New NNRU report explores adoption and impact of Experience-based Co-design (EBCD) approach for improving quality of health care
EBCD is an approach to improving healthcare services that combines participatory and user experience design tools and processes to bring about quality improvements in healthcare organisations. Through a ‘co-design’ process the approach entails staff, patients and carers reflecting on their experiences of a service, working together to identify improvement priorities, devising and implementing changes, and then jointly reflecting on their achievements.
In order to establish how widely EBCD has been adopted - and to gather information on practitioners’ experiences with EBCD and their plans for future implementation - we undertook an international online survey and then conducted follow-up telephone interviews with a sample of respondents. The report explores:
1) the benefits and challenges that have arisen in relation to the approach in different healthcare services and systems;
2) the strengths and weaknesses of the approach itself;
3) the adaptations of the approach that have proven useful or necessary in specific settings; and
4) the contribution of the online King’s Fund EBCD Toolkit to implementation of the approach.
The report entitled 'Using Experience-based Co-design (EBCD) to improve the quality of healthcare: mapping where we are now and establishing future directions' is available here.
Professor Jill Maben provides international perspective on Nursing Work Environments
A cultural exchange between the School of Nursing at the University of North Carolina (UNC) at Chapel Hill and the FNSNM at KCL brought Professor Jill Maben, Director NNRU, to the UNC-Chapel Hill campus in December 2013. Prof Maben presented her findings to nursing faculty and students about the connections between staff well-being and patients' health care experiences. The UNC School of Nursing report on the visit is available here and a full video of Prof Maben's talk can be viewed online here.
Professor Glenn Robert's Inaugural Lecture available on YouTube
Professor Glenn Robert's Inaugural Lecture, Bodies on the pavement, that took place on 5th June 2013, is available to view on YouTube by clicking here.
A reflection following a NNRU internship, Getting to grips with nursing research, is now available
Emily Larkins, an undergraduate Nursing Student with FNSNM, completed an internship with NNRU during the 2013 summer holidays. Emily has written an interesting piece about the experience that she gained and her reflections before she joined the nursing workforce. The piece is available here.
The Director of the National Nursing Research unit, Professor Jill Maben and deputy director, Jane Ball, (pictured above) were short listed for Investigator of the Year and Media Personality of the Year respectively, at the 2013 King's College London Awards. Jill and Jane attended the dinner and awards ceremony on 20 November 2013. The Florence Nightingale School was extremely well represented with 9 nominations in total. Congratulations to Dr Mary Malone for winning Most Innovative Teacher award and Dr Trisha Grocott for winning Research Project of the Year.
NNRU Newsletter 2013
Including a Round-up, Project News, Staff News, Publications list and Conferences attended - please see our latest Newsletter, available here.
NNRU research study available: Health visiting: the voice of service users. Learning from service users’ experiences to inform the development of UK health visiting practice and services
Research carried out by the National Nursing Research Unit has revealed good health visiting makes parents feel 'known', respected and really listened to, confirming earlier work by the NNRU that health visitors deliver real benefits to patients and families.
The project was led by Dr Sara Donetto with support from Professor Jill Maben, Director of the NNRU and Professor Dame Sarah Cowley, Emeritus Professor of Community Practice Development and Health Visitor, who was honoured with a DBE in the 2013 New Year’s Honour’s list for services to health visiting.
For further details: to view the research paper click here and to view the NNRU at FNSNM press release click here.
NNRU research study available: Start and Stay: The Recruitment and Retention of Health Visitors.
New research, completed by the National Nursing Research Unit, reveals that health visitors are motivated by a primary desire to make a difference to children and families. This is the key to recruitment and retention of the health visiting workforce.
The researchers used an asset based approach to explore the experiences of students and qualified health visitors, identifying motivations and aspirations that encourage students to start and qualified practitioners to stay with their careers as health visitors.
The research reveals that students and practitioners remain committed to their career choice, even in periods of heightened workload pressures, when service managers and practice teachers shape working and learning environments in ways consistent with health visitor’s ideology of practice.
The project was led by Dr Karen Whittaker with support from Professor Jill Maben, Director of the National Nursing Research Unit and Professor Dame Sarah Cowley, Emeritus Professor of Community Practice Development and Health Visitor, who was honoured with a DBE in the 2013 New Year’s Honour lists for services to health visiting.
