Motivating Change: a grounded theory of how to achieve large-scale, sustained change, co-created with improvement organisations across the UK

BackgroundVarious theories provide guidance on implementing, sustaining and evaluating innovations within healthcare. There has been less attention given, however, to personal theories drawn from practice and the expertise of managers and front-line staff is a largely untapped resource. In this paper, we share learning from experienced improvement organisations to provide a conceptual level explanation of the conditions necessary to facilitate and sustain improvement at scale.MethodsStaff (n=42) from three leading change organisations in the UK, spanning health, education and social care, took part in three consultation meetings with the aim of sharing knowledge about sustaining large-scale change. This included one government organisation, one National Health Service Board and one large charity organisation. Using a participatory grounded theory approach, the workshops resulted in a co-created theory.ResultsThe theory of Motivating Change describes the psychosocial-structural conditions for large-scale, sustained change from the perspectives of front-line staff. The theory posits that change is more likely to be sustained at scale if there is synergy between staff’s perceived need and desire for improvement, and the extrinsic motivators for change. Witnessing effective change is motivating for staff and positive outcomes provide a convincing argument for the need to sustain improvement activity. As such, evidence of change becomes evidence for change. This is only possible when there is a flow of trust within organisations that capitalises on positive peer pressure and suppresses infectious negativity. When these conditions are in place, organisations can generate self-proliferating improvement.ConclusionsThe theory of Motivating Change has been co-created with staff and offers a useful explanation and guide for others involved in change work that capitalises on front-line expertise.

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The Process of Whistleblowing in a Japanese Psychiatric Hospital

Nursing Ethics ◽

10.1177/0969733008092871 ◽

2008 ◽

Vol 15 (5) ◽

pp. 631-642 ◽

Cited By ~ 16

Author(s):

Kayoko Ohnishi ◽

Yumiko Hayama ◽

Atsushi Asai ◽

Shinji Kosugi

Keyword(s):

Grounded Theory ◽

Psychiatric Hospital ◽

Nursing Staff ◽

Large Scale ◽

Professional Responsibility ◽

Professional Judgment ◽

Theory Approach ◽

Staff Members ◽

Delayed Action ◽

Grounded Theory Approach

This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions.

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Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation-based training

PLoS ONE ◽

10.1371/journal.pone.0249070 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0249070

Author(s):

Sergio A. Silverio ◽

Hilary Wallace ◽

William Gauntlett ◽

Richard Berwick ◽

Simon Mercer ◽

...

Keyword(s):

Grounded Theory ◽

Data Interpretation ◽

Training Programme ◽

Theory Approach ◽

Critical Realist ◽

Training Programmes ◽

The Uk ◽

Induction Of Anaesthesia ◽

Time Critical

The time-critical ‘can’t intubate, can’t oxygenate’ [CICO] emergency post-induction of anaesthesia is rare, but one which, should it occur, requires Anaesthetists to perform rapid emergency front of neck access [FONA] to the trachea, restoring oxygenation, and preventing death or brain hypoxia. The UK Difficult Airway Society [DAS] has directed all Anaesthetists to be trained with surgical cricothyroidotomy [SCT] as the primary emergency FONA method, sometimes referred to as ‘Cric’ as a shorthand. We present a longitudinal analysis using a classical approach to Grounded Theory methodology of ten Specialist Trainee Anaesthetists’ data during a 6-month training programme delivered jointly by Anaesthetists and Surgeons. We identified with a critical realist ontology and an objectivist epistemology meaning data interpretation was driven by participants’ narratives and accepted as true accounts of their experience. Our theory comprises three themes: ‘Identity as an Anaesthetist’; ‘The Role of a Temporary Surgeon’; and ‘Training to Reconcile Identities’, whereby training facilitated the psychological transition from a ‘bloodless Doctor’ (Anaesthetist) to becoming a ‘temporary Surgeon’. The training programme enabled Specialist Trainees to move between the role of control and responsibility (Identity as an Anaesthetist), through self-described ‘failure’ and into a role of uncertainty about one’s own confidence and competence (The Role of a Temporary Surgeon), and then return to the Anaesthetist’s role once the airway had been established. Understanding the complexity of an intervention and providing a better insight into the training needs of Anaesthetic trainees, via a Grounded Theory approach, allows us to evaluate training programmes against the recognised technical and non-technical needs of those being trained.

