47 research outputs found
The ATHENE project:the importance of bricolage in personalising assisted living technologies
Introduction: An aging population is fueling interest in assisted living technologies (ALTs) to support independence at home. Numerous ALTs have been developed and deployed, but uptake and use has fallen short of levels predicted by policymakers. A key reason is a lack of understanding of usersâ needs. In this paper we report findings from the ATHENE (Assistive Technologies for Healthy Living in Elders: Needs Assessment by Ethnography) project, which is funded by the Technology Strategy Board under its Assisted Living Innovation Platform programme. The project aims to produce a richer understanding of the lived experiences and needs of older people and explore how ALT stakeholders â suppliers, health and social care providers â can work with users and carers to âcoproduceâ ALTs. We focus, in particular, on the role of âbricolageâ (pragmatic customisation, combining new with legacy devices) by informal carers, such as family members, in enabling ALTs to be personalised to individual needs. Bricolage allows users and family members to take the initiative in âcoproducingâ ALTs. that making assisted living work relies on collaboration, involving not only formal carers, but also informal ones. We argue that a new research agenda is needed, focusing on solving challenges of involving users and their informal carers in the straightforward and dependable co-production of ALTs
RAMESES publication standards: realist syntheses
PMCID: PMC3558331This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation
Background and aim: The NHS collects a large number of data on patient experience, but there are
concerns that it does not use this information to improve care. This study explored whether or not and
how front-line staff use patient experience data for service improvement.
Methods: Phase 1 â secondary analysis of existing national survey data, and a new survey of NHS trust patient
experience leads. Phase 2 â case studies in six medical wards using ethnographic observations and interviews.
A baseline and a follow-up patient experience survey were conducted on each ward, supplemented by
in-depth interviews. Following an initial learning community to discuss approaches to learning from and
improving patient experience, teams developed and implemented their own interventions. Emerging findings
from the ethnographic research were shared formatively. Phase 3 â dissemination, including an online guide
for NHS staff.
Key findings: Phase 1 â an analysis of staff and inpatient survey results for all 153 acute trusts in England
was undertaken, and 57 completed surveys were obtained from patient experience leads. The most
commonly cited barrier to using patient experience data was a lack of staff time to examine the data
(75%), followed by cost (35%), lack of staff interest/support (21%) and too many data (21%). Trusts were
grouped in a matrix of high, medium and low performance across several indices to inform case study
selection. Phase 2 â in every site, staff undertook quality improvement projects using a range of data
sources. The number and scale of these varied, as did the extent to which they drew directly on patient
experience data, and the extent of involvement of patients. Before-and-after surveys of patient experience
showed little statistically significant change. Making sense of patient experience âdataâ Staff were engaged
in a process of sense-making from a range of formal and informal sources of intelligence. Survey data
remain the most commonly recognised and used form of data. âSoftâ intelligence, such as patient stories,
informal comments and daily ward experiences of staff, patients and family, also fed into staffâs improvement plans, but they and the wider organisation may not recognise these as âdataâ. Staff may lack confidence in
using them for improvement. Staff could not always point to a specific source of patient experience âdataâ
that led to a particular project, and sometimes reported acting on what they felt they already knew needed
changing. Staff experience as a route to improving patient experience Some sites focused on staff motivation
and experience on the assumption that this would improve patient experience through indirect cultural and
attitudinal change, and by making staff feel empowered and supported. Staff participants identified several
potential interlinked mechanisms: (1) motivated staff provide better care, (2) staff who feel taken seriously
are more likely to be motivated, (3) involvement in quality improvement is itself motivating and (4) improving
patient experience can directly improve staff experience. âTeam-based capitalâ in NHS settings We propose
âteam-based capitalâ in NHS settings as a key mechanism between the contexts in our case studies and observed
outcomes. âCapitalâ is the extent to which staff command varied practical, organisational and social resources
that enable them to set agendas, drive process and implement change. These include not just material or
economic resources, but also status, time, space, relational networks and influence. Teams involving a range of
clinical and non-clinical staff from multiple disciplines and levels of seniority could assemble a greater range of
capital; progress was generally greater when the team included individuals from the patient experience office.
Phase 3 â an online guide for NHS staff was produced in collaboration with The Point of Care Foundation.
Limitations: This was an ethnographic study of how and why NHS front-line staff do or do not use
patient experience data for quality improvement. It was not designed to demonstrate whether particular
types of patient experience data or quality improvement approaches are more effective than others.
Future research: Developing and testing interventions focused specifically on staff but with patient
experience as the outcome, with a health economics component. Studies focusing on the effect of team
composition and diversity on the impact and scope of patient-centred quality improvement. Research into
using unstructured feedback and soft intelligence
Experiences of Self-Management Support Following a Stroke: A Meta-Review of Qualitative Systematic Reviews
Abstract Backgroun