Impact of the ‘Learning from Excellence’ programme in NHS trusts: an exploratory study

2020 ◽  
Vol 26 (8) ◽  
pp. 1-10
Author(s):  
Maartje Kletter ◽  
Emma Plunkett ◽  
Adrian Plunkett ◽  
Helen Hunt ◽  
Paul Bird ◽  
...  
Keyword(s):  
Case Studies ◽  
Qualitative Content Analysis ◽  
Contextual Factors ◽  
Realist Evaluation ◽  
Evaluation Methodology ◽  
Organisational Performance ◽  
Programme Theory ◽  
Individual Interviews ◽  
The Uk ◽  
The Impact

Background/Aims The ‘Learning from Excellence’ (LfE) programme aims to provide a means to identify, appreciate, study and learn from episodes of excellence in frontline healthcare. The aim of this study was to explore the impact of LfE on organisational performance in NHS trusts in the United Kingdom (UK), how this impact is achieved and which contextual factors facilitate or hinder impact. Methods A survey and case studies, including individual interviews, were conducted. Data were analysed through qualitative content analysis, informed by realist evaluation methodology. Contextual factors, mechanisms and outcomes were coded, sub-themes were generated and a programme theory was developed. Results There were 47 respondents to the survey (27% response rate) and three case studies were performed. A total of 25 contextual factors were identified, of which 18 acted as a facilitator to uptake or as a barrier if absent. Additionally, 11 mechanisms and 9 outcomes were identified. A programme theory explaining how LfE can impact organisational performance in NHS trusts in the UK, and which contextual factors play a role before design, during design and during implementation, was developed. Conclusions LfE was welcomed by participants, but at the time of this study LfE had not been implemented for long enough for outcomes to be measured. Further research, particularly measuring outcomes and validating mechanisms, as well as exploring the learning based on reported events, is needed.

scholarly journals Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Chama Mulubwa ◽  
Anna-Karin Hurtig ◽  
Joseph Mumba Zulu ◽  
Charles Michelo ◽  
Ingvild Fossgard Sandøy ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Health Systems ◽  
Contextual Factors ◽  
Realist Evaluation ◽  
Health Interventions ◽  
Alternative Theory ◽  
Health Coverage ◽  
Programme Theory ◽  
Community Based ◽  
Sexual Reproductive Health

Abstract Introduction Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights’ needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) ‘ordinary’ community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents. Methods This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention−Context−Actors−Mechanism−Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories. Results We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification’, which was also expected would lead to individuals developing a ‘supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages. Conclusion The two alternative programme theories describe how, why and under what circumstances SRHR interventions that target adolescents can transform ‘ordinary’ community-based health systems into systems that are responsive to adolescents.

scholarly journals Defending the media from itself: Reforming media regulations to minimise the impact of misinformation

European View ◽  
2019 ◽  
Vol 18 (2) ◽  
pp. 210-219
Author(s):  
Juha-Pekka Nurvala ◽  
Amelia Buckell
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Case Studies ◽  
Search Engines ◽  
Behavioural Changes ◽  
Social Media Platforms ◽  
The Media ◽  
The Uk ◽  
The Impact

This article argues that media regulations on correcting incorrect articles are in dire need of reform due to technological and behavioural changes. By using case studies from the UK, the authors demonstrate the huge difference between the number of people who were reached by the original article before the Independent Press Standards Organisation (the regulator in the UK) ruled it incorrect and the number reached by the correction or corrected article. The authors argue that media regulations must be reformed to ensure that corrections reach the same people as the original incorrect article to avoid misinformation impacting peoples’ decision-making, and that reforms must include social media platforms and search engines.

