Jane Melvin

The Pictor Technique: A Method for Exploring the Experience of Collaborative Working

Collaborative working is a crucial part of contemporary health and social care. Researching the experiences of those involved—as professionals, patients, or carers—is challenging, given the complexity of many cases and the taken-for-granted nature of roles and identities in relation to it. In this article we introduce the Pictor technique for exploring experiences of collaborative working. This is a visual technique in which participants construct a representation of roles and relationships in a particular case using arrow-shaped adhesive notes or cards. The chart so produced helps the participant tell the story of his or her experience and serves as a focus for further exploration with the researcher. We describe the background to Pictor and illustrate its use with professionals, patients, and carers, drawing on recent and current research. We examine how Pictor relates to other visual methods, and conclude by considering how the technique might be developed in the future.

Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK

The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy-one per cent of patients died at home. This model may have application elsewhere.

“Go Make Your Face Known”: Collaborative Working through the Lens of Personal Relationships

Background: Collaborative working between professionals is a key component of integrated care. The academic literature on it largely focuses either on integration between health and social care or on the dynamics of power and identity between doctors and nurses. With the proliferation and extension of nursing roles, there is a need to examine collaborative working amongst different types of nurses. Method: This study explored experiences of collaborative working amongst generalist and specialist nurses, in community and acute settings. We carried out semi-structured interviews, incorporating the Pictor technique, with 45 nurses, plus 33 other key stakeholders. Transcripts were analysed using Template Analysis. This article focuses on one major thematic area that emerged from the analysis: the significance of interpersonal relationships amongst nurses, and between them and other professionals, patients and carers. Results: Relationship issues were ubiquitous in participants’ accounts of collaborative working. Good personal relationships facilitated collaboration; face-to-face interaction was especially valued. Relationships were recognized as requiring effort, especially in new roles. Organisational changes could disrupt productive personal networks. Conclusion: Relationship issues are integral to successful collaborative working. Policy and practice leaders must take this into account in future service developments. Further research into collaborative relationships in different settings is needed.

Case management for casualties of war

Purpose To describe how case management can improve the transition between services for returning servicemen injured in war zones who often have very complex and multiple injuries. Context Reviews a project undertaken for the Ministry of Defence in the UK. Data sources Case management across secondary and primary care—studies; Literature relating to care of casualties from war zones; Statistical evidence on casualty numbers and type of injuries. Case description This presentation will focus on the care of injured personnel evacuated back to the UK. Case management is to be implemented to improve the patient care pathway and make the transition between war zone, hospital and primary care fully integrated. (Preliminary) conclusions/Discussion Care is often not co-ordinated, systems inadequate and patients returning as operational casualties have particular needs in terms of health care delivery which can be overlooked, particularly in relation to mental health needs. Case management provides a structured and co-ordinated pathway between the different services to enable continuity, a smooth transition and improve patient outcomes. However, implementation of case management will present many challenges in this environment as the case managers works with the service personnel within an NHS model of health care delivery. Within the NHS alone, integration is difficult as case managers strive to manage organisational differences between health and social care. When you add on the complexity of service personnel who have been injured whilst in a war zone, cross boundary working becomes even more difficult to manage effectively. Case management has the potential to be the one link that brings services together in a fully integrated way.