scholarly journals Patient experience and reflective learning (PEARL): a mixed methods protocol for staff insight development in acute and intensive care medicine in the UK

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e030679 ◽  
Author(s):  
Olivia Brookes ◽  
Celia Brown ◽  
Carolyn Tarrant ◽  
Julian Archer ◽  
Duncan Buckley ◽  
...  
Keyword(s):  
Intensive Care ◽  
Survey Data ◽  
Large Scale ◽  
Care Quality ◽  
Reflective Learning ◽  
Project Teams ◽  
Learning Framework ◽  
Ethnographic Interviews ◽  
Personal Insight ◽  
The Uk

IntroductionPatient and staff experiences are strongly influenced by attitudes and behaviours, and provide important insights into care quality. Patient and staff feedback could be used more effectively to enhance behaviours and improve care through systematic integration with techniques for reflective learning. We aim to develop a reflective learning framework and toolkit for healthcare staff to improve patient, family and staff experience.Methods & analysisLocal project teams including staff and patients from the acute medical units (AMUs) and intensive care units (ICUs) of three National Health Service trusts will implement two experience surveys derived from existing instruments: a continuous patient and relative survey and an annual staff survey. Survey data will be supplemented by ethnographic interviews and observations in the workplace to evaluate barriers to and facilitators of reflective learning. Using facilitated iterative co-design, local project teams will supplement survey data with their experiences of healthcare to identify events, actions, activities and interventions which promote personal insight and empathy through reflective learning. Outputs will be collated by the central project team to develop a reflective learning framework and toolkit which will be fed back to the local groups for review, refinement and piloting. The development process will be mapped to a conceptual theory of reflective learning which combines psychological and pedagogical theories of learning, alongside theories of behaviour change based on capability, opportunity and motivation influencing behaviour. The output will be a locally-adaptable workplace-based toolkit providing guidance on using reflective learning to incorporate patient and staff experience in routine clinical activities.Ethics & disseminationThe PEARL project has received ethics approval from the London Brent Research Ethics Committee (REC Ref 16/LO/224). We propose a national cluster randomised step-wedge trial of the toolkit developed for large-scale evaluation of impact on patient outcomes.

Value Creation through Heterogeneous Cultural Team-Based Environments

2014 ◽  
pp. 124-147 ◽  
Author(s):  
Wilson Ozuem ◽  
Nicole Sarsby
Keyword(s):  
Virtual Teams ◽  
Value Creation ◽  
Large Scale ◽  
Project Managers ◽  
Organisational Learning ◽  
Project Teams ◽  
Public And Private ◽  
Cultural Heterogeneity ◽  
The Uk ◽  
Key Aspects

Previous research has documented cultural heterogeneity within project teams, but still attention mainly centres on project managers who transfer internationally to manage teams of a different culture from their own, or more recently from those who manage virtual teams. Existing literature does not discuss the readiness to manage culturally diverse teams as a result of large-scale EU migration and wider immigration in the UK projectised environments. The objectives of this contribution are: 1) to investigate the factors that influence effective value creation in heterogeneous cultural environments, in both inter- and intra-organisational learning and knowledge creation in the UK project team-based environments, and 2) to illuminate issues of value creation in heterogeneous cultural environments in both public and private team-based project environments. This chapter adds to extant studies of organisational diversity and innovation by elucidating the overwhelming key aspects of cultural heterogeneity and thus explains how challenging it is to affect change in the prevailing praxis, ideas, and values in team-based management.

Value Creation through Heterogeneous Cultural Team-Based Environments

2017 ◽  
pp. 341-366
Author(s):  
Wilson Ozuem ◽  
Nicole Sarsby
Keyword(s):  
Virtual Teams ◽  
Value Creation ◽  
Large Scale ◽  
Project Managers ◽  
Organisational Learning ◽  
Project Teams ◽  
Public And Private ◽  
Cultural Heterogeneity ◽  
The Uk ◽  
Key Aspects

Previous research has documented cultural heterogeneity within project teams, but still attention mainly centres on project managers who transfer internationally to manage teams of a different culture from their own, or more recently from those who manage virtual teams. Existing literature does not discuss the readiness to manage culturally diverse teams as a result of large-scale EU migration and wider immigration in the UK projectised environments. The objectives of this contribution are: 1) to investigate the factors that influence effective value creation in heterogeneous cultural environments, in both inter- and intra-organisational learning and knowledge creation in the UK project team-based environments, and 2) to illuminate issues of value creation in heterogeneous cultural environments in both public and private team-based project environments. This chapter adds to extant studies of organisational diversity and innovation by elucidating the overwhelming key aspects of cultural heterogeneity and thus explains how challenging it is to affect change in the prevailing praxis, ideas, and values in team-based management.