scholarly journals General practitioners and emergency departments (GPED)—efficient models of care: a mixed-methods study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e024012
Author(s):  
Katherine Morton ◽  
Sarah Voss ◽  
Joy Adamson ◽  
Helen Baxter ◽  
Karen Bloor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Studies ◽  
General Practitioners ◽  
Emergency Departments ◽  
Quantitative Methods ◽  
Public Involvement ◽  
Clinical Care ◽  
Urgent Care ◽  
The Uk ◽  
The Impact

IntroductionPressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system.Methods and analysisThe study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination.Ethics and disseminationThe study has been approved by the National Health Service East Midlands—Leicester South Research Ethics Committee: 17/EM/0312. The results of the study will be disseminated through peer-reviewed journals, conferences and a planned programme of knowledge mobilisation.Trial registration numberISRCTN51780222.

scholarly journals Cost Overruns in Tunnelling Projects: Investigating the Impact of Geological and Geotechnical Uncertainty Using Case Studies

2020 ◽  
Vol 5 (9) ◽  
pp. 73
Author(s):  
Chrysothemis Paraskevopoulou ◽  
Georgios Boutsis
Keyword(s):  
Case Studies ◽  
Research Work ◽  
Construction Cost ◽  
Cost Overrun ◽  
Cost Overruns ◽  
Total Cost ◽  
Ground Investigation ◽  
Major Factors ◽  
The Uk ◽  
The Impact

Tunnelling projects seldom meet the initial budget requirements. Commonly, these types of projects suffer from cost overruns, which subsequently lead to project delivery delays mainly due to unsuccessful ground investigation as specified in the literature. The presented work scrutinises the effect of ground investigation in cost overruns. More specifically, various cost figures (total cost, construction cost, tunnel cost) are analysed for two case studies i) the Channel tunnel in the UK and ii) the Olmos Tunnel in Peru. Clayton’s relation between ground investigation and the construction cost is utilised and further investigated. In the Channel tunnel, the main problems faced led to a cost overrun of 78% for the total cost, 66% for the construction cost and 77% for the tunnelling cost. In the Olmos tunnel, two main geological scenarios are analysed and the construction cost overrun is calculated at 9.6% and 6.7%. Drawing on the conclusions, this research work proves that ground investigation can be one of the major factors influencing the tunnel cost.

scholarly journals Realist evaluation of Schwartz rounds® for enhancing the delivery of compassionate healthcare: understanding how they work, for whom, and in what contexts

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. Maben ◽  
C. Taylor ◽  
E. Reynolds ◽  
I. McCarthy ◽  
M. Leamy
Keyword(s):  
Patient Care ◽  
Psychological Health ◽  
Contextual Factors ◽  
Organisational Change ◽  
Formal Theory ◽  
Realist Evaluation ◽  
Self Report ◽  
Framework Analysis ◽  
Role Modelling ◽  
The Impact

Abstract Background Healthcare work is known to be stressful and challenging, and there are recognised links between the psychological health of staff and high-quality patient care. Schwartz Center Rounds® (Rounds) were developed to support healthcare staff to re-connect with their values through peer reflection, and to promote more compassionate patient care. Research to date has focussed on self-report surveys that measure satisfaction with Rounds but provide little analysis of how Rounds ‘work’ to produce their reported outcomes, how differing contexts may impact on this, nor make explicit the underlying theories in the conceptualisation and implementation of Rounds. Methods Realist evaluation methods aimed to identify how Rounds work, for whom and in what contexts to deliver outcomes. We interviewed 97 key informants: mentors, facilitators, panellists and steering group members, using framework analysis to organise and analyse our data using realist logic. We identified mechanisms by which Rounds lead to outcomes, and contextual factors that impacted on this relationship, using formal theory to explain these findings. Results Four stages of Rounds were identified. We describe how, why and for whom Schwartz Rounds work through the relationships between nine partial programme theories. These include: trust safety and containment; group interaction; counter-cultural/3rd space for staff; self-disclosure; story-telling; role modelling vulnerability; contextualising patients and staff; shining a spotlight on hidden stories and roles; and reflection and resonance. There was variability in the way Rounds were run across organisations. Attendance for some staff was difficult. Rounds is likely to be a ‘slow intervention’ the impact of which develops over time. We identified the conditions needed for Rounds to work optimally. These contextual factors influence the intensity and therefore degree to which the key ingredients of Rounds (mechanisms) are activated along a continuum, to produce outcomes. Outcomes included: greater tolerance, empathy and compassion for self and others; increased honesty, openness, and resilience; improved teamwork and organisational change. Conclusions Where optimally implemented, Rounds provide staff with a safe, reflective and confidential space to talk and support one another, the consequences of which include increased empathy and compassion for colleagues and patients, and positive changes to practice.

