The use of, and training provision for, healthcare assistants and support workers in the National Health Service in England

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From transformative learning to social change? Using action research to explore and improve informal complaints management in an NHS trust

Background: The number of complaints from patients and/or carers concerning aspects of care has increased over time. Yet, in spite of a growing body of national and international literature on healthcare complaints, there is a lack of knowledge around how nurses and midwives manage informal complaints at ward level, or staff needs in relation to this. Aim: Using an action research approach with mixed methods, four phases and four cycles, the aim was to explore informal complaints management by nurses and midwives at ward level. We discuss the action research process primarily in connection with learning and service change, drawing from the qualitative data in this paper. Findings: The analysis of the collected qualitative data resulted in three main themes, related to the complexities of complaints and complaints management, staff support needs and the existing ambiguous complaints systems, which are hard for staff and service users to negotiate. The action research approach facilitated learning and change in participants in relation to complaints management, in the collaborating trust. Conclusions: The extant body of research on complaints does not sufficiently recognise the complexity of complaints and informal complaints management, or the complaints systems that are in place. Needs-based staff training can help support staff to manage informal complaints more effectively. Implications for practice: •There needs to be recognition of the complexities involved in complaints management •Complaints systems need to be clearer for the benefit of service users and staff •Staff need training and support that is tailored to their needs to improve their response to complaints, leading to a better patient experience •Limited interventions, informed by staff needs, can lead to change and act as a catalyst for a wider change in informal complaints managemen

From transformative learning to social change? Using action research to explore and improve informal complaints management in an NHS trust

Background: The number of complaints from patients and/or carers concerning aspects of care has increased over time. Yet, in spite of a growing body of national and international literature on healthcare complaints, there is a lack of knowledge around how nurses and midwives manage informal complaints at ward level, or staff needs in relation to this. Aim: Using an action research approach with mixed methods, four phases and four cycles, the aim was to explore informal complaints management by nurses and midwives at ward level. We discuss the action research process primarily in connection with learning and service change, drawing from the qualitative data in this paper. Findings: The analysis of the collected qualitative data resulted in three main themes, related to the complexities of complaints and complaints management, staff support needs and the existing ambiguous complaints systems, which are hard for staff and service users to negotiate. The action research approach facilitated learning and change in participants in relation to complaints management, in the collaborating trust. Conclusions: The extant body of research on complaints does not sufficiently recognise the complexity of complaints and informal complaints management, or the complaints systems that are in place. Needs-based staff training can help support staff to manage informal complaints more effectively. Implications for practice: • There needs to be recognition of the complexities involved in complaints management • Complaints systems need to be clearer for the benefit of service users and staff • Staff need training and support that is tailored to their needs to improve their response to complaints, leading to a better patient experience • Limited interventions, informed by staff needs, can lead to change and act as a catalyst for a wider change in informal complaints managemen

From transformative learning to social change? Using action research to explore and improve informal complaints management in an NHS trust

Background: The number of complaints concerning aspects of care from patients and/or carers have increased over time. Yet, in spite of a growing body of national and international literature on health care complaints there is a lack of knowledge around how nurses and midwives manage informal complaints at ward level, or staff needs in relation to this. Aim: Using an Action research (AR) approach with mixed methods, four phases and four cycles, the aim was to explore informal complaints management by nurses and midwives at ward level. We discuss the AR process primarily in connection with learning and service change, drawing from the qualitative data in this paper. Findings: The analysis of the collected qualitative data resulted in three main themes related to the complexities of complaints and complaints management, staff support needs and the existing ambiguous complaints systems which are hard for both staff and servicer users to negotiate. The AR approach facilitated learning and change in participants in relation to views on complaints management, and the main issues around complaints management in the collaborating trust. Conclusions: The extant body of research on complaints does not sufficiently recognise the complexity of complaints and informal complaints management or the complaints systems in place. Needs based staff training can help support staff to manage informal complaints more effectively

A pilot study evaluating the use of ABCD2 score in pre-hospital assessment of patients with suspected transient ischaemic attack: experience and lessons learned