The report is available here and further details can be found here:
NNRU research paper published online suggests: Nurses forced to 'ration' care
Most ward sisters say they are forced to 'ration' care, and not do certain aspects of it - including adequate monitoring of patients - because they do not have time. These are the research findings suggested by a research paper by Jane Ball et al at NNRU published by BMJ Quality and Safety online that is entitled - 'Care left undone' during nursing shifts: associations with workload and perceived quality of care.
For further details: to view the research paper click here and to view the NNRU at FNSNM press release click here.
Hospital single room accomodation study results: upcoming conference presentation
Dr. Janet Anderson will present an invited paper at the Health and Care Infrastructure Research and Innovation Centre (HacCIRIC) International Conference on Building Future Healthcare – Radical Approaches on September 25th. She will be presenting the results of the Pembury study led by Professor Jill Maben, which investigated a hospital move from multi bed wards to a new hospital with all single rooms and the effect on staff and patient experiences, teamwork and work practices. The conference promises to be very interesting with a focus on how the design of healthcare infrastructure can support better care. For further information about the two-day conference in London (25 and 26 September) please click here.
Available on video - Inaugural Lecture by Professor Glenn Robert: 'Bodies on the pavement': The origins and evolution of an approach for improving patient experience of health care services
You can now watch the film of Glenn Robert's Inaugural Lecture - just click here - and scroll down to the bottom of the page to play the video clip. The slides from the event are also now available - click here.
Jill Maben included on Health Service Journal’s list of Most Inspirational Women in Healthcare
The first HSJ list of the most inspirational women in healthcare, supported by Barclays and the NHS Leadership Academy has just been published. Prof Jill Maben, Director, NNRU is included on the list with this citation:
"There is a danger in academia of losing touch with the real world. Jill’s feet remain firmly planted on solid ground. Her unit delivers research that really impacts on patient care, for example around safe staffing levels, and reflects her passion for her profession. She is also a powerful advocate for the best in nursing - articulating values that she lives in her professional life. She is said to be incredibly supportive of the people around her."
What the judges said: “It’s not just the job but what she has done with it.”
For the HSJ supplement that gives full details - click here
NNRU researchers feature in Health Services Journal (HSJ) report on QUASER project exploring quality and safety in EU hospitals: "The eight challenges facing hospitals in Europe"
A three-year study is exploring the relationships between the organisational and cultural characteristics of hospitals, and how these impact clinical effectiveness, patient safety and patient experience in EU countries. Susan Burnett, Naomi Fulop, Glenn Robert and Janet Anderson from National Nursing Research Unit and other colleagues report in HSJ.
To read the full HSJ article click here.
Professor Dame Sarah Cowley's investiture at Buckingham Palace
Our congratulations go to Professor Dame Sarah Cowley whose investiture took place at Buckingham Palace with Prince Charles on Friday 7th June 2013. The DBE was awarded for services to Health Visiting. Professor Cowley has also recently become an Emeritus Professor of King's College London.
Prof Maben named as one of HSJ 100 most influential clinical leaders in England
Professor Jill Maben, Director NNRU, was named in the Health Service Journal (HSJ) 100 most influential clinical leaders in England. In creating the list, which launched this year, HSJ looked for clinicians influencing policy, innovation and service transformation. From a long list of more than 250 people, a panel of judges including Dr Phil Hammond, Dr James Kingsland and Niall Dickson selected the final 100 names that form this year’s selection. Jill was cited as influencing innovation “The go-to organisation for nursing research is led by nurse and history graduate Professor Jill Maben. Widely respected across the profession for turning research into action, her work on new ways to deliver care will be seminal post-Francis”. Sally Brearley, Visiting Research Fellow at the NNRU, was on the Nursing and Midwifery list. For more details from HSJ please click here.
Inaugural Lecture, Professor Glenn Robert: 'Bodies on the pavement': The origins and evolution of an approach for improving patient experience of health care services.
Patient experience is a core component of health care quality - alongside clinical effectiveness and patient safety - but it is commonly perceived as the one to which least attention has been paid by the ‘quality movement’ in the last 15 years.
