1 / 22

Clinical leadership strategies used to implement large-scale service change in NHS England

Clinical leadership strategies used to implement large-scale service change in NHS England. Olivia Hartrick. Systematic review methodologies.

compton
Télécharger la présentation

Clinical leadership strategies used to implement large-scale service change in NHS England

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Clinical leadership strategies used to implement large-scale service change in NHS England Olivia Hartrick

  2. Systematic review methodologies • Systematic reviews aim to provide a comprehensive, unbiased synthesis of many relevant studies in a single document using rigorous and transparent methods. • Loads of options. JBI reviewer manual:

  3. Systematic methodology • The Joanna Briggs Institute (JBI) is a renowned international not-for-profit research and development organization within the Faculty of Health Sciences at the University of Adelaide. “We provide you with the best available evidence to inform your clinical decision-making at the point of care.”

  4. Scoping review • Definition • Map the key concepts underpinning a research area, as well as to clarify working definitions, and/or the conceptual boundaries of a topic (Arksey and O’Malley, 2005).  • Scoping reviews are useful for examining emerging evidence when it is still unclear what other questions can be posed. • Type of evidence • Encompasses all the evidence available which would answer the question. • Qualitative, quantitative etc.

  5. My Scoping Review

  6. Stage 1: Introduction and Rationale • Lit review to “find the gap” in the research • Rapid review style with a systematic search approach. • 17 primary research papers. • Systematic review research: little focus on leadership in change, more implementation tools, strategies, one type of change, international etc. • Justification of the methodology chosen • 1. 74% health and social sciences • 2. Range of studies • 3. Map key concepts • 4. Clarify working definitions • 5. Lots of primary research • 6. Rigour

  7. Aims & Objectives • The aim of this proposed study is to synthesise a report of the clinical leadership strategies which have been reported in NHS England to implement large-scale change. • The objectives of this proposed study are: • to examine and map the range of clinical leadership strategies found to be used in large-scale change within NHS England; and • to assess the quality of the relevant research. Research question: What are the clinical leadership strategies reported in large scale change within NHS England?

  8. Stage 2: Search strategy • PCC Framework • Population: NHS England • Concept: Clinical Leadership* • “A social influence process in which a person steers members of a group towards a goal” Bryman’s (1986) • Context: Large-scale Change* • spread across at least one geographical, • must deeply challenge current mental models or ways of thinking so much so there is evidence of resistance to the change, • coordinated change in at least two systems. (Mohrman et al. (1989) and Levy (1986) in Bevan et al., 2013).

  9. Stage 2 (cont’d) Search strategy • Terms • ((“NHS” OR “National Health Service” OR “UK” OR “United kingdom” OR “England” OR “Britain” OR “GB”) AND “Clinical Lead*” AND (“Change*” OR “Improve*”)) • Boolean operators • Search fields used • Thesaurus function • Databases searched • AMED, CINAHL, EMBASE, Medline, PsycINFO, Cochrane Library, Business Source Complete, Web of Science, HMIC and HBE. • Gray literature • Reference list screening • Hand search of journals • Relevant policy documents (King’s Fund)

  10. Stage 3: Screening • Inclusion criteria. • 1. Studies must outline an exploration of change and the clinical leadership strategies used; • 2. The change must impact two or more healthcare teams and have an impact on both clinical environments; • 3. Studies must be based in the healthcare environment in NHS England; • 4. Studies must explore a healthcare professional patient-facing population; • 5. Studies must be published 2005-2018 to reflect the current state of the topic. • Exclusion criteria • 1. Studies not published in English; • 2. Text and opinion literature. • 3. Studies without references.

  11. Rayyan • Duplicate screening • Title/abstract screening • Full-text screening (Long process) (Reference list screening) • Independent secondary reviewer 10% screening and % agreement • Expert opinion (meetings, emails, 5 papers reviewed)

  12. Stage 4: Critical Appraisal process • Although Peters et al. (2017) identified no need to assess quality as a scoping review criterion, quality assessment was employed to permit scope to suggest valid research recommendations. • JBI appraisal tools • Chosen after reviewing the literature on critical appraisal tools (Buccheri & Sharifi, 2017) • Use in evidence-based practice • Checklists for qualitative and systematic review research • The JBI Checklists were chosen over the CASP appraisal tools because these tools are only recommended to be used in an educational setting to develop critical appraisal skills.

