Explore the vast range of titles available.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12913-022-07797-7.

The Covid-19 pandemic has created an unprecedented challenge for health and social care systems globally. There is an urgent need for research on experiences of COVID-19 at different levels of health systems, including lessons from professional, organisational and local system responses, that can be used to inform managerial and policy responses. This paper presents the findings from a thematic analysis of front-line staff experiences working across the Norfolk and Waveney integrated care system (ICS) in the East of England during April and October 2020 to address the question \"What are the experiences and perceptions of partner organisations and practitioners at multiple levels of the health system in responding to COVID-19 during the first wave of the pandemic?\" This question was posed to learn from how practitioners, interdependent partner organisations and the system experienced the pandemic and responded. 176 interview transcripts derived from one to one and focus group interviews, meeting notes and feedback from a \"We Care Together\" Instagram campaign were submitted for qualitative thematic analysis to an external research team at a regional University commissioned to undertake an independent evaluation. Three phases of qualitative analysis were systematically undertaken to derive the findings. Thirty-one themes were distilled highlighting lessons learned from things that went well compared with those that did not; challenges compared with the celebrations and outcomes; learning and insights gained; impact on role; and system headlines. The analysis supported the ICS to inform and capitalise on system wide learning for integration, improvement and innovations in patient and care home resident safety, and staff wellbeing to deal with successive waves of the pandemic as well as prioritising workforce development priorities as part of its People Plan. The findings contribute to a growing body of knowledge about what impact the pandemic has had on health and social care systems and front-line practitioners globally. It is important to understand the impact at all three levels of the system (micro, meso and macro) as it is the meso and macro system levels that ultimately impact front line staff experiences and the ability to deliver person centered safe and effective care in any context. The paper presents implications for future workforce and health services policy, practice innovation and research.

IntroductionHigher staffing levels, particularly with experienced registered nurses, are associated with improved patient safety and fewer adverse events, as skilled nurses can quickly identify potential risks and implement strategies to mitigate them, creating a safer environment for patients. This study will investigate the effectiveness and impact of implementing therapeutic optimisation (THEO) intervention, a complex intervention aimed at enhancing nursing care by increasing experienced registered nurse staffing and facilitating practice development (PD) activities for all staff.Methods and analysisA multicentre quasi-experimental (before and after) study with an embedded convergent mixed methods process evaluation in older persons’ wards across two National Health Service (NHS) Trusts in England. Four work packages are proposed. Work Package 1 will use participatory action research to implement the THEO intervention, including an enhanced staffing model and PD activities, involving seven iterative participatory data collection exercises with staff, patients and their personal consultees, as appropriate. Work Package 2 will extract and aggregate anonymised administrative data (patient and staff related) from 1 January 2015 to 30 days after the 12-month intervention period. Work Package 3 will use qualitative interviews to explore the experiences of patients with and without mental capacity (with their personal consultees) and staff regarding the THEO intervention. Work Package 4 is a mixed methods process evaluation to assess implementation and contextual factors impacting the effectiveness of the THEO intervention, collecting both quantitative (survey) and qualitative (guided discussions and workshops) data.Ethics and disseminationThe UK Health Research Authority provided governance and ethical approval (Integrated Research Application System, IRAS ID: 334473). Dissemination will be with key stakeholders (including patient and public representatives), conference presentations and publications in peer-reviewed high-impact journals.

Background Court Mental Health Liaison and Diversion Services (CMHLDS) have developed in some countries as a response to the over-representation of mental illness and other vulnerabilities amongst defendants presenting to criminal justice (or correctional) systems. This study examined the characteristics and rates of mental disorder of 9088 defendants referred to CMHLDS. Method The study analysed service level data, obtained from the National Health Service’s mental health data set, to examine characteristics relating to gender, ethnicity and comorbidity of common mental and neurodevelopmental disorders at five CMHLDS across London between September 2015 and April 2017. Results The sample included 7186 males (79.1%) and 1719 females (18.9%), the gender of 183 (2%) were not recorded. Of those referred, 6616 (72.8%) presented with an identifiable mental disorder and 503 (5.5%) with a neurodevelopmental disorder (NDD). Significantly higher rates of schizophrenia were reported amongst Black defendants ( n  = 681; 37.2%) and Asian defendants ( n  = 315; 29%), while higher rates of depression were found amongst White defendants ( n  = 1007; 22.1%). Substance misuse was reported amongst 2813 defendants (31%), and alcohol misuse amongst 2111 (23.2%), with significantly high rates of substance and alcohol misuse amongst defendants presenting with schizophrenia or personality disorder. Conclusions This is one of the largest studies to examine mental health needs and vulnerabilities amongst defendants presenting to CMHLDS. It will enable an improved understanding of the required service designs and resources required to manage the healthcare pathways for people attending CMHLDS.