Health care organizations have traditionally relied - perhaps over relied - on national patient surveys to provide insights into specific aspects of patients’ experiences of care. In his Inaugural Lecture on 5th June, Glenn Robert explored the origins, development and diffusion of Experience-based Co-design (EBCD), an alternative approach to understanding and improving the relational aspects of patient experience.
EBCD was first piloted in a head and neck cancer service in the south of England in 2006 and has now been implemented in over 40 services in 6 countries. The approach combines (1) a user-centred orientation (by adopting a filmed, narrative approach) and (2) a participatory, co-design process which together allows staff to ‘see the person in the patient’, thereby placing patient experiences at the centre of quality improvement efforts.
Professor Robert reflected on the ongoing need for such alternative approaches to improving patient experience; the underpinning theories and core features of EBCD; lessons from implementing the approach in different settings (successfully and unsuccessfully … ); and findings from recent research which has explored the adoption of the approach internationally, as well as the relative costs and effectiveness of ‘accelerated’ EBCD in NHS settings. The lecture slides are available - click here.
New editorial from Prof. Glenn Robert on measuring and improving patient experience, published in Journal of Health Services Research & Policy:
Professor Glenn Robert, Chair in Healthcare Quality and Innovation, has published a new editorial in the Journal of Health Services Research and Policy.
The editorial is entitled: Rethinking policy approaches to measuring and improving patient experience. For more information and to read the article in full click here.
Prof Jill Maben, newly appointed trustee of the Point of Care Foundation in the UK, took the opportunity to visit the Schwartz Center while in Boston on holiday.
Seen here with Margie Stanzler of the Schwartz Center.
Inaugural Lecture, Prof. Jill Maben: "Care, Compassion and Ideals: Nurses' experiences of Nursing"
Most nurses enter the profession because they are motivated by ideals of altruism and a desire to 'make a difference' in the lives of others. However, in some environments a transformation occurs so that over time these same people are forced to abandon their ideals and protect themselves against a system that erodes humanity and caring.
This inaugural lecture closely examined the experiences of nurses in their daily work, details the challenges and highlighted those aspects of the local culture and climate that support nurses to deliver high quality patient care.
Jill Maben's lecture earned great interest and feedback. David Foster, Department of Health: "Many congratulations on such a wonderful lecture. It was a great blend of challenge, excellent research and personal insight."
Following many requests for transcripts and copies of the slides we will be making a recording of Jill's lecture available soon. If you would like to be sent a link to the recording when it is available please contact Isabell Mayr.
Using Experience based co-design (EBCD) to improve breast and lung cancer services
During a speech at the Nuffield Trust's health policy conference on the 8th March 2013, the Secretary of State for Health Jeremy Hunt referred to the ‘patient experience’ project undertaken by Dr Vicki Tsianakas, Professor Jill Maben and Professor Glenn Robert along with colleagues at Guys and St Thomas Foundation trust as a positive example of hospitals ‘putting patients first’. The project sought to design better experiences for patients and health care staff from breast and lung cancer services across two teaching hospitals in London. It used Experience based co-design (EBCD), an approach developed by Professor Glenn Robert which combines (1) a user-centred orientation (by adopting a narrative storytelling approach) and (2) a participatory, collaborative change process, allowing staff to ‘see the person in the patient’ and placing patient and staff experience at the centre of service development and provision.
In his speech, Mr Hunt highlighted the importance of listening to patients and making meaningful improvements to service provision. He cited one of the improvements made as a result of the project which positively impacted patient experience:
"When breast cancer patients came in for day surgery, they used to be asked to put on their surgical robes and wait by themselves until it was time. But this meant that, at a time of great worry, they spent long periods alone, separated from their loved ones. So after listening to patients, they made a simple change to the schedule that now allows patients to wait with their family until just before the operation. A small change that cost nothing. And made a big difference."
For more information on the ‘patient experience’ project and the EBCD approach, please see the links below:
Tsianakas V, Maben, J, Wiseman T, Robert G, Richardson A, Madden P, Griffin M, Davies EA . Using patients' experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both? BMC Health Services Research 2012; 12:271. DOI:10.1186/1472-6963-12-271.
Tsianakas V, Robert G, Maben J, Richardson A, Dale C, Wiseman T. Implementing patient-centred cancer care: using experience-based co-design to improve patient experience in breast and lung cancer services. Supportive Care in Cancer 2012; 20(11):2639-47. DOI:10.1007/s00520-012-1470-3.
