Applying a Dynamic Performance Management Framework to Wicked Issues: How Coproduction Helps to Transform Young People's Services in Surrey County Council, UK

This article explores how a dynamic performance management (DPM) approach can give policy makers a more integrated, time-related understanding of how to address wicked problems successfully. The article highlights how an outcome-based approach to solving wicked policy problems has to balance three very contrasting objectives of stakeholders in the policy making process-improving service quality, improving quality of life outcomes and improving conformity to the principles of public governance. Simultaneous achievement of these three objectives may not be feasible, as they may form an interactive dynamic system. However the balancing act between them may be achieved by the use of DPM. Policy insights from this novel approach are illustrated through a case study of a highly successful co-production intervention to help young people with multiple disadvantages in Surrey, UK. The implications of DPM are that policy development needs to accept the important roles of emergent strategy and learning mechanisms, rather than attempting 'blueprint' strategic planning and control mechanisms. Some expectations about the results may indeed be justifiable in particular policy systems, as clustering of quality of life outcomes and outcomes in the achievement of governance principles is likely, because behaviours are strongly inter-related. However, this clustering can never be taken for granted but must be tested in each specific policy context. Undertaking simulations with the model and recalibrating it through time, as experience builds up, may allow learning in relation to overcoming barriers to achieving outcomes in the system

Co-producing a digital educational programme for registered children’s nurses to improve care of children and young people admitted with self-harm

Despite the increasing prevalence of hospital admissions for self-harm in children and young people (CYP), there is paucity of registered children’s nurse (rCN) training or involvement of children to improve care for this often stigmatized patient group. This article describes a participatory approach towards using co-production with CYP and rCN to develop a digital educational programme to improve nurses’ knowledge, attitudes and confidence in caring for CYP with self-harm injuries. A priority-setting workshop with rCNs was used to establish consensus of information needs. This was followed by an e-learning content development workshop undertaken with CYP whom had previously experienced hospital admissions for self-harm injuries. Findings from the nurse priority-setting workshop identified three educational priorities: (1) knowledge of self-harm, (2) effective communication and (3) risk management. The CYP subsequently developed these topic areas to ensure the contents and design of the e-learning resource had fidelity by reflecting the experiences of CYP and needs when cared for in hospital. This article illustrates that involving service users to co-develop educational materials is a feasible and important step in designing educational resources and ensures the content is relevant, appropriate and sensitive to both the recipient of care and those responsible for its delivery

Object Permanence and the Relationship to Sitting Development in Infants With Motor Delays

Purpose: This study examines object permanence development in infants with motor delays (MD) compared with infants with typical development (TD) and in relation to sitting skill. Methods: Fifty-six infants with MD (mean age = 10 months) and 36 with TD (mean age = 5.7 months) were assessed at baseline and then at 1.5, 3, and 6 months postbaseline. A scale was developed to measure object permanence (Object Permanence Scale [OPS]), and the Gross Motor Function Measure sitting subsection (GMFM-SS), and the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III) were administered. Results: Interrater reliability of the OPS was excellent and correlation between the OPS and Bayley-III cognitive scores was moderately positive. Compared with TD, infants with MD were delayed in development of object permanence but demonstrated increased understanding over time and as sitting skills improved. Conclusion: In children with MD, object permanence, as quantified by the OPS, emerges in conjunction with sitting skill

How do ecological perspectives help understand schools as sites for teacher learning?

Schools are sites of teachers’ professional learning for both new entrants and experienced practitioners. In this paper, schools are conceptualised as complex, multidimensional ecologies that are constituted by the relations that exist between school leaders, teachers, mentors and all members of the school community. As relational environments, the conditions affecting professional learning – both formal and informal – are constantly dynamic, with multiple and simultaneous interactions taking place between these stakeholders. Interactions are also multi-layered – between the school system, individuals, classrooms, the community and the policy environment. School leaders are a major influence on these dynamics and affect how schools act as sites of professional formation, mediating external policy as well as affecting micro-dynamics within individual school systems. The challenge of realising professional learning within these relational contexts can be viewed as a ‘wicked problem’, a feature of complex systems that resists simplified solutions. In conceptualising a complex ecology at work, we illuminate the relational dynamics with a focus, for all stakeholders within schools, including leaders, on the need to recognise and value the importance of ‘emergence’ in professional learning. This means embracing inevitable uncertainty as a feature of schools as complex systems