scholarly journals “It’s Been Ugly”: A Large-Scale Qualitative Study into the Difficulties Frontline Doctors Faced across Two Waves of the COVID-19 Pandemic

2021 ◽  
Vol 18 (24) ◽  
pp. 13067
Author(s):  
Sophie Harris ◽  
Elizabeth Jenkinson ◽  
Edward Carlton ◽  
Tom Roberts ◽  
Jo Daniels
Keyword(s):  
Content Analysis ◽  
Intensive Care ◽  
Large Scale ◽  
Control Measures ◽  
Emotional Impact ◽  
Infection Control Measures ◽  
Conventional Content Analysis ◽  
The Uk ◽  
Insight Into

This study aimed to gain an uncensored insight into the most difficult aspects of working as a frontline doctor across successive COVID-19 pandemic waves. Data collected by the parent study (CERA) was analysed using conventional content analysis. Participants comprised frontline doctors who worked in emergency, anaesthetic, and intensive care medicine in the UK and Ireland during the COVID-19 pandemic (n = 1379). All seniority levels were represented, 42.8% of the sample were male, and 69.2% were white. Four themes were identified with nine respective categories (in parentheses): (1) I’m not a COVID hero, I’m COVID cannon fodder (exposed and unprotected, “a kick in the teeth”); (2) the relentlessness and pervasiveness of COVID (“no respite”, “shifting sands”); (3) the ugly truths of the frontline (“inhumane” care, complex team dynamics); (4) an overwhelmed system exacerbated by COVID (overstretched and under-resourced, constant changes and uncertainty, the added hinderance of infection control measures). Findings reflect the multifaceted challenges faced after successive pandemic waves; basic wellbeing needs continue to be neglected and the emotional impact is further pronounced. Steps are necessary to mitigate the repeated trauma exposure of frontline doctors as COVID-19 becomes endemic and health services attempt to recover with inevitable long-term sequelae.

scholarly journals A framework and toolkit of interventions to enhance reflective learning among health-care professionals: the PEARL mixed-methods study

2020 ◽  
Vol 8 (32) ◽  
pp. 1-82
Author(s):  
Julian Bion ◽  
Olivia Brookes ◽  
Celia Brown ◽  
Carolyn Tarrant ◽  
Julian Archer ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
Mixed Methods ◽  
Health Services ◽  
Intensive Care Units ◽  
Reflective Learning ◽  
Mixed Methods Study ◽  
Project Teams ◽  
Care Staff ◽  
Health Care Staff

Background Although most health care is high quality, many patients and members of staff can recall episodes of a lack of empathy, respect or effective communication from health-care staff. In extreme form, this contributes to high-profile organisational failures. Reflective learning is a universally promoted technique for stimulating insight, constructive self-appraisal and empathy; however, its efficacy tends to be assumed rather than proven. The Patient Experience And Reflective Learning (PEARL) project has used patient and staff experience to co-design a novel reflective learning framework that is based on theories of behaviour and learning. Objective To create a toolkit to help health-care staff obtain meaningful feedback to stimulate effective reflective learning that will promote optimal patient-, family- and colleague-focused behaviours. Design A 3-year developmental mixed-methods study with four interlinked workstreams and 12 facilitated co-design meetings. The Capability, Opportunity, Motivation – Behaviour framework was used to describe factors influencing the behaviour of reflection. Setting This took place at five acute medical units and three intensive care units in three urban acute hospital trusts in England. Participants Patients and relatives, medical and nursing staff, managers and researchers took part. Data sources Two anonymous surveys, one for patients and one for staff, were developed from existing UK-validated instruments, administered locally and analysed centrally. Ethnographers undertook interviews and observed clinical care and reflective learning activities in the workplace, as well as in the co-design meetings, and fed back their observations in plenary workshops. Main outcome measures Preliminary instruments were rated by participants for effectiveness and feasibility to derive a final set of tools. These are presented in an attractively designed toolbox with multiple sections, including the theoretical background of reflection, mini guides for obtaining meaningful feedback and for reflecting effectively, guides for reflecting ‘in-action’ during daily activities, and a set of resources. Results Local project teams (physicians, nurses, patients, relatives and managers) chaired by a non-executive director found the quarterly reports of feedback from the patient and staff surveys insightful and impactful. Patient satisfaction with care was higher for intensive care units than for acute medical units, which reflects contextual differences, but in both settings quality of communication was the main driver of satisfaction. Ethnographers identified many additional forms of experiential feedback. Those that generated an emotional response were particularly effective as a stimulus for reflection. These sources of data were used to supplement individual participant experiences in the nine local co-design meetings and four workshops to identify barriers to and facilitators of effective reflection, focusing on capability, opportunity and motivation. A logic model was developed combining the Capability, Opportunity, Motivation – Behaviour framework for reflection and theories of learning to link patient and staff experience to changes in downstream behaviours. Participants proposed practical tools and activities to enhance reflection ‘in-action’ and ‘on-action’. These tools were developed iteratively by the local and central project teams. Limitations Paper-based surveys were burdensome to administer and analyse. Conclusions Patients and health-care staff collaborated to produce a novel reflective learning toolkit. Future work The toolkit requires evaluating in a cluster randomised controlled trial. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 32. See the NIHR Journals Library website for further project information.