  13. Stage 5: Data extraction • (Trial process + Template adjustment) • Refinement process • Tidying up the data extraction • Otherwise very complex to thematically analyse data

  14. Stage 6: Thematic analysis • Process in collaboration with supervisors to increase rigour. • Leadership behaviour • Implicit • Explicit • Characteristics • Strategies for system integration • Working across boundaries • Knowledge • Relationships • Leadership approaches • Where – System Leadership • Who – Distributed Leadership • Achieve what? – Transformational Leadership • Barriers to change • Change fatigue • Operational • Organisational culture • Information for change • Leader knowledge • Good measurements • Feedback

  15. Stage 7: Synthesis of results (write-up) • Numerical Summary • Study characteristics • 2011-2013 and based in the acute and community trust sectors. • Qualitative research methodology was the most common. • 20 studies had good or high methodological quality. • Initiative implementation, integration and reorganisation of services. • Map of Clinical leadership strategies • Narrative Summary • Descriptive and analytical summary of all evidence • This was merged with the discussion chapter of my dissertation

  16. Results

  17. Conclusions • Mapped the research base of clinical leadership reported in Large-scale change. • Close association to key leadership models (NHS Leadership model) • The common themes identified include strategies of explicit and implicit leadership behaviour and leadership characteristics. • Importance of relationships and across-boundary working in service integration. • The system leadership approach, dispersed and transformational leadership styles which facilitate implementation of large-scale change. • Organisational culture, change fatigue, staff resistance etc. which act as a barrier to successful change. • Leader knowledge, feedback, and good measurements of impact which facilitate large-scale change.

  18. Strengths & Limitations • Undefined boundaries of Large-scale change • Subjective nature of clinical leadership • The scoping review methodology has allowed this challenging topic to be explored in a systematically objective, transparent and rigorous manner. • Search terms and inclusion/exclusion criteria used were chosen after an exploration and establishment of a firm conceptual definition for the concepts of “clinical leadership” and “large-scale change”. • Secondary researcher and expert opinion. • Quality appraisal. • Thematic analysis is a systematic but subjective technique. • Research which explored the implementation of change do not routinely explore the effective clinical leadership strategies used in-depth limiting the possibility of new insights into this research field. • Unable to specifically identify when a large-scale change has been “completed”.

  19. Recommendations • More primary research of clinical leadership in large-scale change is suggested, with a focus on the community, mental health and commissioning sectors. • Further exploration into more robust conceptual definitions of “clinical leadership” and “large-scale change” – increase direction and depth. • Higher quality methodological approach • Future research into the specific role of clinicians to facilitate largescale change. • A further exploration into the concept of system leadership will inform clinical leadership decisions for integration. • Exploration into the effectiveness of leadership models and leadership approaches in large-scale change which have been presented in the field is suggested.

  20. Personal Results… • MSc • Lots of knowledge • Lots of evidence-based reviewing skills • Contribution to the research field…

  21. Questions?

  22. References • Bevan, H., Pisek, P., & Winstanley, L. (2013). Part 1: Leading large scale change: A practical guide. NHS Academy for Large Scale Change. NHS Institute for Innovation and Improvement, 17-21. • Bryman, A. (1986). Leadership and Corporate Culture. Management Decision, 24(6), 50-53. • JBI. (2017a). Critical Appraisal Tools. Retrieved 26/05/2018 from: http://joannabriggs.org/research/critical-appraisal-tools.html. JBI. (2017b). About Us. Retrieved 26/05/2018 from: http://joannabriggs.org/about.html. • Kaplan, H. C., Brady, P. W., Dritz, M. C., Hooper, D. K., Linam, W. M., Froehle, C. M., & Margolis, P. (2010). The influence of context on quality improvement success in health care: a systematic review of the literature. The Milbank Quarterly, 88, 500559. • Kelly, N., Blake, S., & Plunkett, A. (2016). Learning from excellence in healthcare: a new approach to incident reporting. Archives of Disease in Childhood, 101, 788791. • Levy, A. (1986). ‘Second-order planned change: definitions and conceptualizations’. Org. Dynamics, 15, 5-20. • Pham, M., Rajić, A., Greig, J., Sargeant, J., Papadopoulos, A., & McEwen, S. (2014). A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Research Synthesis Methods, 5(4), 371-385. • Mohrman, A., Mohrman, S., Ledford Jr., G., Cummings, T., & Lawler III., E. (1989). Large-Scale Organizational Change. San Francisco, Jossey-Bass. • Peters L. D., Johnston, W. J., Pressey, A. D., & Kendrick, T. (2010). Collaboration and collective learning: networks as learning organisations. Journal of Business and Industrial Marketing, 25(6), 478-484. • Peters, M. D. J., Godfrey, C., McInerney, P., Baldini, Soares, C., Khalil, H., & Parker, D. (2017). Chapter 11: Scoping Reviews. In: Aromataris, E., Munn, Z., (Editors). Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute. Retrieved 24/12/2017 from https://reviewersmanual.joannabriggs.org/. • Pham, M., Rajić, A., Greig, J., Sargeant, J., Papadopoulos, A., & McEwen, S. (2014). A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Research Synthesis Methods, 5(4), 371-385.

More Related