Towards an asset-based approach to promoting and sustaining well-being for people with aphasia and their families: an international exploratory study

Background: There is growing interest in interventions that promote positive outcomes and well-being for people with aphasia (PWA) and their families, but provision is inconsistent. An asset-based approach, based on the theory of salutogenesis, focuses on what makes you well rather than ill. This approach has been used successfully across a variety of research fields, including health and social care research and practice, and has the potential to provide coherent strategies to support people living successfully with aphasia. Aim: To explore the relevance and potential of an asset-based approach to promoting and sustaining well-being for PWA and their families, across contexts and cultures. Methods & procedures: Exploratory case studies were carried out in the United Kingdom (UK), Norway, Israel, Ireland, and Denmark in a variety of settings. Following an interpretative paradigm, we used qualitative methods including: interviews; appreciative inquiry; group discussions; and participatory action research. 95 PWA and 25 family members were asked to identify assets within themselves and their communities that promote, sustain and maintain well-being, by responding to: “What makes you feel good/well/healthy?” Data were analysed using thematic analysis. Outcomes & results: An asset-based approach proved to be a powerful means for PWA and family members to explore what helps them live well with aphasia. Key themes were identified: (1) personal journey; (2) helping others; (3) connecting to self; (4) connecting to others; (5) recreation; and (6) personal attributes. Self-identification of assets, within the person and their community, and connections to these, helped PWA and their family members to maintain well-being, overcome barriers and regain confidence. Using this approach, focusing on the person’s recognition, activation and mobilisation of assets, could enhance the person’s understanding and restore meaning around the stroke and onset of aphasia. Conclusion: This novel exploratory research demonstrates the relevance and potential across diverse cultural contexts of taking an asset-based approach to promoting and sustaining well-being for PWA and their families. Focusing on maintaining connections to these assets and developing meaning around the event, could prevent some of the negative sequela of stroke. The “patient–professional” relationship must transform into a collaborative partnership, with time and flexibility needed to introduce this approach. Further research should examine how service providers and PWA could develop and operationalise an asset-based approach in clinical and community settings and identify if there is an optimum timing for introducing this approach along the stroke pathway

Squaring the circle: a priority-setting method for evidence-based service development, reconciling research with multiple stakeholder views.

BACKGROUND: This study demonstrates a technique to aid the implementation of research findings through an example of improving services and self-management in longer-term depression. In common with other long-term conditions, policy in this field requires innovation to be undertaken in the context of a whole system of care, be cost-effective, evidence-based and to comply with national clinical guidelines. At the same time, successful service development must be acceptable to clinicians and service users and choices must be made within limited resources. This paper describes a novel way of resolving these competing requirements by reconciling different sources and types of evidence and systematically engaging multiple stakeholder views. METHODS: The study combined results from mathematical modelling of the care pathway, research evidence on effective interventions and findings from qualitative research with service users in a series of workshops to define, refine and select candidate service improvements. A final consensus-generating workshop used structured discussion and anonymised electronic voting. This was followed by an email survey to all stakeholders, to achieve a pre-defined criterion of consensus for six suggestions for implementation. RESULTS: An initial list of over 20 ideas was grouped into four main areas. At the final workshop, each idea was presented in person, visually and in writing to 40 people, who assigned themselves to one or more of five stakeholder groups: i) service users and carers, ii) clinicians, iii) managers, iv) commissioners and v) researchers. Many belonged to more than one group. After two rounds of voting, consensus was reached on seven ideas and one runner up. The survey then confirmed the top six ideas to be tested in practice. CONCLUSIONS: The method recruited and retained people with diverse experience and views within a health community and took account of a full range of evidence. It enabled a diverse group of stakeholders to travel together in a direction that converged with the messages coming out of the research and successfully yielded priorities for service improvement that met competing requirements