For more information see the EBCD Tool Kit.
Jill Maben joins panel discussion with Robert Francis QC at the King's Fund
Professor Jill Maben, Director of the NNRU, was an invited panel member at the King's Fund Conference, The Francis Inquiry: Assuring Patient Safety and Quality Across the System, in February 2013.
Joining David Behan from the CQC, Harry Cayton OBE from the Professional Standards Authority, Professor Sir Ian Kennedy, former Chair of the Healthcare Commission, and Peter Walsh from Action Against Medical Accidents, Professor Maben gave her reactions to the Francis Inquiry report, based on the research of the NNRU.
For more information and to watch a video of the panel discussion click here
NNRU research study available: Why Health Visiting? A review of the literature about key health visitor interventions, processes and outcomes for children and families
Research carried out by the National Nursing Research Unit has revealed that while health visitors deliver real benefits to patients and families, there is a need for more research and better education in order to develop the profession. The review entitled "Why Health Visiting?" supports the Deparment of Health's Health Visitor Implementation Plan 2011-2015.
The project was led by Professor Dame Sarah Cowley, Visiting Professor of Community Practice Development, who was honoured with a DBE in the 2013 New Year’s Honour’s for services to health visiting, as well as a Life Time Achievement Award from Community Practitioners’ and Health Visitors’ Association, in recognition of her contribution to the profession.
Please see further details about the study on following link: http://www.kcl.ac.uk/nursing/newsevents/news/2013/Health-Visitors.aspx
and full report with appendices.
NNRU research study available: Sustaining and managing the delivery of student nurse mentorship: roles, resources, standards and debates
New research led by the National Nursing Research Unit has demonstrated the complex and resource intensive nature of the support from higher education and health care providers that underpins the delivery of student nurse mentorship in practice.
Undertaken in collaboration with Chelsea and Westminster Hospital NHS Foundation Trust, the research team found that the delivery of mentorship is facing considerable challenge in a rapidly changing financial, organisational and professional climate and diverse views are in evidence about its future direction and resourcing.
Please see further details about the study here and there is a full report, short report and executive summary available.
High Quality Care Metrics for Nursing report launched at the CNO Conference
The NNRU report High Quality Care Metrics for Nursing was launched at the Chief Nursing Officer (CNO) Conference in Manchester this week. Further details are available here.
The report is available here
NNRU research study available: Exploring the relationship between patients’ experiences of care and the influence of staff motivation, affect and wellbeing
New research carried out by the National Nursing Research Unit at King’s College London strongly suggests that levels of satisfaction and wellbeing among NHS staff has a direct impact on patients’ experiences of healthcare. Investing in staff wellbeing is therefore not only important for the nursing workforce but also for quality of care overall.
The study, entitled “Exploring the relationship between patients’ experiences of care and the influence of staff motivation, affect and wellbeing”, aimed to determine which particular staff attitudes and behaviours impacted on patient experiences.
Please see further details on this link:
NNRU Newsletter 2012
The latest NNRU Newsletter is now available: Newsletter issue 6, November 2012
CPHVA conference, Brighton
The Health Visitor Programme team presented at the Community Practitioners' and Health Visitors' Association (CPHVA) conference in Brighton, 7 November:
"What are the key components of health visitor interventions and relationships between the current health visiting service, its processes and outcomes?"
"Health Visiting : voice of service users"
"Start and Stay: examining recruitment and retention of health visitors"
and Prof. Sarah Cowley, lead of the NNRU's Health Visitor Programme, was awarded a life time recognition award of contribution to the profession by the CPHVA and received a standing ovation in the hall when announced.
III International Conference on Nursing Research, Sao Paulo, Brazil on 29th-31st October
The University of São Paulo School of Nursing (EEUSP) promoted the III International Conference on Nursing Research on 29th-31st October 2012. The central theme of the event, “Nursing Research: advances in care, management, and policy” gathered information from the three areas that form the basis for the generation, synthesis, transference and implementation of nursing knowledge.
The event promoted the encounter between Brazilian and visiting nurses, to acquire innovating research data, disseminate their own results, and establish contacts with research groups that can strengthen nursing research initiatives.
