undertaking high quality and relevant qualitative research at a time of rapid healthcare reform
TRANSCRIPT
Undertaking high quality and relevant qualitative research
at a time of rapid healthcare reform
Sara E Shaw
Alison Porter, Judith Smith
Rebecca Rosen and Elizabeth Eastmure
The qualitative research
Explore the ways in which NHS commissioning can be enacted to assure high quality care for people living with long-term conditions
– Focus on the practice of commissioning
– Working with three ‘commissioning communities’
– Funded by NIHR Service Delivery & Organisation
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
Two key challenges
1) keeping qualitative
research relevant
2) engaging and
working with
evolving/dissolving
organisations
How has an action research
model enabled us to address
these challenges?
Our action research approach
In line with an action research approach, specific objectives within case studies will be negotiated with local stakeholders. We anticipate that these will focus on the research team assessing and supporting local commissioners at key stages in the 'cycle of commissioning’.
Quote from funding application
3 x
commissioning
communities
Impact and
outcomes
(inc quant)
Stakeholder
interviews
Observations
and documents
Social
network
analysis
1. Wirral
• Diabetes
• Dementia
2. Calderdale
• Diabetes
• Dementia
3. Somerset
• Diabetes
• Stroke
SA
MP
LIN
G A
ND
AC
TIO
NDA
TA
CO
LLE
CT
ION
TEAM INTERVIEWS AND REFLECTIONS
What does action approach involve
1. Engage with - and work alongside –each of the commissioning communities
2. Offer targeted support and advice
3. Balance research with action
� Co-organise workshops and negotiating project focus
� Feed in emerging findings
� Run ‘next steps’ events
� Facilitate stakeholder workshops (e.g. dementia services)
� Advise on e.g. service specifications/care pathways
� Act as ‘critical friend’ (e.g. on emerging information infrastructure)
� Support data analysis (e.g re service utilisation of new model of diabetes care)
How has our approach helped to address the two key challenges?
1) keeping qualitative research relevant
2) engaging and working with evolving/dissolving organisations
CHALLENGE 1keeping qualitative research relevant
� Working with a senior research team
� Engaging with policy and practice
� Identifying action
� 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
Senior team
Engaging policy and practice
Engage with
policy
environment
Understand
policy
deliberations
Provide
advice and
support on
reforms
Study team as ‘boundary spanners’
Familiar with
local contexts,
people &
priorities
Identify local
issues and
contribute to
commiss’ing
Share local
learning
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
...people like the idea of having us involved
but of course then if we don’t then do what
they want us to do or don’t agree with what
they want to do or we’re suggesting there’s
another way of doing it or its not evidence
based...you know, that’s a challenge for us
and for them, and particularly at a vulnerable
time when people are worried about their jobs
Quote from member of the research team
CHALLENGE 2engaging and working with evolving/dissolving organisations
� Reorient sampling and data collection
� Dedicate time to relationship-building
� Develop a ‘Chinese Wall’
Reorient sampling/data collection
� Begin to engage with emerging GP-led commissioning consortia
� Undertake ‘strategic interviews’
� Set up additional ‘tracking interviews’
� Continue to address research aims
� Regular review of ‘scope creep’
� Adapt methods
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
I do have a little worry about the action
across the three sites that, if it’s all filtered
through the PCT lead, we’re doing what the
PCT think they want us to do which isn’t
necessarily what might be needed by the
broader commissioning community.
Quote from member of the research team
Develop a ‘Chinese wall’
Researchers
� Listener, observer, synthesiser
� Facilitate action
� Provide periodic
reports
� Facilitate relationship
building
Actioners
� Planner, catalyser,
facilitator
� Enable action
� Facilitate dialogue
� Nurture ownership
and local leaders
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
Five key questions
1. 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?
