested. In care settings, the clinical manifestations of sepsis are frequently subtle and difficult to distinguish from other common conditions, and the lack of a definitive diagnostic test heightens the range of knowledge clinicians depend upon in order to recognise and treat potentially septic patients. Within this context of uncertainty, connecting the domains of research, policy and practice remains an enduring concern in sepsis care, as with many other clinical issues. In particular, there are significant challenges in ensuring that knowledge (and knowing) in each of these domains better connect for continued improvements in patient care. This thesis then contributes to improved understanding of the persistent ‘knowing in practice’ problem: using a knowledge mobilisation framing to capture the development, sharing, and use of knowledge, where these processes are conceptualised as multifaceted and intertwined rather than segmented and detached. With a dual focus on both knowers and their knowledge, this work seeks a closer understanding of the social interactions that contribute to an interconnected ‘knowledge network’, a network that can, in turn, underpin better, safer patient care. Using a qualitative case study design, this study provides a detailed exploration of an interconnected knowledge network (on sepsis care in Scotland) that successfully drew together the research, policy, and practice communities and resulted in improved patient outcomes. Drawing on documentary, observational, and interview data, this work found that knowledge is carefully curated (through social interactions) in order to connect knowledge from the different domains and to support the mobilisation of new actionable understandings for care. Tensions within both what knowledge ‘is’, as well as the social system in which knowledge is employed, are negotiated and nurtured by social practices that have been termed ‘shepherding’. Shepherding practices are those that tend to the social interactions that support the mobilisation of knowledge, and they are in evidence throughout the distributed areas of research, policy and practice. In concluding, this thesis argues that – because knowledge is complex and emergent, and because mobilising knowledge is an ongoing social process – a developmental perspective needs to be taken as the normative frame for the ‘knowing in practice’ problem. The thesis makes two main contributions: • empirically it provides a rich and detailed account of interconnected knowledge and the social interactions that contribute to the mobilisation of that knowledge in sepsis care in Scotland; • theoretically, this work extends the academic literature that explores the diversity, complexity, and interconnectivity of knowledge for practice by emphasising the role of social interactions in supporting knowledge networks; and the study demonstrates the successful use of Soft Knowledge Systems (SKS) and Clinical Mindlines (CM) as a combined ‘relational knowledge systems’ lens to better understand knowledge mobilisation processes."This work was supported by the 600th Anniversary Scholarship provided by the School of Management, University of St Andrews." -- Acknowledgement

A framework to support the design and cultivation of embedded research initiatives

This work was supported by the National Institute of Health Research (NIHR) Health Services & Delivery Research (HS&DR) programme under grant number 16/52/21.Background: Embedded research involves co-locating researchers within non-academic organisations to better link research and practice. Embedded research initiatives are often complex and emergent with a range of underlying intents, structures and processes. This can create tensions within initiatives and contributes to ongoing uncertainty about the most suitable designs and the effectiveness of different approaches. Aims and objectives: We aimed to devise a practical framework to support those designing and cultivating embedded research by operationalising findings from an extensive study of existing initiatives. Key conclusions: The underpinning research on embedded initiatives – a literature review and scoping exercise of initiatives in health settings across the UK – showed that such initiatives share ten common sets of concerns in relation to their intent, structure and processes. We used these insights during a co-production workshop with embedded researchers and their managers that made use of a range of creative activities. The workshop resulted in a practical framework (and associated web-based tools) that draw on the metaphor of a garden to represent the growing, emergent nature of embedded research initiatives and the active work which individuals and organisations need to put into planning and maintaining such initiatives. Each of the aspects is represented as a separate area within the garden using relevant visual metaphors. Building on this, we also present a series of reflective questions designed to facilitate discussion and debate about design features, and we link these to the wider literature, thereby helping those involved to articulate and discuss their preferences and expectations.Publisher PDFPeer reviewe

The power of animation:encouraging doctors to access support for psychological wellbeing

The COVID-19 pandemic has exacerbated already high rates of poor psychological wellbeing in doctors. Many doctors perceive a stigma associated with acknowledging psychological wellbeing concerns, resulting in a reluctance to seek support for those concerns. The aim of this study was to develop a theoretically-informed and evidence-based composite narrative animation (CNA) to encourage doctors to access support for psychological wellbeing, and to evaluate the acceptability of the CNA.A composite narrative was developed from an evidence-base of interviews with 27 GP participants across Scotland (May–July 2020). The Behaviour Change Wheel was used to identify behaviour change techniques (BCTs) to be embedded within the CNA. The narrative was turned into a script in collaboration with an animation company. A brief animation ‘Jane the GP’ was developed reflecting specific BCTs.Scottish doctors (n = 83) were asked for their views on acceptability of the CNA concept, and subsequently asked to provide views on the acceptability of the CNA after viewing it. Participants thought the concept of a CNA was novel but may not appeal to all. After viewing the CNA, the widespread view was that it portrayed an authentic experience, could reduce stigma around seeking support for psychological wellbeing, and highlighted formal routes to access such support.CNAs are a novel and acceptable intervention method for encouraging doctors to access support for psychological wellbeing. The use of a theory driven intervention development framework to create the CNA facilitates the link between theory and practice

