Using participatory, practice development, Delphi and realist research approaches to understand how frontline teams can use the workplace to make sustainable improvements in the quality of their practice

Lecture


Manley, K., Jackson, C., Martin, A. and Wright, T. 2018. Using participatory, practice development, Delphi and realist research approaches to understand how frontline teams can use the workplace to make sustainable improvements in the quality of their practice.
AuthorsManley, K., Jackson, C., Martin, A. and Wright, T.
TypeLecture
ContributorsManley, K., Jackson, C., Martin, A. and Wright, T.
Description

The symposium will share the approaches and findings from three funded national and international research studies which all contribute to the body of knowledge about how to support person centred, safe and effective care in the workplace. The final presentation will integrate the theoretical insights emerging from the three studies to present a model for sustainable transformation in frontline teams.

Paper 1
Safety culture, quality improvement, realist evaluation Authors and affiliations Professor Kim Manley CBE, (Presenter), Carolyn Jackson, Christine McKenzie, Anne Martin, Dr Toni Wright.

Abstract
Safety in health care is an international concern with impact on quality of care (Hollnagel, et al, 2015). A Regional Patient Safety Collaborative (PSC), one of 15 nationally set up to place patients, carers and staff at the heart of quality improvements in patient safety, supported four large acute NHS hospital trusts with a PSC model to help facilitators use safety and quality improvement tools with frontline teams and to be mutually supported through action learning. The evaluation used realistic evaluation (Pawson & Tilley, 2004) (and the study and its findings are reported using the RAMESES 11 international standards (Wong et al, 2017). The study took place between June 2016-October 2017. Its aim was to understand what works for whom 3S.40-5.10pm1 Symposia- – Tuesday 17 April 2018 and why, when: working with frontline teams in large acute hospitals to embed a safety culture, and grow leadership and quality improvement capability. Specifically, to identify which strategies are effective in supporting front line teams to sustain bottom up change and quality improvement driven by the needs of patients and practitioners.

The study drew on ethnographic principlesacross study sites usingdescriptive case study design. Mixed methods of critical observation of frontline practice, stakeholder evaluation,emotional touch points, self-assessment;qualitative 360 degree feedback; and the Texas safety culture survey tool were used to facilitate the development of a rich picture for each teamand each context so as to answer the evaluation questions. In tandem, interrogation of the literature to distilled relationships between context, mechanisms and outcomes generating hypotheses at individual, team and organisational level factors for safety culture.

Key findings identified an interdependence between clinical leadership within frontline teams, safety culture, safety behaviours and teamwork echoed in microcosm through safety huddles; the skills and attributes of facilitators;and the impact of organisations on microsystems. Theories of culture change at the microsystems level are further embellished.

References
Hollnagel E., Wears R.L. and Braithwaite J. From Safety-I to Safety II: A White Paper. The Resilient Health Care Net: Published simultaneously by the University of Southern Denmark, University of Florida, USA, and Macquarie University, Australia. http://citeseerx.ist.psu.edu/viewdoc/download doi=10.1.1.911.6550&rep=rep1&type=pdf (accessed 1st November 2017) Pawson, R. & Tilley, N. (2004) Realist Evaluation. [Online]. Available at: < http://www. communitymatters.com.au/RE_chapter.pdf>. Accessed: 14th November 2014. Wong, G.; Westhorp, G.; Greenhalgh, J.; Manzano, A.; Jagosh, J.; Greenhalgh, T, (2017) Quality and reporting standards, resources, training materials and information for realist evaluation: the RAMESES II project. Health Services and Delivery Research, 5(28) National Institute for Health Research October ISSN 2050-4349 DOI 10.3310/

Paper 2
Developing integrated facilitation standards to embrace the facilitation of learning in the workplace using e-Delphi Authors and affiliations Professor Kim Manley CBE, (Presenter), Carolyn Jackson, Anne Martin, Dr Toni Wright.

