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
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.
|Authors||Manley, K., Jackson, C., Martin, A. and Wright, T.|
|Contributors||Manley, K., Jackson, C., Martin, A. and Wright, T.|
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.
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.
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.
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.
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.
|Keywords||Person centered sustainable transformation; practice development; e-Delphi; CPD impact; participatory research realist evaluation|
|Conference||RCN international Nursing Research Conference 2018|
|Funder||Health Education England|
|Kent Surrey Sussex AHSN|
|HEE Kent Surrey Sussex|
|Publication process dates|
|Deposited||01 May 2018|
|Completed||17 Apr 2018|
|Accepted author manuscript|
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