Support Service Improvement Research Articles

Extended training to prepare GPs for future workforce needs: a qualitative investigation of a 1-year fellowship in urgent care

BackgroundIt has been argued that UK general practice specialist training should be extended, to better prepare GPs for challenges facing 21st-century health care. Evidence is needed to inform how this should occur.AimTo investigate the experience of recently trained GPs undertaking a 1-year full-time fellowship programme; in particular, workforce impact and career development potential. The fellowship was designed to provide advanced skills training in urgent care, integrated care, leadership, and academic practice.MethodSemi-structured interviews conducted longitudinally over 2 years, augmented by observational data in West Midlands, England. Participants were interviewed on at least three occasions: twice while undertaking the fellowship, and at least once post-completion. Participants’ clinical and academic activities were observed. Data were analysed using a framework approach.ResultsSeven GPs participated in the pilot scheme. The fellowship was highly rated and felt to be balanced in terms of the opportunities for skill development, academic advancement, and confidence building. GPs experienced enhanced employability on completing the scheme, and at follow-up were working in a variety of primary care/urgent care interface clinical and leadership roles. Participants believed the fellowship made general practice a more attractive career option for newly qualified doctors.ConclusionThe fellowship provides a defined framework for training GPs to work in an enhanced manner across organisational interfaces, with the skills to support service improvement and integration. The fellowship model appears appropriate to prepare GPs for portfolio roles. Its impact on NHS service delivery continues to be investigated by Health Education England.

'It's our everyday life' - The perspectives of persons with intellectual disabilities in Norway.

This study illuminates how adults with intellectual disabilities understand and describe their everyday life and its shortcomings when it comes to equal rights in the context of Norwegian community living. An inclusive research design, including nine persons with mild intellectual disability, two university researchers and two intellectual disability nurses from the municipality, was undertaken. An inductive thematic analysis of data identified three key themes: everyday life - context, rhythm and structure, social participation and staff - an ambiguous part of everyday life. Results show that service provision had institutional qualities; participants experienced lack of information and reduced possibilities for social inclusion and community participation like everyone else. More attention on the role of policy development, support staff and leadership, in relation to facilitating an everyday life with more user involvement, social inclusion and community participation of people needing support, is essential. Participatory, appreciative, action and reflection in workshops for persons with intellectual disabilities and support staff represent a promising approach to promote the voices and interests of persons with intellectual disabilities. This article tells you about the everyday life of people with intellectual disabilities living in Norway. Nine people with intellectual disabilities worked together with two university researchers and two intellectual disability nurses in the community, in workshops. The people with intellectual disabilities liked to have their own apartment and going to work every day. They said that they wanted more social participation with friends and more participation in activities in the community, just like everyone else. They wanted to be treated with more respect by their staff. All participants in the project saw great value in working together and some of them are working together in a new project about involvement in the improvement of support services for people with intellectual disabilities.

Establishing a statewide approach to support the developmental needs of children with congenital heart disease following early open heart surgery

Introduction: Infants with congenital heart disease (CHD) requiring open-heart surgery before 12 months are known to have an increased risk of poor neurodevelopmental outcomes. The Queensland Paediatric Cardiac Service (QPCS) has partnered with the Queensland Child and Youth Clinical Network (QCYCN) to establish a contemporary, integrated, statewide approach to meeting the developmental needs of these children.Timeline: two year project scheduled for completion December 2017.Aim: To establish a sustainable practice framework that meets the developmental support needs of CHD children and their families in partnership with services across the state and across the continuum of care.Target population: Children with CHD who had open-heart surgery as infants and who reside in Brisbane, Ipswich, or Cairns regionsHighlights: The QPCS-QCYCN partnership maximised statewide engagement and project outcomes. Partnership with the Innovation Change and Redesign Excellence (iCARE) program enabled application of a robust clinical service re-design methodology. Engagement with consumers and stakeholders enabled contextualised solutions.Sustainability: Supported by executive endorsement, stakeholder engagement and localised solution planning. There is anticipated transferability to other clinical cohorts.Conclusion: A collaborative partnership and application of a clinical service re-design methodology has enabled rigorous planning and effective stakeholder and consumer engagement across partner sites. Key service re-design themes identified include; improve the co-ordination of care, integrate care along the continuum, activate caregivers, build local capability, and support service evaluation and improvement.