Abstract
This paper shares insights into the impact of system wide leadership initiatives that develop the facilitation capacity of the workforce to be effective clinical leaders in a time of increasingly complex system wide change (Manley et al, 2016, Crisp & Wilson 2011). The aim of this Delphi study (2015-16), was to develop a set of standards that could be used to guide an integrated approach to facilitation in and about the workplace. This includes the key qualities and skills required of facilitators who aim to integrate learning, development, improvement, inquiry, knowledge translation and innovation in and about the workplace. The study influenced by the knowledge base underpinning practice development methodology engaged international facilitation expertise. Three e-Delphi rounds involved participants from ten countries with expertise in facilitating either one or more of the purposes in work and/or about the workplace. The result, a set of standards builds on the current knowledge base about facilitation. The standards clarify the key components that facilitators need to attend to when supporting individuals, teams, organisations and services to achieve higher order learning in and about the workplace and positively impact on person centred cultures and health outcomes. The contribution of practice development as a discipline that integrates all the agendas was highlighted and needs to be promoted more explicitly at the policy level.

The key messages from this work are that: Facilitators work within different contexts and help staff appreciate the broader contexts in which they work. These contexts impact on both facilitator and staff purposes within and across each context. An integrated approach to facilitation aims to support a number of purposes. Enablers, skills and strategies for achieving these purposes are identified in the set of standards developed Facilitators need to attend to the evaluation of outcome and impact in the given context whilst keeping focus on constantly refining the processes that are effective.

References
Crisp, J., & Wilson, V. (2011). How do facilitators of practice development gain the expertise required to support vital transformation of practice and workplace cultures? Nurse Education in Practice, 11(3), 173-178. Manley, K., Martin, A., Jackson, C., & Wright, T. (2016). Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study. BMC Health Services Research, 16(1), 1

Paper 3
Developing theoretical insights into sustainable transformation in front line teams – the Venus model Authors and affiliation Carolyn Jackson, Director, England Centre for Practice Development, Canterbury Christchurch University, UK (Presenter), Professor Kim Manley CBE, Anne Martin, DrToni Wright.

Abstract
Definitions for continuous Professional Development (CPD) tend to focus on individual objectives, yet the goals of CPD activity are mutually interdependent on individual and system aspects (Billet, 2002) This paper presents the theoretical and practical insights gathered from a realist synthesis and evaluation (2014-2015) that led to a tool designed to measure the impact of learning on individual, team and organisational effectiveness in relation to improvements in quality of care and patient outcomes in the workplace. The aim of the project was to develop and test a CPD Impact Tool that identifies mechanisms for measuring the impact of learning on individual, team and organisational effectiveness and the indicators useful for providing information on individual and team effectiveness in relation to outcomes in the workplace? The study used mixed methods across two phases with different stakeholder groups to first develop theories about the relationship between contexts, mechanisms and outcomes for CPD to help understand which strategies work best for whom in what circumstance and why?

Phase 1 methods included: a literature review, underpinned by 12 critical questions, to identify what is known about CPD across three broad themes 1) What is CPD is and why it is important? 2) Purpose and impact of CPD, and 3) Facilitating and Judging the Effectiveness of CPD. This together with a stakeholder surveyanalysis and documentary analysis of CPDlearning outputs informed the development of the CPD framework and indicators which was then further tested in phase 2 with CPD providers, learner and an expert international reference group.

Key findings centre on four transformation theories that underpin an overarching framework for understanding effective CPD and a set of Impact indicators for guiding evaluation In order for CPD to be effective it has to address all of the interdependent outcomes for individual, team, service and organisational transformation.

Reference
Billett S. Critiquing Workplace Learning Discourses: Participation and Continuity at Work. Stud Educ Adults. 2002; 34(1):56-67.

Paper 4
Developing theoretical insights into sustainable transformation in front line teams – the Venus model Authors and affiliation Carolyn Jackson, Director, England Centre for Practice Development, CanterburyChristchurch University, UK (Presenter), Professor Kim Manley CBE.

Abstract
This paper presents a synthesis of the theoretical insights emerging from the three research studies together with outputs from a workshop for an international network of fellows. This synthesis is presented as a theoretical framework – the Venus Model for sustainable person centered transformation. This framework describes the key elements and linked concepts (and relationships) required to support front line teams (micro-systems) transform practice through interprofessional learning, development, improvement and innovation, and the essential organisational and systems factors required to enable this.

