Bridging the ‘Two Cultures’ of Research and Service: Can Complexity Theory Help?; Comment on “Experience of Health Leadership in Partnering With University-Based Researchers in Canada – A Call to ‘Re-imagine’ Research”

This commentary addresses Bowen et al’s empirical study of perspectives of Canadian healthcare staff towards research and their call for multi-faceted action to improve misalignments in the system. This commentary argues that tensions and misalignments between research and service are inherent and can never be eradicated. Building on previous work by Lanham et al, I propose seven principles of complexity which may help to develop system capacities that will help bridge the research-service gap: acknowledge unpredictability, recognise self-organisation, facilitate interdependencies, encourage sensemaking, attend to human relationships, develop adaptive capabilities in staff, and harness conflict productively

Reporting the inequalities in the access to medical school depending on applicant’s self-perception: Medical Schools Council’s Report.

The socio-economic inequalities associated with access to medical school are highlighted in the Medical School Council’s (MSC) report where there is a significant gap between the number of medical school applicants who come from disadvantaged areas and the number of medical school applicants from advantaged backgrounds1. Reports highlight that this inequality is driven by the perception young people from low socio-economic backgrounds have of themselves2. The MSC report uses the Multiple Deprivation Index to assess the deprivation of an area which illustrates individuals from deprived areas on average make up 4.8% of medical school applicants annually1. Data collected from The Medical Student Personal Beliefs Questionnaire highlight the different attitudes displayed in students from affluent areas and non-affluent areas. Overall, students from disadvantaged areas believe that medicine is not accessible to them. Differently, the students from higher socio-economic backgrounds believed that medicine is something that they can see themselves fulfilling. Less affluent students believe that having a higher social class and receiving superior education would provide them with an edge in the admissions process2. Individuals from disadvantaged backgrounds perceive themselves as not worthy to practise medicine. Surely, with more doctors being established from lower socio-economic backgrounds there will be more doctors representative of the patients they serve. Therefore, for the morale of university applicants and the future of medicine, schools need to help further break down the stereotype that medical school is only accessible if you come from a background of wealth and a family line of doctors

ATHENE : Assistive technologies for healthy living in elders : needs assessment by ethnography

Numerous assistive technologies to support independent living –including personal alarms, mobile phones, self-monitoring devices, mobility aids, software apps and home adaptations –have been developed over the years, but their uptake by older people, especially those from minority ethnic groups, is poor. This paper outlines the ways in which the ATHENE project seeks to redress this situation by producing a richer understanding of the complex and diverse living experiences and care needs of older people and exploring how industry, the NHS, social services and third sector can work with the older people themselves to ‘co-produce’ useful and useable ALT designs to meet their needs. In this paper, we provide an overview of the project methodology and discuss some of the issues it raises for the design and development process

Small Data and Big Data in the Waves of the Pandemic Building the Boat as we Sailed it

The pandemic hit the research world like a cannonball. ‘Normal’ ways of working and methodological approaches became impossible overnight, but the world desperately needed high-quality research to inform urgent policy decisions. This presentation will describe how one research team mobilised to undertake hypothesis-generating qualitative research (“small data”) to inform a major prospective study of acute COVID symptoms in over 10,000 patients (“big data”). The standard research timelines were upended and governance processes suspended. Nevertheless, some degree of rigour was achieved. In this keynote from the 2021 Research Methods e-Festival, Professor Trisha Greenhalgh reflects on lessons learned from high-stakes research at the interface between health and social care at this time of crisis

Hidden work and the challenges of scalability and sustainability in ambulatory assisted living

Assisted living technologies may help people live independently while also—potentially—reducing health and care costs. But they are notoriously difficult to implement at scale and many devices are abandoned following initial adoption.We report findings from a study of global positioning system (GPS) tracking devices intended to support the independent living of people with cognitive impairment. Our aims were threefold: to understand (through ethnography) such individuals’ lived experience of GPS tracking; to facilitate (through action research) the customization and adaptation of technologies and care services to provide effective, ongoing support; and to explore the possibilities for a co-production methodology that would enable people with cognitive impairment and their families to work with professionals and technical designers to shape these devices and services to meet their particular needs in a sustainable way.We found that the articulation work needed for maintaining the GPS technology in “working order” was extensive and ongoing. This articulation work does not merely supplement formal procedures, a lot of it is needed to get round them, but it is also often invisible and thus its importance goes largely unrecognized. If GPS technologies are to be implemented at scale and sustainably, methods must be found to capitalize on the skills and tacit knowledge held within the care network (professional and lay) to resolve problems, improve device design, devise new service solutions, and foster organizational learning

Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study

Objective To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality

Explaining the UK's 'high-risk' approach to type 2 diabetes prevention: findings from a qualitative interview study with policy-makers in England