scholarly journals Exploring two distinct gentamicin prescribing protocols in UK hospitals: a mixed-methods realist evaluation

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052697
Author(s):  
Nadine Dyar ◽  
Karen Mattick ◽  
Rob Bethune
Keyword(s):  
Mixed Methods ◽  
Improve Patient Safety ◽  
Aminoglycoside Antibiotic ◽  
Therapeutic Index ◽  
Realist Evaluation ◽  
Programme Theory ◽  
Quantitative And Qualitative Research ◽  
Key Characteristics ◽  
Structured Audio ◽  
The Uk

ObjectivesGentamicin is the aminoglycoside antibiotic of choice in the UK. It has a narrow therapeutic index: underdosing results in inefficacy while overdosing is characterised by nephrotoxicity and ototoxicity. To improve patient safety, hospitals have protocols for the prescription of gentamicin, which vary in complexity and approach. This study aimed to explore two distinct protocols for prescribing gentamicin in hospital settings, in order to understand the mechanisms they trigger and the outcomes they achieve.SettingA mixed-methods realist evaluation explored gentamicin prescribing protocols in two hospital surgical admissions units in South West England between January and August 2018. Site 1 had a traditional, complex protocol, while site 2 took a simplified protocol.ParticipantsTesting the initial programme theory (IPT) involved semi-structured audio-recorded interviews of a volunteer sample of healthcare professionals (HCPs) involved in the prescribing and administering process, alongside a clinical audit reviewing accuracy of gentamicin prescribing.Outcome measuresThree sequential phases were used to identify factors in a successful protocol: IPT generation; testing; refinement of the IPT. The IPT was generated by literature search and analysis of existing protocols of sites 1 and 2. Refinement of the IPT synthesised the results of the quantitative and qualitative research to identify the key characteristics of a successful protocol.ResultsOne hundred gentamicin prescriptions were reviewed, with a mean accuracy of gentamicin prescribing at site 1 of 65.67% and at site 2 of 78.79% (p<0.01). Thirty HCPs were interviewed. Key contexts were identified including prescriptiveness, experience and availability of patient information. These triggered hidden mechanisms including uncertainty, fear, confidence and frustration leading to both intended outcomes but also unintended outcomes such as deviation from protocol and unnecessary gentamicin levels.ConclusionsA simplified prescribing protocol for gentamicin is better accepted by prescribers, leading to better adherence to protocol and more accurate prescribing.

Educating for the Cooperative Society

2019 ◽  
pp. 355-373
Author(s):  
Suzanna Tomassi
Keyword(s):  
Case Studies ◽  
Soft Skills ◽  
Public Institution ◽  
The West ◽  
Cooperative Society ◽  
West Midlands ◽  
The Uk ◽  
The Impact ◽  
The Relationship

