Roger Beech, Bie Nio Ong, Sue Jones and Vicky Edwards
This paper is an evaluated case study of the Wellbeing Coordinator (WBC) service in Cheshire, UK. WBCs are non-clinical members of the GP surgery or hospital team who offer advice…
Abstract
Purpose
This paper is an evaluated case study of the Wellbeing Coordinator (WBC) service in Cheshire, UK. WBCs are non-clinical members of the GP surgery or hospital team who offer advice and support to help people with long-term conditions and unmet social needs remain independent at home. The paper aims to discuss this issue.
Design/methodology/approach
A mixed method design assessed the outcomes of care for recipients and carers using interviews, diaries and validated wellbeing measures. Service utilization data, interviews and observations of WBC consultations enabled investigation of changes in processes of care. Data were analysed using simple descriptive statistics, established instrument scoring systems and accepted social science conventions.
Findings
The WBC complements medical approaches to supporting people with complex health and social care problems, with support for carers often a key service component. Users reported improvements in their wellbeing, access to social networks, and maintenance of social identity and valued activities. Health and social care professionals recognized the value of the service.
Practical implications
The WBC concept relieves the burden on health and social care professionals as the social elements of ill-health are addressed. A shift in thinking from ill-health to wellbeing means older people feel more able to regain control over their own lives, being less dependent on consulting professionals.
Originality/value
The WBC is a new service focussing on the individual in their health, social and economic context. Process and outcomes evaluations are rare in this field.
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Bie Nio Ong, Margaret Boaden and Steve Cropper
The impact of the NHS reforms, and the resulting purchaser‐provider split, has refocused attention on the relationship between management and medicine in acute hospitals. It is…
Abstract
The impact of the NHS reforms, and the resulting purchaser‐provider split, has refocused attention on the relationship between management and medicine in acute hospitals. It is timely to assess the explanatory power of various theoretical models regarding the management‐medicine interface. Argues that this interface is currently rather fluid and that a dynamic and adaptive model is best suited to understanding the way in which doctors and managers develop their relationship within the changing policy context. Two examples illustrate these shifting boundaries.
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Andrew Morden, Lauren Brooks, Clare Jinks, Mark Porcheret, Bie Nio Ong and Krysia Dziedzic
Intervention evaluations have not always accounted for long-term implementation of interventions. The purpose of this paper is to explore implementation of a primary care…
Abstract
Purpose
Intervention evaluations have not always accounted for long-term implementation of interventions. The purpose of this paper is to explore implementation of a primary care intervention during the lifespan of the trial and beyond.
Design/methodology/approach
Eight general practices participated in the trial (four control and four intervention). In-depth interviews (with nine GPs and four practices nurses who delivered the intervention) and observation methods were employed. Thematic analysis was utilized and Normalization Process Theory (NPT) constructs were compared with emergent themes.
Findings
Macro-level policy imperatives shaped practice priorities which resulted in the “whole system” new intervention not being perceived to be sustainable. Continued routinization of the intervention into usual care beyond the lifespan of the funded study was dependent on individualized monitoring and taking forward tacit knowledge.
Research limitations/implications
The authors discuss the implications of these findings for sociological theories of implementation and understanding outcomes of research led complex interventions.
Originality/value
The study describes the complex interplay between macro processes and individual situated practices and contributes to understanding if, how, and why interventions are sustained beyond initial “research push”. The value of the study lies in describing the conditions and potential consequences of long-term implementation, which might be translated to other contexts.
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The role of doctors in hospitals continues to change due to both external (policy) and internal (organisational change) pressures. Comparisons between The Netherlands and the UK…
Abstract
The role of doctors in hospitals continues to change due to both external (policy) and internal (organisational change) pressures. Comparisons between The Netherlands and the UK highlight that several models of medical management are formulated and exist alongside each other, leading to more flexibility in the roles of both doctors and managers. In particular, the agendas concerning the quality of clinical care and cost‐effectiveness are converging, emphasising the increasingly important role of medical managers.
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Tom Sanders, Bie Nio Ong, Gail Sowden and Nadine Foster
The purpose of this paper is to report findings from qualitative interviews with physiotherapists to demonstrate why even minor changes to clinical work resulting from the…
Abstract
Purpose
The purpose of this paper is to report findings from qualitative interviews with physiotherapists to demonstrate why even minor changes to clinical work resulting from the introduction of new interventions, are often difficult to implement. The paper seeks to illustrate how some of the obstacles to implementing change were managed by physiotherapists.
Design/methodology/approach
A total of 32 qualitative interviews with participating physiotherapists were conducted, 12 interviews prior to the introduction of the new system, and 20 afterwards. The interviews were coded and analysed thematically.
Findings
The findings reveal a number of perceived limitations of current management of low back pain and identify key themes around convergence with the new approach, such as willingness by physiotherapists to adopt the new approach, the perception of benefits to adopting the new approach, as well as some difficulty in adjusting to it. The authors refer to the positive and negative elements as “soft” and “hard” disruption. The adoption of the new approach is explored with reference to the “situated” dimensions of physiotherapy practice and normalisation process theory.
Research limitations/implications
The study raises the need to conduct future observational research to support the interview findings.
Originality/value
The study describes the “situated” components of physiotherapy work, which have received limited research attention. The value of the study lies less in its ability to explain specifically why physiotherapists adopted or rejected the new system, but in describing the conditions and consequences of change that might be translated to other professions, contexts and interventions.