Background: The World Health Organisation’s Global Strategy on Human Resources for Health: Workforce 2030 sets out how vital the healthcare workforce is to the resilience of communities and health systems. Nurses are the largest professional group in that workforce and therefore support for nurses’ practice roles and wellbeing is pivotal to sustaining the global health economy. Nurses with extensive experience can contribute significantly in this respect, and the notion of the legacy practitioner role arose in response to the need to retain the expertise of long-serving nurses. Aim: The aim of the pilot project evaluation was to gather impact evidence of a newly introduced legacy practitioner role, as a workforce planning strategy for retaining the expertise of professionals considering or close to retirement. Design: A mixed-methods case study evaluation was used to capture stakeholder-driven process and outcome data. Emphasis was placed on interacting with project participants and stakeholders with a view to understanding human interconnectedness in the context of sustainable learning and quality-driven improvements at system level. Data analysis used first-order thematic analysis to capture process indicators, followed by a second-order impact framework analysis of workforce and system-level transformation to capture potential sustainable outcome indicators. Conclusion: Evidence identified six core aspects of the legacy role, with one outcome indicator related to reducing attrition in the workplace. Two overarching themes – enhancing practice skills and knowledge exchange – considered the impact of the role, not only with existing healthcare staff but in ‘feeding forward’ practice expertise to the potential future workforce. Implications for practice: Evidence suggests the legacy role can enable knowledge and skill enhancement, and help stressed or anxious staff and learners overcome thoughts and intentions to leave The role provides clinically credible, practice-driven expertise, helping create the conditions for safe and effective person-centred practice Legacy roles can inspire a professional expertise, based on values of compassion and respect that are spread and sustained among new staff External stakeholders who engage with legacy practitioners can also experience positive outcomes

The THErapeutic Optimisation (THEO) project developed by the NICHE Anchor Institute at the University of East Anglia, is a novel and complex intervention research study aimed at optimising the patients’ experience of care. THEO is providing an uplift of two registered nurses working as embedded researchers, combined with a process of participatory action research (PAR) The THEO intervention is partly influenced by evidence that  showed that higher nurse staffing levels were associated with better patient outcomes, shorter length of stay and less frequent nurse burnout or job dissatisfaction. The participatory action research (PAR) intervention uses an emancipatory, systematic and rigorous process philosophy; which will involve recruiting core volunteer co-researchers from the existing ward nursing team as bringing expertise in this innovation. In addition, participation will be sought from the wider team and patients/ service users through methods such as observation of care and sharing experiences of care. Wrapped around the implementation of PAR are three other research elements; i) quantitative data (eg Length of Stay), ii) qualitative and iii) process evaluation being led by an external collaborating research partner. Practice development (PD) methods will also be used within the PAR framework, as a facilitated intervention to achieve a participatory approach to inquiry, engaging with staff and patients, within two NHS clinical wards. The co-research team which will comprise of the new embedded researchers and the volunteer co- researchers will have time and space to work in collaboration, to “look” (i.e., gather evidence about a situation or context), “think” (i.e., reflect together to critically analyse the evidence), then “act” (i.e., develop a shared action plan, from which to take informed action).  This process will generate both knowledge and agreed action from which to improve the experience and care for both the ward staff and the people who receive care on the ward. The intervention phase of THEO is anticipated to commence in Feb/ March 2025. This paper will be sharing the THEO intervention participatory approach and PD methods that are planned and being implemented.  It will also highlight how facilitated practice development offers the chance for health care teams to learn together, hear the voices of patients and shape and innovate their care delivery approach to improve the care experience for all. Participatory approaches to research moves away from the traditional stance of “studying a subject and making a judgement about that subject” and involves a collaborative, participatory and inclusive approach where all involved are partners in both the research and resulting actions and outcomes. This approach is very rewarding and often time consuming in building relationships and partnerships, which is why some avoid this approach in favour of the more traditional approach. However, we will argue that pursuing a participatory approach will result in the ripple effect of ownership and sustainable action for staff and enable patients voices to be heard. This presentation will an opportunity to reflect on the lessons learnt so far in this collaborative and participatory research study between 3 different universities and two NHS sites.    