Background: Suspected transient ischaemic attack (TIA) is a common presentation to emergency medical services (EMS) in the United Kingdom (UK). Several EMS systems have adopted the ABCD2 score to aid pre-hospital risk stratification and decision-making on patient disposition, such as direct referral to an Emergency Department or specialist TIA clinic. However, the ABCD2 score, developed for hospital use, has not been validated for use in the pre-hospital context of EMS care. Methods: We conducted a pilot study to assess eligibility criteria, recruitment rates, protocol compliance, consent and follow-up procedures to inform the development of a definitive study to validate the ABCD2 tool in pre-hospital evaluation of patients with suspected TIA. Results: From 1st May–1st September 2013, nine patients with an EMS suspected diagnosis of TIA had the TIA diagnosis later confirmed by a specialist from five participating sites. This recruitment rate is comparable to stroke trials in the EMS setting. Bureaucratic obstacles and duplication of approval processes across participating sites took 13 months to resolve before recruitment commenced. Due to the initial difficulty in recruitment, a substantial amendment was approved to modify inclusion criteria, allowing patients with atrial fibrillation and/or taking anticoagulant therapy to participate in the study. Conclusions: It is possible to identify, recruit and follow up patients with suspected TIA in the EMS setting. Training large numbers of EMS staff is required as exposure to TIA patients is infrequent. Significant insight was gained into the complexity of NHS research governance mechanisms in the UK. This knowledge will facilitate the planning of a future adequately powered study to validate the ABCD2 tool in a pre-hospital setting

Reformele din domeniul asistenței medicale primare văzute prin prisma inovării - studii de caz, zona vest-balcanică și est-europeană

CONTEXT: Innovation within healthcare can take many forms, ranging from drug therapies, through to new forms of financing. Most transition countries in CEE are engaged in health reform initiatives aimed at introducing primary health care (PHC) to enhance performance of their health systems. This has been challenging with examples of unequal adoption, professional resistance and poor sustainability. PURPOSE OF THIS PAPER: We aim to explore the introduction and diffusion of family-medicine-centered PHC reforms in Western Balkans and Eastern European Context; THROUGH THE LENS OF INNOVATION.DESIGN/METHODOLOGY/APPROACH: A comparative case studies analysis using cases selected from the Western Balkans and Eastern European Countries. We identified our cases based on a systematic search of peer-reviewed articles the grey literature. Overall 5 cases met the inclusion criteria; then developed an analytical framework based on key aspects of the innovation process FINDINGS: PHC reform is a complex innovation, involving organizational, financial, clinical and relational changes. The framework clearly highlights the value of early analysis of change programmes in order that the leaders of these programmes can anticipate and develop strategies which would ensure a more successful and sustainable change process. THE ORIGINAL/VALUE OF PAPER: The study merges different features of PHC in different post-communist countries, providing empirical evidence on PHC reforms in particular CEE countries both in developed and remote areas.                                                                                            Keywords - Innovation, Primary Healthcare Reforms, Post-Communist Countries,   Systems in Transition,CONTEXT: Inovarea în domeniul asistenței medicale poate îmbrăca diverse forme, variind de la terapiile medicamentoase, până la noi forme de finanțare. Majoritatea țărilor din Europa Centrală, aflate în tranziție sunt implicate în inițiative de reformare a sistemului medical ce vizează introducerea asistenței medicale primare (AMP) în scopul îmbunătățirii performanței sistemelor lor de sănătate. Acest lucru a fost provocator, cu exemple de adoptare diversă și inegală, rezistență din partea profesioniștilor și sustenabilitate scăzută.SCOPUL ARTICOLULUI: Scopul nostru este de a studia introducerea și extinderea reformelor din domeniul AMP centrate pe medicina de familie, în regiunea vest Balcanică și est-Europeană, prin prisma inovării.METODOLOGIE: Studiul de față este o analiză comparativă, utilizând studii de caz selectate din regiunea vest Balcanică și est-Europeană. Am identificat cazurile din studiu pe baza căutării sistematice a articolelor din literatura gri, revizuite pe modelul peer-reviewed . Per ansamblu, 5 cazuri au îndeplinit criteriile de includere; apoi am dezvoltat un cadru de analiză bazat pe aspectele cheie ale procesului de inovare.REZULTATE: Reforma din domeniul AMP reprezintă o inovație complexă, implicând schimbări organizaționale, financiare, clinice și relaționale. Cadrul de lucru pune în evidență, în mod clar, valoarea analizei precoce a programelor și planurilor de schimbare, astfel încât liderii acestor programe să poată anticipa și dezvolta strategii care să asigure un proces de schimbare mai sustenabil și de succes.                                                                                                                                                                                                                                    AUTENTICITATEA/ VALOAREA ARTICOLULUIStudiul combină aspecte diferite ale AMP din diferite țări post-comuniste, oferind dovezi empirice privind reformele AMP, în special în țările Europei Centrale și de Est (ECE), atât din zone dezvoltate cât și din celelalte zone, izolate.  Cuvinte cheie: inovare, reforme asistență medicală primară, țări post-comuniste, sisteme în tranziţi

