Glenda Cook

Decision-making in teams: issues arising from two UK evaluations

Interagency and interprofessional working has often been operationalised through the development of integrated, multiprofessional teams in the UK. However, there is considerable ambivalence reported about the success of such teams. This paper reports on two evaluations of different types of inter-agency/intra-agency, interdisciplinary/unidisciplinary teams. One study used a soft systems methodology to evaluate a health and social care team for people with enduring mental health needs and the other used a pluralistic framework to examine integrated nursing teams in primary care. In both studies, the team-working arrangements influenced the decisions made by the team members such that client care became increasingly responsive and proactive. These changes were made possible by two processes. First, information transaction was augmented and was instrumental in supporting effective client-related decision-making. Second, there was enhanced support for decision-making, especially in respect of problem solving. However, the increased autonomy of the team members had the potential to marginalise those outside the team from decision-making. It is suggested that working within a team can impact on the decisions made by team members, which exceeds a collection of individual decisions. The strengths of complex multiprofessional teams for service users may be realised if the processes of decision-making are respected.Interagency and interprofessional working has often been operationalised through the development of integrated, multiprofessional teams in the UK. However, there is considerable ambivalence reported about the success of such teams. This paper reports on two evaluations of different types of inter-agency/intra-agency, interdisciplinary/unidisciplinary teams. One study used a soft systems methodology to evaluate a health and social care team for people with enduring mental health needs and the other used a pluralistic framework to examine integrated nursing teams in primary care. In both studies, the team-working arrangements influenced the decisions made by the team members such that client care became increasingly responsive and proactive. These changes were made possible by two processes. First, information transaction was augmented and was instrumental in supporting effective client-related decision-making. Second, there was enhanced support for decision-making, especially in respect of problem solving. However, the increased autonomy of the team members had the potential to marginalise those outside the team from decision-making. It is suggested that working within a team can impact on the decisions made by team members, which exceeds a collection of individual decisions. The strengths of complex multiprofessional teams for service users may be realised if the processes of decision-making are respected.

Older persons' experiences of whole systems: the impact of health and social care organizational structures.

AIMS An in-depth case study of whole systems working. BACKGROUND This paper reports on the second part of a two-part study exploring whole systems working. Part 1 of the study focused on an in-depth review of the literature pertaining to continuity of care and service integration. The second part, reported here, focused on an in-depth case study of one whole system. Evaluation Informed by the findings of part 1 of the study, data collection methods included in-depth interviews, real-time tracking of 18 older people, focus groups and consensus conferencing. Different data sets were analysed individually and synthesized using matrices derived from the literature review findings. KEY ISSUE Key themes from data synthesis include: (1) access to the most appropriate services; (2) service fragmentation; (3) continuity of care; and (4) routinized care. CONCLUSIONS The four themes of the case study reflect the need to address issues of demarcation of professional responsibilities, complicated channels of communication, information flows, assessment and reassessment in whole systems working. IMPLICATIONS FOR NURSING MANAGEMENT The impact of disempowering relationships on actual continuity of care and perceptions of quality among service users and providers. Lessons need to be learnt from specialist services and applied to service delivery in general.

The risk to enduring relationships following the move to a care home

Aim.  To explore findings from a study which investigated the meanings that older people attributed to their experiences of living in a care home and consequently the risks that they identify in this. Background.  There is evidence from this and other studies that being able to engage in long-time friendships is important to older people. The move to a care home has the potential to disrupt these relationships and there is a risk of breakdown of the friendships that have been valued throughout life. Method.  A hermeneutic inquiry that explored the meaning that eight older people ascribed to their life in the care home. This paper focuses on the narratives that concerned relationships with long-time friends and the risks to these relationships. Results.  The paper highlights the importance of engaging in meaningful relationships with other people. The participants stories illuminated the importance of maintaining friendships following the move to a care home and how these had had a positive impact on their lives in that setting. With advancing age and increasing frailty the participants were acutely aware that their friendships were vulnerable to breakdown and they implemented a range of strategies to sustain their relationships with these people. Conclusion.  The findings point to the importance of acknowledging the value of long-time friendships to older people and the need to support them in their efforts to sustain these relationships and reduce risks to them.

Promoting partnership with older people through quality assurance systems: Issues arising in care homes:

This paper reports on a study in which a quality assurance package was introduced into 11 care homes for older people and evaluated. The package (Qual A Sess) has two features. First, it is designed to provide a mechanism for self-regulation, by providing homes with a framework for assessing care and services in a systematic way. Second, it promotes the participation of residents in the quality process, by including them as members of self-assessment teams. A case study methodology was used to evaluate the process of introduction, and this paper focuses on data from older people which describes their views about participation. The paper concludes that skills in communication and assessment, and sensitivity to individual needs and problems is required in order to facilitate meaningful participation from older people.

