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A strategic needs assessment for Nottinghamshire
No full textPeter Murphy, Kirsten Greenhalgh and Craig Parkin from Nottingham Trent University, University of Nottingham and Nottinghamshire Fire and Rescue Service, report on their joint project
A comparative case study of two models of a clinical informaticist service
No full textObjectives: To describe and evaluate two different models of a clinical informaticist service. Design A case study approach, using various qualitative methods to illuminate the complexity of the project groups' experiences. Setting UK primary health care. Interventions: Two informaticist projects to provide evidence based answers to questions arising in clinical practice and thereby support high quality clinical decision making by practitioners. Results: The projects took contrasting and complementary approaches to establishing the service. One was based in an academic department of primary health care. The service was academically highly rigorous, remained true to its original proposal, included a prominent research component, and involved relatively little personal contact with practitioners. This group achieved the aim of providing general information and detailed guidance to others intending to set up a similar service. The other group was based in a service general practice and took a much more pragmatic, flexible, and facilitative approach. They achieved the aim of a credible, acceptable, and sustainable service that engaged local practitioners beyond the innovators and enthusiasts and secured continued funding. Conclusion An informaticist service should be judged on at least two aspects of quality - an academic dimension (the technical quality of the evidence based answers) and a service dimension (the facilitation of questioning behaviour and implementation). This study suggests that, while the former may be best achieved within an academic environment, the latter requires a developmental approach in which pragmatic service considerations are addressed
Ethnographic study of ICT-supported collaborative work routines in general practice
No full textAbstract Background 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. Methods/design 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. Discussion 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
Transferability of principles of evidence based medicine to improve educational quality: systematic review and case study of an online course in primary health care
No full textThe success of evidence based medicine has led to pressure to make medical education more evidence based. Greenhalgh and colleagues tested the transferability, of these principles when developing a postgraduate course
Sharing stories: complex intervention for diabetes education in minority ethnic groups who do not speak English
No full textObjective: To develop and refine a complex intervention for diabetes support and education in minority ethnic groups, delivered through bilingual health advocates.
Design: Action research framework-a variety of methods used in an emergent and developmental manner, in partnership with clinicians, managers, and service users, drawing especially but not exclusively on narrative methods.
Setting: Deprived inner London district.
Interventions: Development and evaluation of three components of the complex intervention: a group based learning set for bilingual health advocates, in which stories about clients with diabetes formed the basis for action learning; advocate led support and education groups for people with diabetes, which used personal stories as the raw material for learning and action; organisational support to help to develop these new models and embed them within existing services.
Results: Both advocate groups and user groups were popular and well evaluated. Through storytelling, advocates identified and met their own educational needs in relation to diabetes and the unmet needs of service users. In the advocate led user groups, story fragments were exchanged in a seemingly chaotic way that the research team initially found difficult to facilitate or follow. Stories were not so much told as enacted and were often centred on discussion of "what to do." Whereas some organisations welcomed, successfully implemented, and sustained the advocate led groups, others failed to do so. A key component of the complex intervention was organisational support.
Conclusions: An action research approach allowed engagement with an underserved group of health service staff and with hard to reach service users. ne study produced subjective benefits to these groups locally as well as a worked-up complex intervention that will now be formally tested in a randomised controlled trial
Collaboration and interconnectivity: Nottinghamshire Fire and Rescue Services and higher education institutions in Nottingham
No full textThis paper will describe the developing relationship between Nottinghamshire Fire and Rescue Services and the two Higher Education Institutions in Nottingham. It will chronicle how a very traditional relationship has been transformed, initially by a simple consultancy project, into a much closer working relationship characterised by a much richer variety of collaborative projects. It demonstrates the potential mutual benefits that greater trust and reciprocity between the institutions can bring to both academia and to practice and the impact it has already had on curriculum development, teaching and learning in Nottingham
Caring for the patient, caring for the record: an ethnographic study of 'back office' work in upholding quality of care in general practice
No full text© 2015 Swinglehurst and Greenhalgh; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Additional file 1: Box 1. Field notes on summarising (Clover Surgery). Box 2. Extract of document prepared for GPs by summarisers at Clover
Surgery. Box 3. Fieldnotes on coding incoming post, Clover (original notes edited for brevity).This work was funded by a research grant from the UK Medical Research Council (Healthcare Electronic Records in Organisations 07/133) and a
National Institute of Health Research doctoral fellowship award for DS (RDA/03/07/076). The funders were not involved in the selection or analysis of data nor did they make any contribution to the content of the final
manuscript
“No decisions about us without us”? Individual healthcare rationing decisions in a fiscal ice age
No full textJill Russell and colleagues examine whether patients and the public should be involved in rationing decisions about individual patient access to healthcare interventions
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