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Professional Translators’ Theorising Patterns in Comparison with Classroom Discourse on Translation: The Case of Japanese/English Translators in the UK

Meta Journal des traducteurs ◽

10.7202/1041024ar ◽

2017 ◽

Vol 62 (2) ◽

pp. 271-288 ◽

Cited By ~ 4

Author(s):

Akiko Sakamoto

Keyword(s):

Grounded Theory ◽

Classroom Discourse ◽

Theory Approach ◽

Main Concept ◽

Professional Career ◽

Knowledge Of Language ◽

The Uk ◽

Grounded Theory Approach ◽

Japanese English

If we aim to offer translation education that prepares our students adequately for their future professional career, it is important to recognise the different subcultures of translation, particularly those of professional translators and translation academics/teachers. The present study describes how the subculture of working translators theorise their practice, specifically, what concepts they use when they justify their translations. Seventeen Japanese/English translators, all commercially successful professionals who work in the UK, were interviewed about their experience of conflictive situations with their clients. In this article, I present an analysis of their justifications of their translation choices using a grounded theory approach. The analysis identifies the concept of the Role of Participants as the most prominent concept in the translators’ discourse. It also highlights several sub-concepts which relate to the main concept in intricate ways. These sub-concepts include Relationship, Knowledge of Language, Time and Effort, Authority and Natural/Literal Translation. The translators’ theorization is compared with classroom discourse about translation and the differences and similarities are discussed.

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Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK

BMJ Open ◽

10.1136/bmjopen-2020-040503 ◽

2020 ◽

Vol 10 (11) ◽

pp. e040503 ◽

Cited By ~ 1

Author(s):

Cecilia Vindrola-Padros ◽

Lily Andrews ◽

Anna Dowrick ◽

Nehla Djellouli ◽

Harrison Fillmore ◽

...

Keyword(s):

Healthcare Workers ◽

Care Delivery ◽

Well Being ◽

Media Analysis ◽

Routine Practice ◽

Front Line ◽

Framework Analysis ◽

Daily Work ◽

Line Staff ◽

The Uk

ObjectiveThe COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK.MethodsThe study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) in-depth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis.ResultsLimited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work. Lack of training for redeployed staff and the failure to consider the skills of redeployed staff for new areas were identified as problems. Positive aspects of daily work reported by HCWs included solidarity between colleagues, the establishment of well-being support structures and feeling valued by society.ConclusionOur study highlighted the importance of taking into consideration the experiences and concerns of front-line staff during a pandemic. Staff working in the UK during the COVID-19 pandemic advocated clear and consistent guidelines, streamlined testing of HCWs, administration of PPE and acknowledgement of the effects of PPE on routine practice.

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The Experiences of First-Time Fathers in Perinatal Services: Present but Invisible

Healthcare ◽

10.3390/healthcare9020161 ◽

2021 ◽

Vol 9 (2) ◽

pp. 161

Author(s):

Suzanne Hodgson ◽

Jon Painter ◽

Laura Kilby ◽

Julia Hirst

Keyword(s):

Grounded Theory ◽

Healthcare Professionals ◽

Healthcare Services ◽

Constructivist Grounded Theory ◽

Theory Approach ◽

Structured Interviews ◽

Research Findings ◽

Perinatal Services ◽

The Uk ◽

First Time

Fathers in the UK are becoming more involved in the care of their infants and children. A constructivist grounded theory approach was adopted to explore men’s transition to fatherhood. This paper reports on one of the sub-categories derived from the data. First-time fathers with a child under two were recruited predominantly via social media. Audio-recorded semi-structured interviews were undertaken with an opening question asking men to tell their story of becoming a father. Interviews were transcribed and analysed using constructivist grounded theory methods. This paper reports one core aspect of the research findings which has particular relevance for healthcare professionals. The men in this study were highly appreciative of the care their partner and baby received but consistently reported a lack of father-specific support throughout their journey to fatherhood. This ranged from generally poor communication with healthcare professionals to being ignored and side-lined in maternity settings where they continued to be treated as visitors before, during and after the birth of their baby. Despite similar findings being reported over the last 30 to 40 years and policy directives emphasising the importance of working with fathers, change within healthcare services remains slow. Currently, fathers’ needs are not being adequately met by perinatal services.