Why are some care homes better than others? An empirical study of the factors associated with quality of care for older people in residential homes in Surrey, England

This paper reports an empirical study that investigated associations between the quality of care received by older people in residential settings and features of the care homes in which they live. Data were gathered from the first announced inspection reports (2002–2003) of all 258 care homes for older people in one county of England (Surrey). The number of inspected standards failed in each home was used as the main indicator of quality of care. Independent variables (for each home) were: size, type, specialist registration, on-site nursing, ownership, year registered, location, maximum fee, vacancies, resident dependency, whether the home took publicly funded residents, care staff qualifications and managerial quality. Quality of care was modelled using a Poisson count maximum likelihood method based on 245 (91%) of the inspected homes for which relevant data were available. The results showed that quality of care (as defined by failures on national standards) was statistically associated with features of care homes and their residents. A higher probability of failing a standard was significantly associated with being a home that: was a for-profit small business (adjusted risk ratio (RR) = 1.17); was registered before 2000(adj. RR = 1.22), accommodated publicly funded residents (adj. RR = 1.12); was registered to provide nursing care (adj. RR = 1.12). Fewer failures were associated with homes that were corporate for-profit (adj. RR = 0.82); held a specialist registration (adj. RR = 0.91); charged higher maximum fees (adj. RR = 0.98 per 100 pound sterling unit). A secondary analysis revealed a stronger model: higher scores on managerial standards correlated with fewer failures on other standards (r = 0.65, P < 0.001). The results of this study may help inform future policy. They are discussed in the context of alternative approaches to measuring quality of residential care, and in terms of their generalisability

Why are some care homes better than others? An empirical study of the factors associated with quality of care for older people in residential homes in Surrey, England

This paper reports an empirical study that investigated associations between the quality of care received by older people in residential settings and features of the care homes in which they live. Data were gathered from the first announced inspection reports (2002–2003) of all 258 care homes for older people in one county of England (Surrey). The number of inspected standards failed in each home was used as the main indicator of quality of care. Independent variables (for each home) were: size, type, specialist registration, on-site nursing, ownership, year registered, location, maximum fee, vacancies, resident dependency,whether the home took publicly funded residents, care staff qualifications and managerial quality. Quality of care was modelled using a Poisson count maximum likelihood method based on 245 (91%)of the inspected homes for which relevant data were available. The results showed that quality of care (as defined by failures on national standards) was statistically associated with features of care homes and their residents. A higher probability of failing a standard was significantly associated with being a home that: was a for-profit small business (adjusted risk ratio (RR) = 1.17); was registered before 2000(adj. RR = 1.22), accommodated publicly funded residents (adj. RR = 1.12); was registered to provide nursing care (adj. RR = 1.12). Fewer failures were associated with homes that were corporate for-profit (adj. RR = 0.82); held a specialist registration (adj. RR = 0.91); charged higher maximum fees (adj. RR = 0.98 per 100 pound sterling unit). A secondary analysis revealed a stronger model: higher scores on managerial standards correlated with fewer failures on other standards (r = 0.65, P < 0.001). The results of this study may help inform future policy. They are discussed in the context of alternative approaches to measuring quality of residential care, and in terms of their generalisability

Gatekeeping access to the midwifery unit: managing complaints by bending the rules

While poor communication between service users and front-line staff causes many service user complaints in the British National Health Service, staff rarely reflect on the causes of these complaints. We discuss findings from an action research project with midwives which suggest that the midwives struggled to fully understand complaints from women, their partners and families particularly about restricted visiting and the locked door to the midwifery unit. They responded to individual requests to visit out of hours while maintaining the general policy of restricted visiting. In this way, the door was a gatekeeping device which allowed access to the unit within certain rules. The locked door remained a barrier to women and their families and as a result was a common source of informal complaints. We argue that the locked door and restricted visiting to the midwifery unit were forms of gatekeeping and boundary making by midwives which reveals a tension between their espoused woman-centred care and contemporary midwifery practice which is increasingly constrained by institutional values