The power of animation:encouraging doctors to access support for psychological wellbeing

The COVID-19 pandemic has exacerbated already high rates of poor psychological wellbeing in doctors. Many doctors perceive a stigma associated with acknowledging psychological wellbeing concerns, resulting in a reluctance to seek support for those concerns. The aim of this study was to develop a theoretically-informed and evidence-based composite narrative animation (CNA) to encourage doctors to access support for psychological wellbeing, and to evaluate the acceptability of the CNA.A composite narrative was developed from an evidence-base of interviews with 27 GP participants across Scotland (May–July 2020). The Behaviour Change Wheel was used to identify behaviour change techniques (BCTs) to be embedded within the CNA. The narrative was turned into a script in collaboration with an animation company. A brief animation ‘Jane the GP’ was developed reflecting specific BCTs.Scottish doctors (n = 83) were asked for their views on acceptability of the CNA concept, and subsequently asked to provide views on the acceptability of the CNA after viewing it. Participants thought the concept of a CNA was novel but may not appeal to all. After viewing the CNA, the widespread view was that it portrayed an authentic experience, could reduce stigma around seeking support for psychological wellbeing, and highlighted formal routes to access such support.CNAs are a novel and acceptable intervention method for encouraging doctors to access support for psychological wellbeing. The use of a theory driven intervention development framework to create the CNA facilitates the link between theory and practice

Perceptions and experiences of different Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals.

To explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation. We used a qualitative descriptive design over two rounds of data collection with three participant groups: i) people with experience of rehabilitation for Long COVID (PwLC), ii) NHS staff delivering and/or managing community rehabilitation services (allied health professionals (AHPs)), and iii) NHS staff involved in strategic planning around Long COVID in their health board (Long COVID leads). Four NHS Scotland territorial health boards. 51 interviews were undertaken, eight Long COVID leads (11 interviews), 15 AHPs (25 interviews), and 15 PwLC (15 interviews). Three key themes were identified: i) Accessing care for PwLC, ii) Understanding Long COVID and its management, and iii) Strengths and limitations of existing Long COVID rehabilitation services. Organisational delivery of Long COVID community rehabilitation is complex and presents multiple challenges. In addition, access to Long COVID community rehabilitation can be challenging. When accessed, these services are valued by PwLC but require adequate planning, publicity, and resource. The findings presented here can be used by those developing and delivering services for people with Long COVID

Perceptions and experiences of different Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals

Objectives: To explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation.Design: We used a qualitative descriptive design over two rounds of data collection with three participant groups: i) people with experience of rehabilitation for Long COVID (PwLC), ii) NHS staff delivering and/or managing community rehabilitation services (allied health professionals (AHPs)), and iii) NHS staff involved in strategic planning around Long COVID in their health board (Long COVID leads).Setting: Four NHS Scotland territorial health boards. Participants: 51 interviews: eight Long COVID leads (11 interviews), 15 AHPs (25 interviews), and 15 PwLC (15 interviews).Results: Three key themes were identified: i) Accessing care for PwLC, ii) Understanding Long COVID and its management, and iii) Strengths and limitations of existing Long COVID rehabilitation services.Conclusions: Organisational delivery of Long COVID community rehabilitation is complex and presents multiple challenges. In addition, access to Long COVID community rehabilitation can be challenging. When accessed, these services are valued by PwLC but require adequate planning, publicity, and resource. The findings presented here can be used by those developing and delivering services for people with Long COVID

Investigating Scottish Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals:a qualitative descriptive study

Objectives:This study aimed to explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation.Design:We used a qualitative descriptive design over two rounds of data collection with three participant groups: (1) people with experience of rehabilitation for Long COVID (PwLC); (2) National Health Service (NHS) staff delivering and/or managing community rehabilitation services (allied health professionals (AHPs)); and (3) NHS staff involved in strategic planning around Long COVID in their health board (Long COVID leads).Setting:Four NHS Scotland territorial health boards.Participants:51 interviews: eight Long COVID leads (11 interviews); 15 AHPs (25 interviews) and 15 PwLC (15 interviews).Results:Three key themes were identified: (1) accessing care for PwLC, (2) understanding Long COVID and its management, and (3) strengths and limitations of existing Long COVID rehabilitation services.Conclusions:Organisational delivery of Long COVID community rehabilitation is complex and presents multiple challenges. In addition, access to Long COVID community rehabilitation can be challenging. When accessed, these services are valued by PwLC but require adequate planning, publicity, and resource. The findings presented here can be used by those developing and delivering services for people with Long COVID.<br/

