Abstract This article discusses ‘special observation’, a practice used in inpatient units and in ... more Abstract This article discusses ‘special observation’, a practice used in inpatient units and in mental health and learning disability services. I present some perspectives on this practice from women detained on locked wards, and staff members. Despite the many valid criticisms, I show that constant observations can be used as a way to harness engagement and to improve relationships between staff and residents.
In the period since multi-agency working became the dominant approach to tackling domestic abuse,... more In the period since multi-agency working became the dominant approach to tackling domestic abuse, there has been ongoing development and innovation. However, little is known about what tends to enhance or inhibit the roll-out of such initiatives. This article examines the process of building an enhanced flagship multi-agency model for policing domestic abuse. We report on results from semi-structured interviews, observations of meetings and an online survey with stakeholders who were involved in the development of the principles underlying a new multi-agency risk assessment conference (MARAC) process. The participants representatives from policing, third sector, health, and probation organisation-described positive benefits of the process, whilst challenges coalesced around the focus on and engagement of perpetrators, and the problem of assessing the dynamics of risk.
Purpose
Finding a balance between the provision of quality individualized care and the ongoing ed... more Purpose Finding a balance between the provision of quality individualized care and the ongoing education of junior doctors had been flagged as a concern at a large National Health Service (NHS) teaching hospital in the north of England. In response to this, the organization introduced an intervention designed to improve educational culture by providing support to educators, leaders and clinical staff.
Design/methodology/approach This paper features themed results from eight in-depth interviews with educators, consultants and junior doctors to describe and evaluate the process and impact.
Findings Factors that contributed to a positive educational environment included trainees and educators feeling valued, the presence of supportive leaders and the provision of a safe space for learning. Perceived barriers included time constraints, differing motivation and the generic format of formal education. Participants reflected on how the Wrap Around project helped improve the workplace educational culture and offered suggestions for further improvement including the provision of ongoing feedback to learners about their performance.
Originality/value Research aimed at recognizing and resolving the perceived tensions between the priorities of education and health-care delivery has been flagged as a gap in the literature. The authors argue that developing and enhancing collaborative leadership and educational culture within an organization can reduce these tensions for those working on the front line. Future work should focus on addressing the perceived distinction between the two within services.
Journal of Medical Education and Curricular Development, 2020
Background: The delivery of patient care in the United Kingdom is under increasing financial pres... more Background: The delivery of patient care in the United Kingdom is under increasing financial pressure. The need to continuously improve service delivery while making financial savings is challenging. Alongside this, National Health Service (NHS) Trusts must provide a suitable educational environment that meets the needs of all learners while meeting performance standards and targets set by external regulating authorities. This research addresses the gap in literature concerning educational culture in the NHS. Methods: This case study examines the delivery of postgraduate medical education in the workplace. Semi-structured interviews were conducted with 6 lead educators in the Medical Division of a North West NHS Trust to glean their insights into what works and what needs to change. Results: A thematic analysis of the transcripts revealed a number of factors that facilitated and hindered educational opportunities for doctors in training, including the role of leadership, the demands of external regulatory authorities, and the pressures on frontline staff to deliver safe, personal, and effective care. Conclusion: Opportunities for developing a collaborative approach between educational and clinical leaders and the individuals delivering education in the workplace to enhance the educational environment are discussed. Finally, an evaluatory toolkit based on the themes emerging from the data is proposed, as a resource for other health care organisations to help improve the delivery of workplace-based medical education.
Background: Despite repeated policy initiatives an enduring number of people with learning disabi... more Background: Despite repeated policy initiatives an enduring number of people with learning disabilities remain resident in secure settings (also referred to as locked wards). The distance, geographic and emotional, from family and friends when resident in these settings makes relationships with staff central to people’s lives and a critical factor in residents’ ability to be in a successfully transition or ‘move on’ to make their home in the community. Materials and Methods This article uses a synthesis of evidence from two qualitative studies. Data from field notes and transcripts of interviews with people with learning disabilities resident in secure settings and with staff who worked with them were analysed. The purpose of the original studies was service improvement, however relationships, particularly with between staff and residents emerged as a significant theme in both studies. Therefore, the data was revisited to explore these relationships in more depth and comparatively between both studies. Results and Discussion The analysis identified that positive relationships with staff was critical in enabling residents to be ‘being in a good space’, something they and staff viewed as a crucial factor for moving to less secure hospital settings and ultimately being at home in the community. The analysis identified four main themes: (i) the characteristics of positive relationships. (ii) the challenges for positive relationships, (iii) how positive relationships can be encouraged and (iv) how they support people to move on. Conclusion: We conclude that flattening the hierarchy between staff and residents is key when supporting people with learning disabilities to move back into the community. There is a pressing need for research with people who have made the transition from hospital to generate retrospective narratives about what elements of these relationships are most significant in supporting a successful transition to life in the community.