The five key elements of the model are 1) supporting development of facilitation skills across a continuum of complex purposes, 2) leadership development at clinical to systems levels, 3) practice development - a complex methodology that focuses on collaborative, inclusive and participative approaches with stakeholders,to develop person-centred, safe and effective cultures, 4) using quality improvement skills and tools, and 5) the culture change skills at the front line of practice. Bottom up, as opposed to top down models for supporting complex change in organisations are crucial to understand how to transform systems, services and cultures of care within and across organisations to deliver new models for 21st century health and well-being.

The symposium will conclude by sharing implications for practice based research and inquiry, workforce development and new emergent roles by considering how best to support and evidence the contribution of nurses to the future workforce on a global platform. This will include consideration of how nurses can take a leadership roles in both the delivery and evaluation of sustainable transformation across the health economy to impact on future new models of care.

KeywordsPerson centered sustainable transformation; practice development; e-Delphi; CPD impact; participatory research realist evaluation
Year2018
ConferenceRCN international Nursing Research Conference 2018
Official URLhttps://www.rcn.org.uk/news-and-events/events/research-2018
Related URLhttps://www.rcn.org.uk/news-and-events/events/research-2018
FunderHealth Education England
Kent Surrey Sussex AHSN
HEE Kent Surrey Sussex
NHS Improvement
Publication process dates
Deposited01 May 2018
Completed17 Apr 2018
Output statusPublished
Page range81-82
Accepted author manuscript
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Manley, K., Greaves, J., Health Education Kent Surrey and Sussex, Kent Community Healthcare Foundation Trust and Medway Community Health 2016. Implementing & evaluating a community of practice for health visiting - final report.
Measuring the impact of continuing professional development (CPD) learning on patient experience outcomes in the workplace – a realist synthesis and evaluation
Jackson, C. 2015. Measuring the impact of continuing professional development (CPD) learning on patient experience outcomes in the workplace – a realist synthesis and evaluation.
Review: The influence of authentic leadership and supportive professional practice environments on new graduate nurses’ job satisfaction
Jackson, C. 2016. Review: The influence of authentic leadership and supportive professional practice environments on new graduate nurses’ job satisfaction. Journal of Research in Nursing. 21 (2), pp. 137-138. https://doi.org/10.1177/1744987115624840
Managing gendered expectations upon resettlement: the experiences of Iraqi Kurdish Muslim women in the UK
Wright, T. 2013. Managing gendered expectations upon resettlement: the experiences of Iraqi Kurdish Muslim women in the UK. Gender, Place and Culture. 21 (6), pp. 733-749. https://doi.org/10.1080/0966369X.2013.802665
On ‘sisterhood’: What Iraqi Kurdish women migrants have to say about women and the commonalities they share
Wright, T. 2014. On ‘sisterhood’: What Iraqi Kurdish women migrants have to say about women and the commonalities they share. Journal of International Women's Studies. 15 (2), pp. 182-196.
Reconceptualising dementia friendly communities
Wright, T. 2014. Reconceptualising dementia friendly communities. Diversity and Equality in Health and Care. 11 (3), pp. 282-283.
The contrary nature of ‘differentiation’ in higher education
Wright, T. 2014. The contrary nature of ‘differentiation’ in higher education. Journal of Perspectives in Applied Academic Practice. 2 (2), pp. 52-55. https://doi.org/10.14297/jpaap.v2i2.107
Whatever happened to the F word in higher education?
Wright, T. 2014. Whatever happened to the F word in higher education? Journal of Gender Studies. https://doi.org/10.1080/09589236.2014.931801
Developing a caseload model to reflect the complexity of district and community nursing
Wright, T., Jackson, C., Manley, K., Martin, A. and Leary, A. 2015. Developing a caseload model to reflect the complexity of district and community nursing. Primary Health Care. 25 (7), pp. 32-33. https://doi.org/10.7748/phc.25.7.32.e1057
Continuing professional development (CPD) for quality care: context, mechanisms, outcome and impact: Education Outcomes Framework: round 2 funding: final report January 2015
Jackson, C., Manley, K., Martin, A. and Wright, T. 2015. Continuing professional development (CPD) for quality care: context, mechanisms, outcome and impact: Education Outcomes Framework: round 2 funding: final report January 2015. Canterbury Christ Church University England Centre for Practice Development.