Extended training to prepare GPs for future workforce needs: a qualitative investigation of a 1-year fellowship in urgent care.

It has been argued that UK general practice specialist training should be extended to better prepare GPs for the challenges facing 21st-century health care. Evidence is needed to inform how this should occur. To investigate the experience of recently trained GPs undertaking a 1-year full-time fellowship programme designed to provide advanced skills training in urgent care, integrated care, leadership, and academic practice; and its impact on subsequent career development. Semi-structured interviews conducted longitudinally over 2 years augmented by observational data in the West Midlands, England. Participants were interviewed on at least three occasions: twice while undertaking the fellowship, and at least once post-completion. Participants' clinical and academic activities were observed. Data were analysed using a framework approach. Seven GPs participated in the pilot scheme. The fellowship was highly rated and felt to be balanced in terms of the opportunities for skill development, academic advancement, and confidence building. GPs experienced enhanced employability on completing the scheme, and at follow-up were working in a variety of primary care/urgent care interface clinical and leadership roles. Participants believed it was making general practice a more attractive career option for newly qualified doctors. The 1-year fellowship provides a defined framework for training GPs to work in an enhanced manner across organisational interfaces with the skills to support service improvement and integration. It appears to be well suited to preparing GPs for portfolio roles, but its wider applicability and impact on NHS service delivery needs further investigation.

Clinician Response to Child Abuse Presentations in the Vietnamese Hospital Emergency Setting.

Ongoing fiscal stability has enabled the National Assembly in Vietnam to turn its attention to improving the health and well-being of women and children. Training pediatric health care professionals in the recognition and response to child abuse presentations in the emergency setting has the potential to improve outcomes for the disproportionate number of vulnerable children presenting to the emergency setting with nonaccidental injuries. This study explored the training needs and expectations of the staff preparing to undertake such a clinical training program. This qualitative study is based on semistructured interviews with 16 clinicians from the emergency setting of a leading pediatric hospital in Vietnam. Interview questions focused on current practice in recognizing and responding to child abuse and neglect presentations, the level of training and experience of participants, and subjective reports of confidence in recognizing abuse. Interviews were conducted in English and Vietnamese, with check-translation of transcripts performed by an independent translator. A culture of collegiality and innovative workplace practices was revealed. Analysis revealed two overarching themes that were related to the need for evidence, forensic analysis, respecting families, and consultation. Despite participant confidence in recognizing and reporting child abuse and neglect presentations, knowledge deficits were found. This article presents a critical analysis of the context within which the first evidence-based clinical training program of its kind in Vietnam was developed and implemented in a pediatric children's hospital. Clinicians felt a strong moral obligation to protect children from further harm, however encountered a number of barriers inhibiting this process. Findings significantly shaped the Safe Children Vietnam training program and will also contribute to the development of protocols and improvement of community support services at the study site.

A qualitative formative evaluation of a patient-centred patient safety intervention delivered in collaboration with hospital volunteers.

BackgroundEvidence suggests that patients can meaningfully feed back to healthcare providers about the safety of their care. The PRASE (Patient Reporting and Action for a Safe Environment) intervention provides a way to systematically collect feedback from patients to support service improvement. The intervention is being implemented in acute care settings with patient feedback collected by hospital volunteers for the first time.ObjectiveTo undertake a formative evaluation which explores the feasibility and acceptability of the PRASE intervention delivered in collaboration with hospital volunteers from the perspectives of key stakeholders.DesignA qualitative evaluation design was adopted across two acute NHS trusts in the UK between July 2014 and November 2015. We conducted five focus groups with hospital volunteers (n=15), voluntary services and patient experience staff (n=3) and semi‐structured interviews with ward staff (n=5). Data were interpreted using framework analysis.ResultsAll stakeholders were positive about the PRASE intervention as a way to support service improvement, and the benefits of involving volunteers. Volunteers felt adequate training and support would be essential for retention. Staff concentrated on the infrastructure needed for implementation and raised concerns around sustainability. Findings were fed back to the implementation team to support revisions to the intervention moving into the subsequent summative evaluation phase.ConclusionAlthough there are concerns regarding sustainability in practice, the PRASE intervention delivered in collaboration with hospital volunteers is a promising approach to collect patient feedback for service improvement.