Background: The Norfolk Initiative for Coastal and Rural Health Equalities (NICHE) is one of six ‘Anchor Institutes’ , funded by NHS England (East of England). Based at the University of East Anglia, NICHE aims to co-create a healthy place to live and work, underpinned by collaborative and innovative approaches to building embedded research, improvement and innovation capacity whilst  maximising sustainable initiatives for the Integrated Care System (ICS). Approach: NICHE is working across an ICS made-up of three ‘Place’ localities with a geography of coastal and rural communities. We aim through embedded, participatory approaches to engage people and communities, coproducing meaningful outcomes relevant to local, national and international contexts. NICHE’s approach draws upon key principles of Collaboration, Inclusion and active Participation (CIP). Our embedded funded programmes of learning, research and evaluation offer significant opportunities for ICS development. NICHE core objectives are to: 1: Improve health inequalities across rural and coastal communities 2: Achieve workforce development and sustainable transformation 3: Enhance system collaboration and transformation through effective partnership working 4: Improve wellbeing and sustainable outcomes These objectives are mapped to our four workstreams which are: 1: Workforce Intelligence Network (WIN) 2: Therapeutic Optimisation (THEO) 3: Workforce Optimisation 4: Evaluation This presentation will focus on Workstream 3 (Workforce Optimisation) that is based within ‘Place’. We will present the programmes of embedded research, evaluation and learning activity that is impacting on the development of the ICS across the three Place based localities in Norfolk by drawing on the ‘voices’ of participant through embedded learning. Examples will be drawn from: Embedded NICHE Fellowships stretching across the lifespan of ageing ‘Kintsugi’ and ‘Mini Kintsugi’ Embedded Research and Programme Evaluations   Results and Emerging Themes: Evaluation of NICHE work is underway and will be fully reported towards the end of 2025. Within the first 18 months of Place funded embedded projects across the Norfolk and Waveney ICS the following themes are emerging: a) Working with and through system complexity, by navigating changing, new and emergent ICS landscapes and structures. b) Embedded Transformation requires new approaches to authentic collaboration and joint working. c) Creative arts engagement, heritage and inclusion of historical aspects are all important and often overlooked assets when working in rural, coastal and isolated communities. d) Co-produced, embedded programmes of work, enhances talent release and promotes local expertise which are highly effective strategies for cultural ICS transformation. e) Cultural transformation cannot be rushed as new language, partnerships and interactions are formed. When based on the principles of CIP these can be built, based on trust, commitment and release of energy required to engage and sustain embedded transformation across complex, changing ICS’s. f) Shared Values and beliefs are key to authentic relationships based on the key principles of reciprocity, shared power, trust and learning. Implications: Whilst global health and social care challenges consist of similar themes across different countries, when working with coastal, rural and isolated communities it is imperative to engage local ICS partners, to curate cultural contextual wisdom across ‘Place’ with communities and people.  