Emotional robotics in elder care --- a comparison of findings in the UK and germany

Robot-therapy with emotional robots is a new approach for people with cognitive impairments. This article looks at explorative findings of the therapeutic seal PARO in a practice network in England and findings of PARO and the toy dinosaur PLEO in teaching research projects in Germany. The findings in the UK and Germany have comparable outcomes on social interaction of the residents. Examples of the outcomes are presented and analysed with respect to the question in how far there are indicators for a new quality of interaction due to the robotic intervention and in how far it can contribute to interventions which enhance social interaction in care.

The impact of research governance in the United Kingdom on research involving a national survey.

PURPOSE The purpose of this paper is to examine the impact that research governance processes in the National Health Service (NHS) are having on the conduct of research that involves a national survey and to point to ways that existing processes may develop to facilitate such research. DESIGN/METHODOLOGY/APPROACH The paper describes the experiences of a research team of seeking approval in 357 NHS organisations to carry out a national postal survey to investigate specialist services and specialist staffing for older people in England in the wake of recent policy developments. Through reflection on this experience, the team propose approaches for the development of existing research governance processes. The national survey was the first stage of the study, which was followed by a detailed investigation of the development of specialist service provision for older people in six case study sites across England. The national survey aimed to map specialist service provision for older people by identifying the range of service models, agency and professional involvements, and nature of the case load in statutory services (health and social care), independent and voluntary sector organisations. FINDINGS Of the 357 NHS organisations approached for approval to carry out the survey within the organisation, this was achieved only in 247 organisations over 12 months. Many organisations were facilitative of the process; however, protracted and extensive approval processes in others led to long delays and redesigning of the research that was commissioned by the Department of Health. ORIGINALITY/VALUE The paper is of value in that it highlights processes and practices that hinder research and builds on those that work well.

Research governance issues in the care home sector

Research governance in care homes is a complex process, due to the ambiguous status of the care home as a public and a private space. As such, public sector research governance processes may infringe individuals rights to make decisions about participation in research, while treating the processes of informed consent as a purely individual matter may fail to safeguard individuals who may be vulnerable. This paper discusses these dilemmas in the light of existing research governance frameworks, and goes on to outline protocols that the team have developed for their own use.

Quality improvement in German and UK care homes

This paper reports on data from two linked studies in the UK and Germany which evaluated the potential of a quality management system, Qual A Sess, to play a role in self‐regulation in care homes for older people in the context of calls for EU‐wide harmonization of standards. Qual A Sess was developed by German and UK organisations to assess the quality of care in care homes and mechanisms to improve the quality of care through the development of action plans involving residents, families and staff in the process. This paper compares the outcomes of Qual A Sess in care homes in both countries, by focusing on the data available about the action plans generated by the Qual A Sess process, and suggests that standardization of quality indicators may be inappropriate in the context of local differences.

Opening research data: issues and opportunities

Purpose – This paper aims to explore the issues, the role of research data management (RDM) as a mechanism for implementing open research data and the role and opportunities for records managers. The open data agenda is premised on making as much data as possible open and available. However, in the context of open research data there are methodological, ethical and practical issues with this premise. Design/methodology/approach – Two collaborative research projects focusing on qualitative health data were conducted. “DATUM for Health” designed and delivered a tailored RDM skills training programme for postgraduate research students in health studies. “DATUM in Action” was an action research project between researchers from information sciences, health, mathematics and computing, looking at planning and implementing RDM. Findings – Three key issues emerged about what research data is appropriate to make open/accessible for sharing and reuse: re-using qualitative data conflicts with some of the epistemologi...

Specialist services for older people: issues of negative and positive ageism

This paper reports findings of a study in 2004 of the development of specialist services for older people in the National Health Service (NHS) in England, as recommended in the Department of Health’s National Service Framework for Older People (NSF-OP). The study was funded by the Department of Health as part of a programme of research to explore the Framework’s implementation. Information was collected through a questionnaire survey about the nature of specialist developments at three levels of the NHS: strategic health authorities (SHAs), provider Trusts, and service units. This produced an overview of developments and a frame from which to select detailed case studies. Analysis of the survey data showed that there were variations in the way that the NSF-OP was being interpreted and implemented. In particular, there was inconsistency in the interpretation of the NSF-OP’s anti-ageism standard ; some concluded that the strategy discouraged services exclusively for older people, others that it encouraged dedicated provision for them. The tension between creating ageblind and age-defined services was played out in the context of existing service structures, which had been shaped over decades by many local and national influences. These conceptual and historical factors need to be taken into account if services are to change, as developments are shaped by ‘ bottom-up ’ local processes as well as ‘ top-down ’ policy initiatives. In particular, the tension inherent in the NSF-OP between negative and positive ageism, and its varied interpretations at local levels needs to be taken into account when evaluating progress in implementation.