This chapter investigates the relationship between industry and academia from the perspective of industry. In addition to the theoretical review, it is based on feedback from industry leaders on how they see the role of their organizations in wider society. This chapter utilizes case studies to examine the relationship between specific companies, their academic partners, and the wider society. It focuses on the UK experience reflecting the location of its author. It specifically looks at the links between Coventry University, a British public institution located in the West Midlands, and its selected partners: the Unipart Group, Horiba MIRA, Interserve, and KPIT in India. It also refers to a bespoke Global Leaders Programme which is an exclusive, extra-curricular offering, designed to enhance students’ leadership and soft skills and prepare them for future employment after graduation. Wherever possible, the author aimed to obtain feedback from the industry representatives to assess their views on the impact of their companies on the wider society. In the same spirit, relevant colleagues from Coventry University were asked for their feedback to ensure that both perspectives were fairly captured. The examples given, and indeed, the philosophy behind the projects could be transferred to other countries and applied to other industries.

scholarly journals The European Parliament Elections 2014

2014 ◽  
pp. 5-20
Author(s):  
A. Avilova ◽  
A. Gutnick ◽  
Y. Kvashnin ◽  
V. Olenchenko ◽  
N. Toganova ◽  
...  
Keyword(s):  
Case Studies ◽  
Debt Crisis ◽  
Public Awareness ◽  
European Parliament ◽  
Public Understanding ◽  
The Public ◽  
The Uk ◽  
European Parliament Elections ◽  
The Impact ◽  
The Eu

The article is devoted to the European Parliament elections held in May 2014. Their results are analyzed on two levels – national and pan-European. On the national one the authors provide case studies of the United Kingdom, France, Germany, Poland, Italy and Greece. The impact of economic crisis and later the severe public debt crisis in Eurozone countries on the EU Parliament elections is estimated. Another factor examined in the study is the public awareness of the EU’s institutions in everyday life. The authors point out the contradiction between the public opinion on these institutions and the ongoing process of further integration due to the crises in such fields as finances and government expenditures. The latest process is viewed by the experts as a positive one, but the lack of public understanding resulted in abstention, protest voting and the rise of right-wing and populist parties. The national case studies showed that the situation varied from country to country. In some of them the pan-European agenda has played a greater role, in others it influenced the elections, but in the end they were mainly a referendum on the national government performance. The case of the UK illustrated the first tendency, but partly also the second one: the elections not only put the question about the country’s role in the EU, but also reflected the citizens’ discontent in mainstream politics. France, Greece and partly Italy showed that the voters disapprove the EU politics, especially concerning such fields as immigration and economic and debt crisis. The Polish case demonstrates that the lack of information on the EU’s institutions can jeopardize the positions of centrist parties even in a very pro-European country. The election results in FRG confirm that the Germans are trying to identify their country’s role in the European institutions and find the right attitude toward its growing responsibility for the integration process.

scholarly journals The role of contextual factors on participation in the life area of work and employment after rehabilitation: A qualitative study on the views of persons with chronic pain

Work ◽  
2021 ◽  
pp. 1-14
Author(s):  
Thomas Friedli ◽  
Brigitte E. Gantschnig
Keyword(s):  
Qualitative Content Analysis ◽  
Contextual Factors ◽  
Rehabilitation Program ◽  
Realist Evaluation ◽  
Evaluation Framework ◽  
Research Assessment ◽  
Post Intervention ◽  
The Social ◽  
Program Content ◽  
Work And Employment

BACKGROUND: A deeper understanding of how contextual factors affect the ability to participate in the life area of work and employment despite chronic musculoskeletal pain is needed as a basis for interprofessional rehabilitation programs. OBJECTIVE: To investigate which contextual factors influence rehabilitation program clients’ ability to participate in the life area of work and employment, and how they do this. METHODS: Nested case study using a realist evaluation framework of interprofessional interventions. Qualitative content analysis of problem-centered interviews to identify influential context-mechanism-outcome configurations. RESULTS: We identified several important context-mechanism-outcome configurations. In the pre-interventional phase, socioeconomic and environmental factors affected two mechanisms, “exhaustion” and “discrimination”. In the intra-interventional phase, the social skills of health professionals and opportunities for discussion with peers affected the ability of program participants to engage with program content. In the post-intervention phase, volitional competences of the social system affected the sustainable application of program content in everyday life. CONCLUSION: The identified context-mechanism-outcome configurations shows that the ability to participate in the life area of work is interdependent with the ability to participate in other areas of life. In practice and research, assessment and treatment should be carried out based on this understanding.