Medical travellers’ perspectives in selecting in-patient services at selected private hospitals in Sri Lanka

ABSTRACTThe Sri Lankan government has clear plans to develop medical tourism as an industry. Availability of high-quality medical professionals and accredited hospitals has encouraged medical travellers to come to Sri Lanka and to expand the medical tourism industry in the country. The purpose of this cross-sectional study was to describe medical travellers’ perspectives in seeking in-patient services at selected four private hospitals in Sri Lanka. Foreign national in-patients (n = 252) were interviewed using an interviewer-administered questionnaire. The response rate was 93.25%. The majority (68.1%) were Maldivians followed by Indians (20.4%) and 51.1% sought surgical care. Availability of high-quality medical professionals (94.2%) and accredited hospitals (81.3%), easy visa (90.2%) were top reasons to select Sri Lanka. Medical travellers faced difficulties in communication (37.4%), transport (31.9%), accommodation (57%) and finding quality food (41.7%). The study recommends improvement of infrastructure and support services for medical travellers and that private hospitals obtain international accreditation to improve medical tourism potentials.

Current Status of Use and Satisfaction with Family Support Services for Families of Children with Disabilities

연구목적: 본 연구는 장애인 가족의 삶의 질 제고를 위한 장애인 가족지원 서비스 및 장애인가족지원센터의 운영 개선 방안을 제안하고자 실시되었다. 가족지원 서비스의 유형은 장애인 가족의 삶의 질 척도 영역에 따라 분류한 가족지원 서비스의 신체적․물질적 안녕 지원, 양육 활동 지원, 가족 상호작용 지원, 정서적 안녕 지원, 장애 관련 지원 등 5개 하위유형과 각 16개 세부 항목으로 구분하였다. 연구방법: 장애인 가족의 어려움과 특성을 파악하기 위해‘장애인 가족지원 조사지’를 사용하였다. 조사지는 기초정보 조사용 12개 문항, 장애인가족지원 서비스와 장애인가족지원센터의 이용 현황 및 만족도 파악을 위해 서비스 이용 여부, 이용한 서비스의 유형, 이용기간 비용과 같은 이용 현황, 그리고 서비스 만족도 등이 11개 문항으로 총 23개 문항으로 구성하였다. 이를 전국장애인부모연대의 17개 시도지부, 전국의 40개 장애인가족지원센터의 도움을 받아 최종 1,140부를 분석 대상 자료로 선정하여 조사결과를 분석하였다. 연구결과: 장애인 가족의 10명중 7.5명 정도는 가족지원 서비스를 최소 1회 이상 이용한 경험이 있는 것으로 나타났으며, 서비스 유형별로는 ‘장애자녀 활동지원, 돌봄지원 등의 양육지원’서비스, 방과후학교 등은 높은데 반해, 가정의 주거환경 개선 지원, 부모 노후 대책 등 가족의 미래 설계 지원, 장애인 가족 사례관리 지원, 가족상담ㆍ가족치료 등은 낮은 것으로 나타났다. 또한, 장애인 부모 간 친교 활동 지원 영역의 경우 다른 서비스에 비해 만족도가 높게 나타났고, 장애인 가족 사례관리 지원에 대한 만족도는 낮은 것으로 나타났다. 또한 장애인가족지원센터를 통해 가족지원 서비스를 가장 많이 이용하고 있었다. 결론: 장애인 가족지원 서비스는 다양한 방법으로 제공될 필요가 있으며 장애인가족지원센터를 통한 전달체계 구축 마련을 제안하였다.

The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial.

BackgroundAs an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users’ experiences of care, service use, staff well-being, and team model fidelity.Methods/designTwenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services’ electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study’s primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme.DiscussionOur trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams.Trial registrationCurrent Controlled Trials ISRCTN47185233Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1283-7) contains supplementary material, which is available to authorized users.