Art for women’s sake: understanding feminist art therapy as didactic practice re-orientation
Wright, T. and Wright, T. 2013. Art for women’s sake: understanding feminist art therapy as didactic practice re-orientation.
Transforming urgent & emergency care together: phase 1 final report
Manley, K., Jackson, C., Martin, A., Apps, J., Setchfield, I., Oliver, G., East Kent Hospitals University NHS Foundation Trust, South East Coast Ambulance Service and Ashford, NHS Canterbury & Coastal, NHS South Kent Coast and NHS Thanet Clinincal Commissioning Groups 2014. Transforming urgent & emergency care together: phase 1 final report. Canterbury, UK England Centre for Practice Development: Canterbury Christ Church University.
Art for women’s sake: understanding feminist art therapy as didactic practice re-orientation
Wright, K. and Wright, T. 2013. Art for women’s sake: understanding feminist art therapy as didactic practice re-orientation.
The Cassandra Project- building a sustainable workload activity model for future community and district nursing workforce capacity planning
Jackson, C., Leary, A., Manley, K., Wright, T. and Martin, A. 2015. The Cassandra Project- building a sustainable workload activity model for future community and district nursing workforce capacity planning.
Art for women’s sake: understanding feminist art therapy as didactic practice re-orientation
Wright, T. and Wright, K. 2013. Art for women’s sake: understanding feminist art therapy as didactic practice re-orientation. International Practice Development Journal. 3 (Suppl.).
Transforming urgent & emergency care together: developing standards for integrated facilitation in and about the workplace
Manley, K., Martin, A., Jackson, C., Wright, T. and Health Education Kent Surrey and Sussex 2015. Transforming urgent & emergency care together: developing standards for integrated facilitation in and about the workplace. Canterbury, UK Canterbury Christ Church University.
The Cassandra project: building a sustainable workload activity model for future community and district nursing workforce capacity planning
Jackson, C. 2015. The Cassandra project: building a sustainable workload activity model for future community and district nursing workforce capacity planning.
Facilitating a culture of innovation across health care- spirals of connectedness for multiple transformations from workplace to system
Jackson, C. 2016. Facilitating a culture of innovation across health care- spirals of connectedness for multiple transformations from workplace to system.
Transforming the NHS through transforming ourselves
Akhtar, M., Casha, J., Ronder, J., Sakel, M., Wight, C. and Manley, K. 2016. Transforming the NHS through transforming ourselves. International Practice Development Journal. 6 (2). https://doi.org/10.19043/ipdj.62.005
Supporting social justice in art therapy
Wright, T. 2015. Supporting social justice in art therapy.
Making the complexity of community nursing visible
Jackson, C. and Leary, A. 2015. Making the complexity of community nursing visible.
Cassandra community workload activity project: phase 1
Jackson, C. 2015. Cassandra community workload activity project: phase 1.
Bespoke CPD for practice nurses
Jackson, C., Crouch, S., Price, S. and Wright, T. 2015. Bespoke CPD for practice nurses. Practice Nursing. 26 (2), pp. 1-5. https://doi.org/10.12968/pnur.2015.26.2.94
Transforming primary care: vision and reality: a whole systems approach to developing the workforce
Jackson, C. and Manley, K. 2015. Transforming primary care: vision and reality: a whole systems approach to developing the workforce.
Making the complexity of community nursing visible: the Cassandra project
Jackson, C., Manley, K., Martin, A., Wright, T. and Leadbetter, T. 2015. Making the complexity of community nursing visible: the Cassandra project. British Journal of Community Nursing. 20 (3), pp. 126-133. https://doi.org/10.12968/bjcn.2015.20.3.126
Engagement-related process factors in services for street-connected children and young people in low and middle income countries: a thematic synthesis
Coren, E., Hossain, R., Ramsbotham, K., Martin, A. and Pardo Pardo, J. 2014. Engagement-related process factors in services for street-connected children and young people in low and middle income countries: a thematic synthesis. London International Initiative for Impact Evaluation (3ie).
Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people
Coren, E., Hossain, R., Pardo Pardo, J., Veras, M., Chakraborty, K., Harris, H. and Martin, A. 2013. Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people. The Cochrane Library. https://doi.org/10.1002/14651858.CD009823.pub2
