Undertaking high quality and relevant qualitative research at a time of rapid healthcare reform


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Undertaking high quality and relevant qualitative research at a time of rapid healthcare reform

  1. 1. Undertaking high quality andrelevant qualitative research at a time of rapid healthcare reform Sara E Shaw Alison Porter, Judith Smith Rebecca Rosen and Elizabeth Eastmure
  2. 2. The qualitative researchExplore the ways in which NHS commissioningcan be enacted to assure high quality care forpeople living with long-term conditions – Focus on the practice of commissioning – Working with three ‘commissioning communities’ – Funded by NIHR Service Delivery & Organisation
  3. 3. The bigger context Project started in March 2010 White Paper published in July 2010 Entire landscape changing: – Clustering of PCTs in June 2011 – Abolition of PCTs by 2013 – Formation of new GP-led commissioning consortia Combined with drive for £20million ‘efficiency savings’ Little detailed guidance on how to transition And from April 2011.... The Pause
  4. 4. Two key challenges1) keeping qualitative research relevant2) engaging and working with evolving/dissolving organisations
  5. 5. How has an action researchmodel enabled us to addressthese challenges?
  6. 6. Our action research approachIn line with an actionresearch approach, specificobjectives within casestudies will be negotiatedwith local stakeholders. Weanticipate that these willfocus on the research teamassessing and supportinglocal commissioners at keystages in the cycle ofcommissioning’. Quote from funding application
  7. 7. Observations and documents 1. Wirral Stakeholder SAMPLING AND ACTION • Diabetes interviewsDATA COLLECTION • Dementia 3x 2. Calderdale commissioning • Diabetes communities • Dementia Social 3. Somerset network • Diabetes analysis • Stroke Impact and outcomes (inc quant) TEAM INTERVIEWS AND REFLECTIONS
  8. 8. What does action approach involve1. Engage with - and Co-organise workshops and work alongside – negotiating project focus each of the Feed in emerging findings commissioning Run ‘next steps’ events communities Facilitate stakeholder workshops (e.g. dementia services)2. Offer targeted Advise on e.g. service support and advice specifications/care pathways Act as ‘critical friend’ (e.g. on3. Balance research emerging information with action infrastructure) Support data analysis (e.g re service utilisation of new model of diabetes care)
  9. 9. How has our approach helpedto address the two keychallenges?1) keeping qualitative research relevant2) engaging and working with evolving/dissolving organisations
  10. 10. CHALLENGE 1keeping qualitative research relevant Working with a senior research team Engaging with policy and practice Identifying action
  11. 11. Senior team Conscious decision from the outset to: – Bring together senior team – With strong background in action research – Good knowledge/skills in support and facilitation – Expertise of research in/on commissioning – And experience of contextually aware frameworks Supported by dedicated project management Seek high level of funding Two years, transfer findings asap
  12. 12. Engaging policy and practiceEngage with Familiar with policy local contexts,environment people & prioritiesUnderstand policy Identify localdeliberations issues and contribute to Provide commiss’ingadvice andsupport on Share local reforms learning Study team as ‘boundary spanners’
  13. 13. Identifying ‘action’ On-going discussion and negotiation Action element negotiated with senior execs Much of the detail enacted with middle managers Balancing challenge and facilitation Enabling local ownership of initiatives/change
  14. 14. ...people like the idea of having us involvedbut of course then if we don’t then do whatthey want us to do or don’t agree with whatthey want to do or we’re suggesting there’sanother way of doing it or its not evidencebased...you know, that’s a challenge for usand for them, and particularly at a vulnerabletime when people are worried about their jobs Quote from member of the research team
  15. 15. CHALLENGE 2engaging and working withevolving/dissolving organisations Reorient sampling and data collection Dedicate time to relationship-building Develop a ‘Chinese Wall’
  16. 16. Reorient sampling/data collection Begin to engage with Continue to address emerging GP-led research aims commissioning consortia Regular review of Undertake ‘strategic ‘scope creep’ interviews’ Adapt methods Set up additional ‘tracking interviews’
  17. 17. Building relationships Time intensive Early recognition & extended engagement phases 2 of 3 lead contacts changed More time-consuming to organise events (e.g. workshops) Less embedded than planned Observations combined with more interviews Links with individuals rather than organisations
  18. 18. I do have a little worry about the actionacross the three sites that, if it’s all filteredthrough the PCT lead, we’re doing what thePCT think they want us to do which isn’tnecessarily what might be needed by thebroader commissioning community. Quote from member of the research team
  19. 19. Develop a ‘Chinese wall’Researchers Actioners Listener, observer, Planner, catalyser, synthesiser facilitator Facilitate action Enable action Provide periodic Facilitate dialogue reports Nurture ownership Facilitate relationship and local leaders building
  20. 20. Early conclusions The current programme of NHS reforms is impacting on the people and structures allied to commissioning Flexibility and adaptation are essential, more so than usual Action research approach enables engagement and support, as well as observation and analysis The link between policy and practice should help to convert the research conclusions into relevant policy recommendations
  21. 21. Five key questions1. What approaches work ‘best’ in building effective relationships at a time of rapid and intensive reform?2. How can we shift from engaging with individuals to engaging with ‘commissioning communities’?3. Flexibility and adaptability are fine in the face of rapid reform, but is the quid pro quo a lack of clarity?4. Is there scope for more challenge, even in sensitive times?5. Is this simply a ‘ticket of entry’ or will our action research approach lead to actionable policy recommendations?
  22. 22. E: sara.shaw@nuffieldtrust.org.ukT: +44 (0)20 7631 8450W: www.nuffieldtrust.org.uk