All behaviours occur within a relational and circumstantial context (Milton, Mills, and Jones 201... more All behaviours occur within a relational and circumstantial context (Milton, Mills, and Jones 2016), and from time to time everyone behaves in ways that are difficult to understand and respond to. This book is described as ‘an honest framework for supporting people’ (9) to be used as a guide by anyone working with or caring for people who can become distressed and overwhelmed. Andrew McDonnell tells us that he named the book The Reflective Journey because it is ‘so important to be aware of our own behaviour in order to truly support people in crisis’ (9). In the 24 years I have been working as a researcher alongside people with learning disabilities and/or autism, I have heard many tropes about ‘challenging behaviour’, as well as individualising ways of referring to people and their ‘management’. I know that ‘challenging behaviour’ can be reduced even eliminated by recognising the contextual requirements of the person and making accommodations for them, so I welcome the principles f...
Purpose Finding a balance between the provision of quality individualized care and the ongoing ed... more Purpose Finding a balance between the provision of quality individualized care and the ongoing education of junior doctors had been flagged as a concern at a large National Health Service (NHS) teaching hospital in the north of England. In response to this, the organization introduced an intervention designed to improve educational culture by providing support to educators, leaders and clinical staff. Design/methodology/approach This paper features themed results from eight in-depth interviews with educators, consultants and junior doctors to describe and evaluate the process and impact. Findings Factors that contributed to a positive educational environment included trainees and educators feeling valued, the presence of supportive leaders and the provision of a safe space for learning. Perceived barriers included time constraints, differing motivation and the generic format of formal education. Participants reflected on how the Wrap Around project helped improve the workplace educa...
Abstract This article discusses ‘special observation’, a practice used in inpatient units and in ... more Abstract This article discusses ‘special observation’, a practice used in inpatient units and in mental health and learning disability services. I present some perspectives on this practice from women detained on locked wards, and staff members. Despite the many valid criticisms, I show that constant observations can be used as a way to harness engagement and to improve relationships between staff and residents.
In the period since multi-agency working became the dominant approach to tackling domestic abuse,... more In the period since multi-agency working became the dominant approach to tackling domestic abuse, there has been ongoing development and innovation. However, little is known about what tends to enhance or inhibit the roll-out of such initiatives. This article examines the process of building an enhanced flagship multi-agency model for policing domestic abuse. We report on results from semi-structured interviews, observations of meetings and an online survey with stakeholders who were involved in the development of the principles underlying a new multi-agency risk assessment conference (MARAC) process. The participants representatives from policing, third sector, health, and probation organisation-described positive benefits of the process, whilst challenges coalesced around the focus on and engagement of perpetrators, and the problem of assessing the dynamics of risk.
Purpose
Finding a balance between the provision of quality individualized care and the ongoing ed... more Purpose Finding a balance between the provision of quality individualized care and the ongoing education of junior doctors had been flagged as a concern at a large National Health Service (NHS) teaching hospital in the north of England. In response to this, the organization introduced an intervention designed to improve educational culture by providing support to educators, leaders and clinical staff.
Design/methodology/approach This paper features themed results from eight in-depth interviews with educators, consultants and junior doctors to describe and evaluate the process and impact.
Findings Factors that contributed to a positive educational environment included trainees and educators feeling valued, the presence of supportive leaders and the provision of a safe space for learning. Perceived barriers included time constraints, differing motivation and the generic format of formal education. Participants reflected on how the Wrap Around project helped improve the workplace educational culture and offered suggestions for further improvement including the provision of ongoing feedback to learners about their performance.
Originality/value Research aimed at recognizing and resolving the perceived tensions between the priorities of education and health-care delivery has been flagged as a gap in the literature. The authors argue that developing and enhancing collaborative leadership and educational culture within an organization can reduce these tensions for those working on the front line. Future work should focus on addressing the perceived distinction between the two within services.