Origin and distribution of dolomite in Permian Rotliegend siliciclastic sandstones (Dutch Southern Permian Basin)

2019 ◽  
Vol 89 (10) ◽  
pp. 1055-1073 ◽  
Author(s):  
Nicolaas Molenaar ◽  
Marita Felder
Keyword(s):  
Large Scale ◽  
Permian Basin ◽  
Advective Flow ◽  
Gas Reservoirs ◽  
Carbonate Cement ◽  
Thin Section Petrography ◽  
The Uk ◽  
Pressure Dissolution ◽  
Dolomite Cement ◽  
Detrital Carbonate

ABSTRACT Dolomite is a common and volumetrically important mineral in many siliciclastic sandstones, including Permian Rotliegend sandstones (the Slochteren Formation). These sandstones form extensive gas reservoirs in the Southern Permian Basin in the Netherlands, Germany, Poland, and the UK. The reservoir quality of these sandstones is negatively influenced by the content and distribution of dolomite. The origin and the stratigraphic distribution of the dolomite is not yet fully understood. The aim of this study is to identify the origin of carbonate. The main methods used to achieve those aims are a combination of thin-section petrography, scanning electron microscopy (SEM and EDX), and XRD analyses. The present study shows that the typical dispersed occurrence of the dolomite is a consequence of dispersed detrital carbonate grains that served both as nuclei and source for authigenic dolomite cement. The dolomite cement formed syntaxial outgrowths and overgrowths around detrital carbonate grains. The study also shows that dolomite cement, often in combination with ankerite and siderite, precipitated during burial after mechanical compaction. Most of the carbonate grains consisted of dolomite before deposition. The carbonate grains were affected by compaction and pressure dissolution, and commonly have no well-defined outlines anymore. The distribution of dolomite cement in the Rotliegend sandstones was controlled by the presence of stable carbonate grains. Due to the restricted and variable content of carbonate grains and their dispersed occurrence, the cement is also dispersed and the degree of cementation heterogeneous. Our findings have important implications on diagenesis modeling. The presence of detrital carbonate excludes the need for external supply by any large-scale advective flow of diagenetic fluids. By knowing that the carbonate source is local and related to detrital grains instead of being externally derived from an unknown source, the presence of carbonate cement can be linked to a paleogeographic and sedimentological model.

scholarly journals Establishment and lineage dynamics of the SARS-CoV-2 epidemic in the UK

Science ◽  
2021 ◽  
pp. eabf2946
Author(s):  
Louis du Plessis ◽  
John T. McCrone ◽  
Alexander E. Zarebski ◽  
Verity Hill ◽  
Christopher Ruis ◽  
...  
Keyword(s):  
Large Scale ◽  
Phylogenetic Analyses ◽  
Transmission Dynamics ◽  
Genetic Lineage ◽  
Size Dependent ◽  
Spatio Temporal ◽  
The Uk ◽  
Lineage Structure ◽  
And Control ◽  
Lineage Diversity

The UK’s COVID-19 epidemic during early 2020 was one of world’s largest and unusually well represented by virus genomic sampling. Here we reveal the fine-scale genetic lineage structure of this epidemic through analysis of 50,887 SARS-CoV-2 genomes, including 26,181 from the UK sampled throughout the country’s first wave of infection. Using large-scale phylogenetic analyses, combined with epidemiological and travel data, we quantify the size, spatio-temporal origins and persistence of genetically-distinct UK transmission lineages. Rapid fluctuations in virus importation rates resulted in >1000 lineages; those introduced prior to national lockdown tended to be larger and more dispersed. Lineage importation and regional lineage diversity declined after lockdown, while lineage elimination was size-dependent. We discuss the implications of our genetic perspective on transmission dynamics for COVID-19 epidemiology and control.

scholarly journals Protocol for a qualitative study to identify strategies to optimise hospital ePrescribing systems

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e044622
Author(s):  
Catherine Heeney ◽  
Stephen Malden ◽  
Aziz Sheikh
Keyword(s):  
Qualitative Interviews ◽  
Geographical Area ◽  
Health Resources ◽  
Round Table ◽  
Developed Countries ◽  
Care Quality ◽  
Electronic Prescribing ◽  
Study Results ◽  
Electronic Health ◽  
The Uk