Optimising the impact of health services research on the organisation and delivery of health services : a mixed-methods study

The research reported in this issue of the journal was funded by the HSDR programme or one of its preceding programmes as project number 16/52/21.Background The limitations of ‘knowledge transfer’ are increasingly recognised, with growing interest in ‘knowledge co-production in context’. One way of achieving the latter is by ‘embedding’ researchers in health service settings, yet how to deliver such schemes successfully is poorly understood. Objectives The objectives were to examine the nature of ‘embedded knowledge co-production’ and explore how embedded research initiatives can be designed more effectively. Design The study used four linked workstreams. Workstream 1 involved two parallel literature reviews to examine how ‘knowledge co-production’ and ‘embedded research’ are conceptualised, operationalised and discussed. In workstream 2, a scoping review of exisiting or recent ‘embedded researcher’ schemes in UK health settings was carried out. Workstream 3 involved developing four in-depth case studies on such schemes to understand their mechanisms, effectiveness and challenges. In workstream 4, insights from the other workstreams were used to provide recommendations, guidance and templates for the different ways embedded co-production may be framed and specified. The overall goal was to help those interested in developing and using such approaches to understand and address the design choices they face. Setting Embedded research initiatives in UK health settings. Data sources Data were sourced from the following: analysis of the published and grey literature (87 source articles on knowledge co-production, and 47 published reports on extant embedded research initiatives), documentation and interviews with key actors across 45 established embedded research initiatives, in-depth interviews and site observations with 31 participants over 12 months in four intensive case studies, and informal and creative engagement in workshops (n = 2) and with participants in embedded research initiatives who joined various managed discussion forums. Participants The participants were stakeholders and participants in embedded research initiatives. Results The literature reviews from workstream 1 produced practical frameworks for understanding knowledge co-production and embedded research initiatives, which, with the scoping review (workstream 2), informed the identification and articulation of 10 design concerns under three overarching categories: intent (covering outcomes and power dynamics), structures (scale, involvement, proximity and belonging) and processes (the functional activities, skills and expertise required, nature of the relational roles, and the learning mechanisms employed). Current instances of embedded research were diverse across many of these domains. The four case studies (workstream 3) added insights into scheme dynamics and life cycles, deepening understanding of the overarching categories and showing the contingencies experienced in co-producing knowledge. A key finding is that there was often a greater emphasis on embeddedness per se than on co-production, which can be hard to discern. Finally, the engaging and influencing activities running throughout (workstream 4) allowed these research-rooted insights to be translated into practical tools and resources, evidenced by peer-reviewed publications, for those interested in exploring and developing the approach. Conclusions Embedded research has a strong underpinning rationale, and more is becoming known about its design and management challenges. The tools and resources developed in this project provide a coherent evidence-informed framework for designing, operationalising and managing such schemes. It cannot yet be said with clarity that the potential benefits of embedded research are always deliverable, nor what the cost would be. Future work With the means to describe and categorise different types of embedded research initiatives, more evaluative work is now needed to examine the relative merits and costs of different designs. Funding This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.Publisher PDFPeer reviewe

Investigating Scottish Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals:a qualitative descriptive study

Objectives:This study aimed to explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation.Design:We used a qualitative descriptive design over two rounds of data collection with three participant groups: (1) people with experience of rehabilitation for Long COVID (PwLC); (2) National Health Service (NHS) staff delivering and/or managing community rehabilitation services (allied health professionals (AHPs)); and (3) NHS staff involved in strategic planning around Long COVID in their health board (Long COVID leads).Setting:Four NHS Scotland territorial health boards.Participants:51 interviews: eight Long COVID leads (11 interviews); 15 AHPs (25 interviews) and 15 PwLC (15 interviews).Results:Three key themes were identified: (1) accessing care for PwLC, (2) understanding Long COVID and its management, and (3) strengths and limitations of existing Long COVID rehabilitation services.Conclusions:Organisational delivery of Long COVID community rehabilitation is complex and presents multiple challenges. In addition, access to Long COVID community rehabilitation can be challenging. When accessed, these services are valued by PwLC but require adequate planning, publicity, and resource. The findings presented here can be used by those developing and delivering services for people with Long COVID.<br/