Journal of Medical Education and Curricular Development, 2020
Background: The delivery of patient care in the United Kingdom is under increasing financial pres... more Background: The delivery of patient care in the United Kingdom is under increasing financial pressure. The need to continuously improve service delivery while making financial savings is challenging. Alongside this, National Health Service (NHS) Trusts must provide a suitable educational environment that meets the needs of all learners while meeting performance standards and targets set by external regulating authorities. This research addresses the gap in literature concerning educational culture in the NHS. Methods: This case study examines the delivery of postgraduate medical education in the workplace. Semi-structured interviews were conducted with 6 lead educators in the Medical Division of a North West NHS Trust to glean their insights into what works and what needs to change. Results: A thematic analysis of the transcripts revealed a number of factors that facilitated and hindered educational opportunities for doctors in training, including the role of leadership, the demands of external regulatory authorities, and the pressures on frontline staff to deliver safe, personal, and effective care. Conclusion: Opportunities for developing a collaborative approach between educational and clinical leaders and the individuals delivering education in the workplace to enhance the educational environment are discussed. Finally, an evaluatory toolkit based on the themes emerging from the data is proposed, as a resource for other health care organisations to help improve the delivery of workplace-based medical education.
Background: Despite repeated policy initiatives an enduring number of people with learning disabi... more Background: Despite repeated policy initiatives an enduring number of people with learning disabilities remain resident in secure settings (also referred to as locked wards). The distance, geographic and emotional, from family and friends when resident in these settings makes relationships with staff central to people’s lives and a critical factor in residents’ ability to be in a successfully transition or ‘move on’ to make their home in the community. Materials and Methods This article uses a synthesis of evidence from two qualitative studies. Data from field notes and transcripts of interviews with people with learning disabilities resident in secure settings and with staff who worked with them were analysed. The purpose of the original studies was service improvement, however relationships, particularly with between staff and residents emerged as a significant theme in both studies. Therefore, the data was revisited to explore these relationships in more depth and comparatively between both studies. Results and Discussion The analysis identified that positive relationships with staff was critical in enabling residents to be ‘being in a good space’, something they and staff viewed as a crucial factor for moving to less secure hospital settings and ultimately being at home in the community. The analysis identified four main themes: (i) the characteristics of positive relationships. (ii) the challenges for positive relationships, (iii) how positive relationships can be encouraged and (iv) how they support people to move on. Conclusion: We conclude that flattening the hierarchy between staff and residents is key when supporting people with learning disabilities to move back into the community. There is a pressing need for research with people who have made the transition from hospital to generate retrospective narratives about what elements of these relationships are most significant in supporting a successful transition to life in the community.
All behaviours occur within a relational and circumstantial context (Milton, Mills, and Jones 201... more All behaviours occur within a relational and circumstantial context (Milton, Mills, and Jones 2016), and from time to time everyone behaves in ways that are difficult to understand and respond to. This book is described as ‘an honest framework for supporting people’ (9) to be used as a guide by anyone working with or caring for people who can become distressed and overwhelmed. Andrew McDonnell tells us that he named the book The Reflective Journey because it is ‘so important to be aware of our own behaviour in order to truly support people in crisis’ (9). In the 24 years I have been working as a researcher alongside people with learning disabilities and/or autism, I have heard many tropes about ‘challenging behaviour’, as well as individualising ways of referring to people and their ‘management’. I know that ‘challenging behaviour’ can be reduced even eliminated by recognising the contextual requirements of the person and making accommodations for them, so I welcome the principles f...
Purpose Finding a balance between the provision of quality individualized care and the ongoing ed... more Purpose Finding a balance between the provision of quality individualized care and the ongoing education of junior doctors had been flagged as a concern at a large National Health Service (NHS) teaching hospital in the north of England. In response to this, the organization introduced an intervention designed to improve educational culture by providing support to educators, leaders and clinical staff. Design/methodology/approach This paper features themed results from eight in-depth interviews with educators, consultants and junior doctors to describe and evaluate the process and impact. Findings Factors that contributed to a positive educational environment included trainees and educators feeling valued, the presence of supportive leaders and the provision of a safe space for learning. Perceived barriers included time constraints, differing motivation and the generic format of formal education. Participants reflected on how the Wrap Around project helped improve the workplace educa...
This was a User-Led Project by Vision Sense (PI Susie Balderston) with
Centre for Disability Res... more This was a User-Led Project by Vision Sense (PI Susie Balderston) with Centre for Disability Research (CeDR) Lancaster University and Against Violence & Abuse (AVA). Funded by Big Lottery Fund through DRILL (Disability Research on Independent Living and Learning) Fast Track.