IntroductionElectronic prescribing (ePrescribing) is a key area of development and investment in the UK and across the developed world. ePrescribing is widely understood as a vehicle for tackling medication-related safety concerns, improving care quality and making more efficient use of health resources. Nevertheless, implementation of an electronic health record does not itself ensure benefits for prescribing are maximised. We examine the process of optimisation of ePrescribing systems using case studies to provide policy recommendations based on the experiences of digitally mature hospital sites.Methods and analysisQualitative interviews within six digitally mature sites will be carried out. The aim is to capture successful optimisation of electronic prescribing (ePrescribing) in particular health systems and hospitals. We have identified hospital sites in the UK and in three other developed countries. We used a combination of literature reviews and advice from experts at Optimising ePrescribing in Hospitals (eP Opt) Project round-table events. Sites were purposively selected based on geographical area, innovative work in ePrescribing/electronic health (eHealth) and potential transferability of practices to the UK setting. Interviews will be recorded and transcribed and transcripts coded thematically using NVivo software. Relevant policy and governance documents will be analysed, where available. Planned site visits were suspended due to the COVID-19 pandemic.Ethics and disseminationThe Usher Research Ethics Group granted approval for this study. Results will be disseminated via peer-reviewed journals in medical informatics and expert round-table events, lay member meetings and the ePrescribing Toolkit (http://www.eprescribingtoolkit.com/)—an online resource supporting National Health Service (NHS) hospitals through the ePrescribing process.

scholarly journals Collateral impact of COVID-19: why should children continue to suffer?

2021 ◽  
Author(s):  
Prasad Nagakumar ◽  
Ceri-Louise Chadwick ◽  
Andrew Bush ◽  
Atul Gupta
Keyword(s):  
Young People ◽  
Large Scale ◽  
Hospital Admissions ◽  
Severe Disease ◽  
Children And Young People ◽  
Collateral Effects ◽  
Rsv Infection ◽  
Syncytial Virus ◽  
Set Up ◽  
The Uk

AbstractThe COVID-19 pandemic caused by SARS-COV-2 virus fortunately resulted in few children suffering from severe disease. However, the collateral effects on the COVID-19 pandemic appear to have had significant detrimental effects on children affected and young people. There are also some positive impacts in the form of reduced prevalence of viral bronchiolitis. The new strain of SARS-COV-2 identified recently in the UK appears to have increased transmissibility to children. However, there are no large vaccine trials set up in children to evaluate safety and efficacy. In this short communication, we review the collateral effects of COVID-19 pandemic in children and young people. We highlight the need for urgent strategies to mitigate the risks to children due to the COVID-19 pandemic. What is Known:• Children and young people account for <2% of all COVID-19 hospital admissions• The collateral impact of COVID-19 pandemic on children and young people is devastating• Significant reduction in influenza and respiratory syncytial virus (RSV) infection in the southern hemisphere What is New:• The public health measures to reduce COVID-19 infection may have also resulted in near elimination of influenza and RSV infections across the globe• A COVID-19 vaccine has been licensed for adults. However, large scale vaccine studies are yet to be initiated although there is emerging evidence of the new SARS-COV-2 strain spreading more rapidly though young people.• Children and young people continue to bear the collateral effects of COVID-19 pandemic

scholarly journals Losing the Discursive Battle but Winning the Ideological War: Who Holds Thatcherite Values Now?

2021 ◽  
pp. 003232172098670
Author(s):  
Stephen Farrall ◽  
Emily Gray ◽  
Phil Mike Jones ◽  
Colin Hay
Keyword(s):  
Survey Data ◽  
Prime Minister ◽  
Public Attitudes ◽  
New Right ◽  
The Political ◽  
Political Leaders ◽  
Margaret Thatcher ◽  
The Uk

In what ways, if at all, do past ideologies shape the values of subsequent generations of citizens? Are public attitudes in one period shaped by the discourses and constructions of an earlier generation of political leaders? Using Thatcherism – one variant of the political New Right of the 1980s – as the object of our enquiries, this article explores the extent to which an attitudinal legacy is detectable among the citizens of the UK some 40 years after Margaret Thatcher first became Prime Minister. Our article, drawing on survey data collected in early 2019 (n = 5781), finds that younger generations express and seemingly embrace key tenets of her and her governments’ philosophies. Yet at the same time, they are keen to describe her government’s policies as having ‘gone too far’. Our contribution throws further light on the complex and often covert character of attitudinal legacies. One reading of the data suggests that younger generations do not attribute the broadly Thatcherite values that they hold to Thatcher or Thatcherism since they were socialised politically after such values had become normalised.

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