Objectives When seeking to prevent type 2 diabetes, a balance must be struck between individual approaches (focusing on people’s behaviour ‘choices’) and population approaches (focusing on the environment in which those choices are made) to address the socioeconomic complexity of diabetes development. We sought to explore how this balance is negotiated in the accounts of policy-makers developing and enacting diabetes prevention policy. Methods Twelve semistructured interviews were undertaken with nine UK policy-makers between 2018–2021. We explored their perspectives on disease prevention strategies and what influenced policy decision-making. Interviews were transcribed and analysed thematically using NVIVO. We used Shiffman’s political priority framework to theorise why some diabetes prevention policy approaches gather political support while others do not. Results The distribution of power and funding among relevant actors, and the way they exerted their power determined the dominant approach in diabetes prevention policy. As a result of this distribution, policy-makers framed their accounts of diabetes prevention policies in terms of individual behaviour change, monitoring personal quantitative markers but with limited ability to effect population-level approaches. Such an approach aligns with the current prevailing neoliberal political context, which focuses on individual lifestyle choices to prevent disease rather than on infrastructure measures to improve the environments and contexts within which those choices are made. Conclusion Within new local and national policy structures, there is an opportunity for collaborative working among the National Health Service, local governments and public health teams to balance the focus on disease prevention, addressing upstream drivers of ill health as well as targeting individuals with the highest risk of diabetes

Ethnographic study of ICT-supported collaborative work routines in general practice

<p>Abstract</p> <p>Background</p> <p>Health informatics research has traditionally been dominated by experimental and quasi-experimental designs. An emerging area of study in organisational sociology is routinisation (how collaborative work practices become business-as-usual). There is growing interest in the use of ethnography and other in-depth qualitative approaches to explore how collaborative work routines are enacted and develop over time, and how electronic patient records (EPRs) are used to support collaborative work practices within organisations.</p> <p>Methods/design</p> <p>Following Feldman and Pentland, we will use 'the organisational routine' as our unit of analysis. In a sample of four UK general practices, we will collect narratives, ethnographic observations, multi-modal (video and screen capture) data, documents and other artefacts, and analyse these to map and compare the different understandings and enactments of three common routines (repeat prescribing, coding and summarising, and chronic disease surveillance) which span clinical and administrative spaces and which, though 'mundane', have an important bearing on quality and safety of care. In a detailed qualitative analysis informed by sociological theory, we aim to generate insights about how complex collaborative work is achieved through the process of routinisation in healthcare organisations.</p> <p>Discussion</p> <p>Our study offers the potential not only to identify potential quality failures (poor performance, errors, failures of coordination) in collaborative work routines but also to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in EPR technologies and via which "automated" safety features have an impact in practice.</p

Toward a Values-Informed Approach to Complexity in Health Care:Hermeneutic Review

Policy Points The concept of value complexity (complexity arising from differences in people's worldviews, interests, and values, leading to mistrust, misunderstanding, and conflict among stakeholders) is introduced and explained. Relevant literature from multiple disciplines is reviewed. Key theoretical themes, including power, conflict, language and framing, meaning-making, and collective deliberation, are identified. Simple rules derived from these theoretical themes are proposed.</p

Protocol - realist and meta-narrative evidence synthesis: Evolving Standards (RAMESES)

<p>Abstract</p> <p>Background</p> <p>There is growing interest in theory-driven, qualitative and mixed-method approaches to systematic review as an alternative to (or to extend and supplement) conventional Cochrane-style reviews. These approaches offer the potential to expand the knowledge base in policy-relevant areas - for example by explaining the success, failure or mixed fortunes of complex interventions. However, the quality of such reviews can be difficult to assess. This study aims to produce methodological guidance, publication standards and training resources for those seeking to use the realist and/or meta-narrative approach to systematic review.</p> <p>Methods/design</p> <p>We will: [a] collate and summarise existing literature on the principles of good practice in realist and meta-narrative systematic review; [b] consider the extent to which these principles have been followed by published and in-progress reviews, thereby identifying how rigour may be lost and how existing methods could be improved; [c] using an online Delphi method with an interdisciplinary panel of experts from academia and policy, produce a draft set of methodological steps and publication standards; [d] produce training materials with learning outcomes linked to these steps; [e] pilot these standards and training materials prospectively on real reviews-in-progress, capturing methodological and other challenges as they arise; [f] synthesise expert input, evidence review and real-time problem analysis into more definitive guidance and standards; [g] disseminate outputs to audiences in academia and policy. The outputs of the study will be threefold:</p> <p>1. Quality standards and methodological guidance for realist and meta-narrative reviews for use by researchers, research sponsors, students and supervisors</p> <p>2. A 'RAMESES' (Realist and Meta-review Evidence Synthesis: Evolving Standards) statement (comparable to CONSORT or PRISMA) of publication standards for such reviews, published in an open-access academic journal.</p> <p>3. A training module for researchers, including learning outcomes, outline course materials and assessment criteria.</p> <p>Discussion</p> <p>Realist and meta-narrative review are relatively new approaches to systematic review whose overall place in the secondary research toolkit is not yet fully established. As with all secondary research methods, guidance on quality assurance and uniform reporting is an important step towards improving quality and consistency of studies.</p