Understanding the problem of coordination in a large scale distributed environment from a service lens view — Towards the South African public sector e-Administration criteria for coordination support

Collaborative work arrangements are often subject to many challenges, especially when the participants are physically dispersed across large geographical spaces. Usually, collaborating members of a particular work arrangement need to coordinate their actions to avoid conflicting or repetitive actions. However, coordination can be difficult and demanding, as collaborative work arrangements are dynamic and often emerging in response to different requirements. This paper is intended to create an understanding of the coordination needs of a cooperative distributed environment from a service lens perspective. By employing an interpretive case study approach the paper aims to answer the question “How can service components assist in understanding the coordination status quo in a heterogeneous and distributed collaborative work context?” The paper contributes to both theory and practice, through providing a systematic manner of contemplating coordination issues in a specific heterogeneous and distributed context, viz. the South African (SA) public sector. In addition, through the provision of design requirements, the article contributes towards a design theory in Information System (IS) research for the development and improvement of coordination support services in a distributed environment.

A UK approach to using economic modelling to support service improvement and cost reduction: a falls prevention example

A UK approach to using economic modelling to support service improvement and cost reduction: a falls prevention example

The development of safety cases for healthcare services: Practical experiences, opportunities and challenges

There has been growing interest in the concept of safety cases for medical devices and health information technology, but questions remain about how safety cases can be developed and used meaningfully in the safety management of healthcare services and processes. The paper presents two examples of the development and use of safety cases at a service level in healthcare. These first practical experiences at the service level suggest that safety cases might be a useful tool to support service improvement and communication of safety in healthcare. The paper argues that safety cases might be helpful in supporting healthcare organisations with the adoption of proactive and rigorous safety management practices. However, it is also important to consider the different level of maturity of safety management and regulatory oversight in healthcare. Adaptations to the purpose and use of safety cases might be required, complemented by the provision of education to both practitioners and regulators.

Fuzzy Clustering of Students’ Data Repository for At-Risks Students Identification and Monitoring

In educational data mining, identifying academic courses that contribute significantly to students’ class of degree and predicting students’ performances can help in the choice and improvement of intervention and support services for students whose performances are poor. Experience shows that graduates with weak class of degree find it difficult to gain employment, hence, the need to identify and group these at-risk students at an early stage of their academic career and then develop a plan to improve their performance. This paper identifies possible academic courses with significant contribution to academic performance and predicts students’ graduating class of degree. 11Ants Model Builder provided a means for course rank analysis while MATLAB was the system development tool. Fuzzy c-Means (FCM) algorithm was used to partition students into weak, average and good clusters. Four (4) natural clusters of at-risk students were automatically identified with k-means algorithm. Results show that Sugeno-type inference system is best suitable for the provision of initial parameters for Adaptive Neuro Fuzzy Inference System (ANFIS) training of students’ dataset. The results also prove the effectiveness of the combination of FCM, k-means and ANFIS in the classification of students based on academic performance and at-risk levels. The results will help educational managers monitor groups of students at the same level of performance, and those at the boundary of two classes of degree for the provision of informed counseling and intervention plans, to improve academic performance.

We Said … We Did!: A Partnership Approach to Developing Library and Student Support Services

This article discusses the UK higher education environment and how increasing student expectations have led to students engaging with their academic institutions as partners. The differences between consumerist and partnership models of engagement are discussed and the article includes a UK-based case study which illustrates how effective student partnership relationships and practices can be beneficial for the development and continual improvement of academic library and student support services. The case study provides practical examples of effective partnership initiatives which can be applied to a wider group of university professional services areas.

Analisis dan Perancangan Sistem Interactive Voice Response (IVR) Berbasis Openvxi Menggunakan Asterisk Pada Hotel Sahid Jaya

The purpose of this study is to provide a deep understanding of technology of IVR (Interactive Voice Recognition) in OpenVXI based network using Asterisk, that help Sahid Jaya hotel to streamline communication with the guests, improving service and employee effectiveness. The methodology used is analysis which is through surveys, observation and interviews with the company and the design method by designing system from the existing needs analysis. The results obtained from this research is Communication System based in IVR OpenVXI can be applied to existing VoIP network, without disrupting the existing network. Some existing services can be supported with this system usage. Conclusions can be drawn is the use of IVR in the network using VoIP technology is the best solution to overcome the problems and needs of the hospitality which one of these is limited information guest cna get that can provided by non-operators and for support service improvement.