Norfolk Initiative for Coastal and Rural Health Equalities (NICHE) is an ‘Anchor Institute’, at the University of East Anglia, which aims to co-create a healthy place to live and work, underpinned by collaborative and innovative approach to research, education, and evaluation, maximising sustainable initiatives for Integrated Care System (ICS) workforce and system level transformation. National strategic direction for health and social care aims to develop an integrated whole systems approach to position people and communities and what matters to them at the heart of care providing services that are person and people centred, compassionate, safe, and effective using targeted resources (including the workforce) effectively across place-based systems (NHS 2016,2019a/b, 2020). There is an urgent need to draw on the strengths of the whole workforce and the full potential of our communities to contribute to people working together effectively to achieve a common purpose, as well as focussing on what matters to people and communities and how it is evaluated through co-production and leadership (Best et al; 2012; Stromgren et al; 2017). NICHE works across a geography of coastal, rural and isolated communities, seeking to engage and co-create embedded activity for those who live and work across our locality, coproducing outcomes relevant to local, national and international communities. Central to our shared governance approach is effectively engaging with patients, people and partners across health and social care. NICHE is a co-ordinated approach to embedded programmes of activity working in collaboration with system partners across the Norfolk and Waveney ICS aimed at delivering maximum, sustainable impact for workforce and system transformation focused around four core work streams of activity. Evaluation is integral to all our work, capturing what works, for whom and how through mixed and creative methodologies. NICHE draws upon  key principles of Collaboration, Inclusion and Participation. Through working alongside and with communities, government, and industry partners, our programmes and funded research and evaluation activity offers improvements to the economic, health and social sustainability agendas, all of which form part of our Anchor Institute status. Our programmes are  in their early phases of development, the following aspects are emerging: a)Caring for the workforce, through addressing their wellbeing is a central aspect of health and social care workforce sustainability b)Health and care system requires new and flexible roles, and the importance of 'live' effective supervision plays a significant role in retaining staff across the ICS. c)Creative arts engagement, heritage sites and inclusion of historical aspects of the locality context are important and often overlooked assets when working in rural, coastal and isolated communities. d)Coproduced, embedded packages as bespoke programmes of work, facilitated effectively to enhance and release talent and promote local expertise are highly effective strategies for cultural transformation across coastal and rural communities. e)Cultural transformation cannot be rushed as new language, partnerships and interactions are formed. When working with coastal, rural and isolated communities it is imperative to engage local partners, to ascertain cultural contextual wisdom to initiate and sustain change for good.

Revealing Nursing Expertise Through Practitioner Inquiry explores and reveals the often hidden workings of ‘expert practitioners’. It provides valuable insights into developing practice expertise and how expert nursing practice is a key influence on health care practice. The authors present evidence around the interconnected components needed to facilitate, support and enable nurses in their practice settings through a transformational framework used to further develop and refine nursing practice expertise. Part 1 explores the current context of practice expertise and the process of practitioner inquiry.  Part 2 examinplores the evidence for practice expertise, using exemplars from the extensive ‘Expertise in Practice Project’. This includes perspectives of practitioners developing their expertise in diverse areas of clinical practice as well as of from those who facilitate practitioners to develop and articulate their practice expertise. Part 3 explores the development of portfolios of evidence that demonstrate expertise, examines models and approaches to facilitation and provides a toolkit of resources. Revealing Nursing Expertise Through Practitioner Inquiry provides important evidence to support the claim that expert nurses change patients’ worlds as well as transforming practice, workplace performance and organisational wide service developments. Provides a framework for exploring and developing nursing expertise Enables nurses to articulate their expertise and examine their own practice Offers practical guidance on facilitating inquiry based practitioners Draws on results of the RCN Expertise in Practice project Written collaboratively by practitioners, practice developers and nurse academics

This paper outlines the process of new forms of collaboration, associated with integrated care systems introduced in England in 2022. Lessons learned from a novel approach to anchor institutes, being positioned in higher education institutions, to form distinctive partnerships across local, national, regional and international collaborators forms the basis of impact evidence reported here as 'ripples in the pond'. Using critical social science, participatory approaches and collaborative inquiry has been useful theoretical and pragmatic methodologies, from which to explore 'true' collaboration. Our findings suggest that facilitating effective partnerships, across complex systems is a dynamic process that brings tensions, challenges and opportunities. We outline examples of each, and argue how infinite change and structural inequalities can impeded innovation uptake, whilst creative methodologies blended with critical social science have forged new alliances, that are shaping the future of health and social care systems and architecture. Implications arising from our work to date identify the need for closer alliances and collaborative arrangements are still needed, to encourage embeddedness, where innovation update can be scaled with sensitivity, suitable for the communities they serve. Importantly, the workforce plays a significant core role in transformation, as both knowledge wealth creators, but also as knowledge wealth mobilisers. Influencing and shaping service models, fit for purpose, within the contexts within which people live and work together. For successful sustainable change to cascade further, the workforce remain central to any transformative process to be reimagined.  We  conclude with a horizon scan as to what and how improved population outcomes can be realised, in the face of climate change and manmade disasters looming ahead.