The Cassandra project: recognising the multidimensional complexity of community nursing for workforce development
Jackson, C., Leary, A., Wright, T., Leadbetter, T., Manley, K. and Martin, A. 2015. The Cassandra project: recognising the multidimensional complexity of community nursing for workforce development. Canterbury Christ Church University England Centre for Practice Development.
A snapshot culture assessment undertaken for Kent and Medway Partnership NHS Trust
Jackson, C. 2014. A snapshot culture assessment undertaken for Kent and Medway Partnership NHS Trust. Canterbury Canterbury Christ Church University.
Action learning: maximizing learning in the workplace
Jackson, C. and Thurgate, C. 2011. Action learning: maximizing learning in the workplace. British Journal of Healthcare Assistants. 5 (9), pp. 454-456.
Developing the role of the Assistant Practitioner
Jackson, C. 2010. Developing the role of the Assistant Practitioner.
Preparing for the new graduate workforce across health provider organisations
Manley, K. and Jackson, C. 2011. Preparing for the new graduate workforce across health provider organisations.
Navigating contested terrain - AP stories from the frontline
Jackson, C. and Thurgate, C. 2011. Navigating contested terrain - AP stories from the frontline. British Journal of Healthcare Assistants. 5 (7), pp. 346-349.
Career planning for the future - where to from here?
Jackson, C. 2011. Career planning for the future - where to from here? in: Jackson, C. and Thurgate, C. (ed.) Workplace Learning in Health and Social Care: A Student's Guide Maidenhead Open University Press. pp. 112-126
How does learning happen in the workplace?
Jackson, C. 2011. How does learning happen in the workplace? in: Jackson, C. and Thurgate, C. (ed.) Workplace Learning in Health and Social Care: A Student's Guide Maidenhead Open University Press. pp. 12-21
First do no harm: reflections on setting up a fitness to practice panel at Canterbury Christ Church University
Jackson, C., Biela, C. and Levine, A. 2008. First do no harm: reflections on setting up a fitness to practice panel at Canterbury Christ Church University.
Becoming a learning community: a transformative journey towards a sustainable model to support student learning in practice
Jackson, C. and West, S. 2008. Becoming a learning community: a transformative journey towards a sustainable model to support student learning in practice.
Personal development plans and workplace learning
Jackson, C. and Thurgate, C. 2011. Personal development plans and workplace learning. British Journal of Healthcare Assistants. 5 (6), pp. 292-296.
Transforming professional development for an era of interagency leadership
Hryniewicz, L. and Jackson, C. 2010. Transforming professional development for an era of interagency leadership.
The importance of partnership working in the design and implementation of band A assistant practitioner roles - a case example
Thurgate, C. and Jackson, C. 2010. The importance of partnership working in the design and implementation of band A assistant practitioner roles - a case example. British Journal of Healthcare Assistants. 4 (12), pp. 603-604.
Learning leaders, new professional identities and the implications for children’s centres and early years
Jackson, C. and Hryniewicz, L. 2011. Learning leaders, new professional identities and the implications for children’s centres and early years.
Understanding the importance of career planning
Thurgate, C. and Jackson, C. 2011. Understanding the importance of career planning. British Journal of Healthcare Assistants. 5 (1), pp. 35-37.
Partnership working and the assistant practitioner
Thurgate, C. and Jackson, C. 2010. Partnership working and the assistant practitioner. British Journal of Healthcare Assistants. 4 (12), pp. 603-604.
Facing the challenge: the development of assistant practitioners
Thurgate, C. and Jackson, C. 2010. Facing the challenge: the development of assistant practitioners. British Journal of Healthcare Assistants. 4 (11), pp. 546-547.
Developing foundation degrees in adult health services
Thurgate, C. and Jackson, C. 2010. Developing foundation degrees in adult health services. British Journal of Healthcare Assistants. 4 (8), pp. 382-383.
Creative thinking for whole systems working
Jackson, C. and Ellis, P. 2010. Creative thinking for whole systems working. in: Standing, M. (ed.) Clinical Judgement and Decision-Making in Nursing and Interprofessional Healthcare Maidenhead Open University Press.
An overview of the national challenges of embedding an assistant practitioner workforce in health and social care
Thurgate, C. and Jackson, C. 2010. An overview of the national challenges of embedding an assistant practitioner workforce in health and social care. British Journal of Healthcare Assistants. 4 (11), pp. 546-547.