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Papers by Rebecca Fish
Finding a balance between the provision of quality individualized care and the ongoing education of junior doctors had been flagged as a concern at a large National Health Service (NHS) teaching hospital in the north of England. In response to this, the organization introduced an intervention designed to improve educational culture by providing support to educators, leaders and clinical staff.
Design/methodology/approach
This paper features themed results from eight in-depth interviews with educators, consultants and junior doctors to describe and evaluate the process and impact.
Findings
Factors that contributed to a positive educational environment included trainees and educators feeling valued, the presence of supportive leaders and the provision of a safe space for learning. Perceived barriers included time constraints, differing motivation and the generic format of formal education. Participants reflected on how the Wrap Around project helped improve the workplace educational culture and offered suggestions for further improvement including the provision of ongoing feedback to learners about their performance.
Originality/value
Research aimed at recognizing and resolving the perceived tensions between the priorities of education and health-care delivery has been flagged as a gap in the literature. The authors argue that developing and enhancing collaborative leadership and educational culture within an organization can reduce these tensions for those working on the front line. Future work should focus on addressing the perceived distinction between the two within services.
improve service delivery while making financial savings is challenging. Alongside this, National Health Service (NHS) Trusts must provide a
suitable educational environment that meets the needs of all learners while meeting performance standards and targets set by external regulating authorities. This research addresses the gap in literature concerning educational culture in the NHS.
Methods: This case study examines the delivery of postgraduate medical education in the workplace. Semi-structured interviews were
conducted with 6 lead educators in the Medical Division of a North West NHS Trust to glean their insights into what works and what needs
to change.
Results: A thematic analysis of the transcripts revealed a number of factors that facilitated and hindered educational opportunities for
doctors in training, including the role of leadership, the demands of external regulatory authorities, and the pressures on frontline staff to
deliver safe, personal, and effective care.
Conclusion: Opportunities for developing a collaborative approach between educational and clinical leaders and the individuals delivering education in the workplace to enhance the educational environment are discussed. Finally, an evaluatory toolkit based on the themes
emerging from the data is proposed, as a resource for other health care organisations to help improve the delivery of workplace-based
medical education.
Finding a balance between the provision of quality individualized care and the ongoing education of junior doctors had been flagged as a concern at a large National Health Service (NHS) teaching hospital in the north of England. In response to this, the organization introduced an intervention designed to improve educational culture by providing support to educators, leaders and clinical staff.
Design/methodology/approach
This paper features themed results from eight in-depth interviews with educators, consultants and junior doctors to describe and evaluate the process and impact.
Findings
Factors that contributed to a positive educational environment included trainees and educators feeling valued, the presence of supportive leaders and the provision of a safe space for learning. Perceived barriers included time constraints, differing motivation and the generic format of formal education. Participants reflected on how the Wrap Around project helped improve the workplace educational culture and offered suggestions for further improvement including the provision of ongoing feedback to learners about their performance.
Originality/value
Research aimed at recognizing and resolving the perceived tensions between the priorities of education and health-care delivery has been flagged as a gap in the literature. The authors argue that developing and enhancing collaborative leadership and educational culture within an organization can reduce these tensions for those working on the front line. Future work should focus on addressing the perceived distinction between the two within services.
improve service delivery while making financial savings is challenging. Alongside this, National Health Service (NHS) Trusts must provide a
suitable educational environment that meets the needs of all learners while meeting performance standards and targets set by external regulating authorities. This research addresses the gap in literature concerning educational culture in the NHS.
Methods: This case study examines the delivery of postgraduate medical education in the workplace. Semi-structured interviews were
conducted with 6 lead educators in the Medical Division of a North West NHS Trust to glean their insights into what works and what needs
to change.
Results: A thematic analysis of the transcripts revealed a number of factors that facilitated and hindered educational opportunities for
doctors in training, including the role of leadership, the demands of external regulatory authorities, and the pressures on frontline staff to
deliver safe, personal, and effective care.
Conclusion: Opportunities for developing a collaborative approach between educational and clinical leaders and the individuals delivering education in the workplace to enhance the educational environment are discussed. Finally, an evaluatory toolkit based on the themes
emerging from the data is proposed, as a resource for other health care organisations to help improve the delivery of workplace-based
medical education.
Centre for Disability Research (CeDR) Lancaster University
and Against Violence & Abuse (AVA).
Funded by Big Lottery Fund through DRILL (Disability Research on
Independent Living and Learning) Fast Track.