scholarly journals Social impact measurement in social housing: a theory-based investigation into the context, mechanisms and outcomes of implementation

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Alice Jones ◽  
Néstor Valero-Silva
Keyword(s):  
Social Housing ◽  
Social Impact ◽  
Contextual Factors ◽  
Realist Evaluation ◽  
Theory Of Change ◽  
Green Paper ◽  
Impact Measurement ◽  
Implementation Theory ◽  
Programme Theory ◽  
Content Type

Purpose English social housing providers are increasingly turning to social impact measurement to assess their social value. This paper aims to understand the contextual factors causing this rise in the practice, specifically within this sector; the mechanisms that enable it to be effectively implemented within an individual organisation and the outcomes of successful implementation for individual organisations and more widely across the sector and beyond. Design/methodology/approach A realist theory-based approach is applied to the study of a small number of social housing organisations and leaders within the sector to explore the use of social impact measurement. The paper addresses three questions: Why is social impact measurement being adopted in this sector? How is it successfully implemented? And what happens (outcomes) when it is successfully implemented? Addressing these questions necessitates deeper insight into the contextual pressures that have brought to the fore social impact measurement within the sector and the beneficial outcomes the practice provides (or is anticipated to provide) to social housing providers. The methodological approach of Realist Evaluation (Pawson and Tilley, 1997, 2004) is used to structure and analyse the empirical data and findings into a programme theory for social impact measurement. Realist Evaluation provides a programme theory perspective, seeking to answer the question “what works, for whom and in what circumstances?”. In this research, the “whom” refers to English social housing providers and the circumstances are the contextual conditions experienced by the sector over the past decade. The programme theory aims to set out the links between the contextual drivers for social impact measurement, the mechanisms that bring about its implementation and the outcomes that occur as a result. Within this, greater detail on the implementation perspective is provided by developing an implementation theory using a Theory of Change approach (Connell et al., 1995; Fulbright-Anderson et al., 1998). The implementation theory is then embedded within the wider programme theory so as to bring the two elements together, thereby creating a refinement of the overall theory for social impact measurement. In turn, this paper demonstrates its importance (the outcomes that it can achieve for organisations and the sector) and how it can effectively be implemented to bring about those outcomes. Findings Social housing providers use social impact measurement both internally, to determine their organisational priorities and externally, to demonstrate their value to local and national governments and cross-sector partners then to shape and influence resource allocation. The practice itself is shown to be an open and active programme, rather than a fixed calculative practice. Research limitations/implications The intensive nature of the research means that only a limited number of cases were explored. Further research could test theories developed here against evidence collected from a wider range of cases, e.g. other types of providers or non-adopters. Practical implications The research makes a strong contribution to practice in the form of a re-conceptualisation of how social impact measurement can be shown to be effective, based on a deeper understanding of causal mechanisms, how they interact and the outcomes that result. This is of value to the sector as such information could help other organisations both to understand the value of social impact measurement and to provide practical guidance on how to implement it effectively. Social implications As the practice of impact measurement continues to develop, practitioners will need to be aware of any changes to these contextual factors and consider questions such as: is the context still supportive of impact measurement? Does the practice need to be adjusted to meet the needs of the current context? For instance, the recent tragedy at Grenfell Tower has led to a reconsideration of the role of social housing; a new Green Paper is currently being drafted (Ministry for Housing, Communities and Local Government, 2018). This may have a number of implications for social impact measurement, such as a rebalancing of emphasis on outcomes relating to environmental improvements, towards outcomes relating to the well-being of tenants. Originality/value Existing literature is largely limited to technical guides. This paper links theory-based evaluation to practice contributing to social housing practice.

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