The Long Term Conditions Delivery Support (LTC DS) Team

The LTC DS Team is a small, NHS-funded organization with one team member based in each of the ten Strategic Health Authority regions around the country. Over the past few years, the direction and focus of our work has had a few twists and turns, not least of all owing to the recent change in government. Our remit is, broadly speaking, to support the implementation of government policy, and we do this by supporting service improvement and innovation for people with long-term conditions, with an emphasis on neurology.

Mentally disordered offenders who are born abroad: pathway of care through medium secure services

Recent changes in UK immigration policy have led to increasing deportation of foreign national offenders and more than 5000 were deported in 2008. This rise follows a review in 2006 which found that some foreign national offenders were being lost due to disposal or transfer through mental health services. As a result, a department was set up within the United Kingdom Border Agency (UKBA) to identify and review those detained under Restrictions Orders who were due to be conditionally released from hospital, so that they could be considered for deportation. As a result of these changes, forensic clinicians are more frequently presented with detained patients who have immigration problems that can lead to problems in the care pathway through secure services. A local audit was carried out in an inner‐London medium secure service to quantify the number of detained patients who are born abroad, and to review their care pathways to determine whether they are affected by immigration difficulties. It is hoped that the discussion of the issues identified by this audit can support service improvement and provide better care for patients in medium secure services.

Transforming access: the role of data within service improvement to transform access to services

PurposeData have a critical role in supporting service improvement and this is particularly the case for service improvement to reduce waiting times. The purpose of this paper is to identify some of the barriers managers face in accessing and using data effectively for 18 weeks and then describes how a service improvement tool developed by the NHS Institute can help to overcome these.Design/methodology/approachA review of the core function of data to support service improvement processes and the development of a national tool to support the transformation of access with the National Health Service in England.FindingsThe review of the core function of data identified a range of barriers: access to data for service improvement; the appropriate use of data to analyse the dynamics of variation and therefore for decision making; and the capacity and capability to use data. The size and immediacy of the 18‐week challenge means that a national solution needs to focus on being practical and overcoming some of these barriers.Originality/valueA perspective of the reality of using data for service improvement and using it to transform access to health services.

Erectile Dysfunction and Premature Ejaculation are the Most Frequently Self-Reported Sexual Concerns: Profiles of 9,536 Men Calling A Helpline

ObjectivesTo describe the range of sexual problems, as reported by men calling a help-line and to investigate factors associated with help seeking behaviour. MethodsThe study included all calls between 1999 and 2004. The information used for analysis comprised caller’s demographic characteristics, the sexual problem reported, previous doctor contacts, coexisting physical and mental health problems. ResultsErectile dysfunction (ED) and premature ejaculation (PE) were the most frequently reported problems (57 and 19.2% respectively). ED-reporting callers were older (OR 0.63 for the ages of 50–59 yrs), with co-morbidities (OR 1.75) and in stable relationship (OR 0.46), while PE-reporting callers were younger (OR 5.83 for the ages of 20–29 yrs), relatively healthy and more likely single (OR 2.62 and OR 2.92 respectively). Type and duration of sexual concern, age, coexisting health problems and marital status relate significantly (p<0.01) with willingness to seek medical help. ConclusionsThe study demonstrates that ED and PE are men’s major sexual concerns with personal and interpersonal factors influencing their help-seeking behaviour. Help-lines can serve as a link between health services and callers, while provide useful information for policy formation and improvement of support services.

Issues in IT Service-Oriented Requirements Engineering

Corporate information technology (IT) management is increasingly service-oriented, offering continuous evaluation and improvement of application, communication, delivery and support services to internal and external customers. Service-oriented requirements engineering (SoRE) plays a significant role in identifying and specifying service requirements, formally defined through service-level agreements (SLAs). However, the new frameworks and approaches emerging to guide these developments have not yet addressed how requirements for such services can be effectively developed, nor identified the diverse issues involved. We report a case study of a web services team development of requirements for an internal Service Desk service. The study revealed five main issues of concern when developing service provider requirements: service roles, responsibilities and accountability; service performance metrics; resolution of conflicting stakeholder service requirements; customer acceptance of service change; and service provider team structure. This study suggests that in the new IT services era, new techniques and approaches are needed for eliciting and determining provider and customer requirements that involve key stakeholder groups equitably and more closely negotiate the sometimes-conflicting provider and customer needs.