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Exploring the Interactions of Factory Workers in China: A Model Development Using the Grounded Theory Approach

Sustainability ◽

10.3390/su12176750 ◽

2020 ◽

Vol 12 (17) ◽

pp. 6750

Author(s):

Ye Ye ◽

Rosmini Omar ◽

Binyao Ning ◽

Hiram Ting

Keyword(s):

Grounded Theory ◽

Large Scale ◽

Model Development ◽

Individual Characteristics ◽

Management Style ◽

Human Interaction ◽

Theory Approach ◽

Technological Advancement ◽

Factory Workers ◽

Grounded Theory Approach

This study uses the grounded theory approach to explore factory workers to factory worker interaction (FWI) in the context of Chinese factories and proposes a model of FWI in the workplace. Human interaction in the workplace is indispensable in most sectors. Compared with large-scale factories, China’s small and medium-sized enterprise (SME) factories lack capital resources and technological advancement, and sustainably managing factory workers is essential for the development of Chinese SME factories. However, previous studies have ignored FWI in Chinese factories. The model developed in this study considers the types, driving factors, and influential outcomes of FWI. The main factors affecting FWI are the individual characteristics of the workplace and external environmental factors and, among types of FWI, information sharing is the most dominant and prevailing. The managers’ management style and the emotional state of factory workers are playing moderating roles in FWI. Results show that factory managers can take advantage of the positive impacts of FWI to improve the efficiency of factory workers and avoid its negative effects to achieve sustainable development of the factory. Theoretical and managerial implications are provided.

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Perceptions of Factors Leading to Teenage Pregnancy in Lindi Region, Tanzania: A Grounded Theory Study

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-0151 ◽

2021 ◽

Vol 104 (4) ◽

pp. 1562-1568

Author(s):

Luka te Lindert ◽

Maarten van der Deijl ◽

Agripa Elirehema ◽

Marianne van Elteren-Jansen ◽

Raynald Chitanda ◽

...

Keyword(s):

Grounded Theory ◽

Low Income ◽

Teenage Pregnancy ◽

Sexual Coercion ◽

Peer Pressure ◽

Low Income Countries ◽

Theory Approach ◽

Snowball Sampling ◽

Key Informants ◽

High Prevalence

ABSTRACTHigh prevalence of teenage pregnancy in low-income countries impacts health, social, economic, and educational situations of teenage girls. To acquire better understanding of factors leading to high prevalence of teenage pregnancy in rural Lindi region, Tanzania, we explored perspectives of girls and key informants by conducting a facility-based explorative qualitative study according to the grounded theory approach. Participants were recruited from Mnero Diocesan Hospital using snowball sampling, between June and September 2018. Eleven pregnant teenagers, two girls without a teenage pregnancy, and eight other key informants were included. In-depth interviews (including photovoice) and field observations were conducted. Analysis of participant perspectives revealed five main themes: 1) lack of individual agency (peer pressure, limited decision-making power, and sexual coercion); 2) desire to earn money and get out of poverty; 3) dropping out of school contributing to becoming pregnant; 4) absence of financial, material, psychological, or emotional support from the environment; and 5) limited access to contraception. A majority of girls reported the pregnancy to be unplanned, whereas some girls purposely planned it. Our findings and the resulting conceptual framework contribute to a new social theory and may inform national and international policies to consider the needs and perspectives of teenagers in delaying pregnancy and promoting sexual and reproductive health in Tanzania and beyond.

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