New initiatives in the delivery and organisation of gastrointestinal endoscopy services – focus groups in England and Wales

Abstract

Background – This poster presents a qualitative study that formed part of a mixedmethod evaluation of modernising gastrointestinal endoscopy services in England catalysed by the NHS Modernisation Agency (NHSMA). The complete evaluation of 20 English gastroenterology units, covered quantitative data collection on innovations in units, activity, patient outcomes, health economics, and qualitative data collection on professionals’ and patients’ views and experiences. This evaluation was analysed using an innovative approach (MATRICS) to fully integrate findings from the different arms of the study. Method – As part of the qualitative data capture element of the mixed method study, professionals’ views and experiences were examined through four focus groups with senior health professionals working in endoscopy units that had no support from the NHSMA to examine views independent of their programme. Participants represented 10 different Trusts across England and Wales. Focus groups were facilitated, taperecorded and transcribed. Transcripts were analysed adapting van Manen’s ‘sententious’ or ‘wholistic’ approach to thematic analysis. Seven analysts worked individually and as a group to distil lengthy transcripts into summative paragraphs to capture the essentiality of text. The methodological framework offered a comprehensive approach to data and enabled the group to arrive at a consensus of opinion. Findings - Findings were refined to five major themes: lack of senior management understanding and appropriate management systems in place to support positive change, inadequate resources to engender long-term change, loss of personal autonomy and erosion of professionalism, barriers and facilitators to change that affect meaningful change and, differences between English and Welsh units regarding speed of change and support for change – the Welsh perspective. Conclusions – It is apparent that achieving long-lasting, positive effects of modernisation within complex systems such as gastroenterology services, demands senior management to actively support innovations, consider staff morale and provide appropriate levels of funding. However, although professional morale was low, and participants were frustrated by the perceived lack of management systems that adequately supported their needs, ambition to improve services was strong. The methodological framework for clarifying findings through assessment of the qualitative data offered a comprehensive and applicable approach to data analysis and adapting van Manen’s groupwork approach was inclusive and collaborative, enabling researchers with both quantitative and qualitative expertise to work closely together. This approach offers far-reaching possibilities for experimental studies and large-scale, mixed method studies of the future, including trials