Prof Jill Maben presented on "Nursing Workforce Research: strategies and tools to improve the quality of healthcare" and jointly presented a pre-conference course and conference session with Marina Peduzzi (Associate Professor of the Department of Professional Guidance at EEUSP) on “Intervention research in nursing and health management”.
At the Sao Paulo conference: Prof. Bick, Prof. Peduzzi and Prof . Maben (from left to right)
International Society for Quality in Health Care (ISQua) 29th International Conference, Geneva on 21st-24th October - presentations and best research poster prize won
Professor Glenn Robert presented on Understanding and improving patient experience: a national survey of training courses provided by higher education providers and healthcare organisations in England. The abstract is available here: ISQua-1299-Abstract
Laura Nasir presented on Spanning boundaries between primary and social care: examining knowledge exchange and the impact of integration efforts on healthcare quality. The abstract is available here: ISQua-1364-Abstract
Dr Jocelyn Cornwell (The King’s Fund) presented on the findings from a joint project with NNRU staff regarding What are healthcare organisations doing to measure and improve patient experience? 12 case studies from England. The abstract is available here: ISQua-1569-CaseStudies
Dr Jocelyn Cornwell (The King’s Fund) and Professor Glenn Robert jointly presented on Designing the future: approaches to measuring patient experience. The poster which won the best research poster prize is available here: ISQua-1568-Poster
Attended by over 1,000 delegates from 70 countries the conference attracted 300 posters. Professor Robert and Dr Cornwell’s winning poster reported on research carried out on behalf of the Department of Health in England to explore ‘what matters most’ to patients and the implications for the design of future approaches to measuring patient experience and improving the quality of care in the English NHS.
NNRU Lecture by Professor Pam Smith
The National Nursing Research Unit hosted a lecture by Professor Pam Smith on Tuesday 16th October entitled A personal research journey: ‘The Emotional Labour of Nursing’.
Pam Smith, Professor of Nursing at the University of Edinburgh, and Visiting Professor with the National Nursing Research Unit presented a well attended lecture on the emotional labour of nursing using the notion of the research journey to explore the influence of biography, history and imagination on developing a programme of research.
Professor Smith presented the findings of a number of interconnected studies which describe the learning and caring experiences of nurses in a changing world. These studies are featured in her recent book ‘The emotional labour of nursing revisited’ and include research on student nurses’ clinical learning - ‘can nurses still care?’, patient safety – ‘a caring nurse is a safe nurse’ and overseas’ nurses - ‘how do we capture all the talents?’
The presentation slides are available for download here: ProfSmith-LectureNotes.
35th anniversary celebation
On Tuesday 11th September the National Nursing Research Unit (NNRU), along with nursing leaders and academics from across the country, celebrated thirty five years of research impact. The evening was a huge success, with fine food and wine, and live music played by a string quartet.
Professor Helen McCutcheon, Head of School, said:
“The unit is an example of what we can achieve when we work together for the common good. The NNRU can be held as a gold standard example of how
good research really can make an impact on patient and staff care.”
The event was also an opportunity for the NNRU to launch their latest publication, Policy + Review , which provides evidence of the Unit’s inquiries over the past five years and was available for all attendees to take home with them.
Director of the Unit, Professor Jill Maben, was presented with a piece of commemorative artwork for her hard work and expertise within the Unit and four of the previous Directors who were able to attend were also given gifts.
On receiving her gift, Jill said:
“What I have really cherished during my time in the NNRU is the very able colleagues I have had the privilege of working with and the opportunity to focus upon issues that affect Nursing Care quality that I am passionate about. I would like to thank the School for supporting the Unit so that we can continue providing evidence that will shape nursing policy and have a real impact on patients, carers and the wider healthcare system.”
Nursing workforce pressures put patient care at risk
Results of a survey of nearly 3,000 nurses across England have revealed that nurse staffing and workforce issues have a significant impact on both staff satisfaction levels and patient care.
Led by researchers at the National Nursing Research Unit (NNRU) at King’s College London and the University of Southampton, the RN4CAST survey of nurses in over 400 general medical and surgical wards at 31 Trusts, was part of an international research programme looking at links between nursing workforce issues and patient outcomes across 15 countries.
Jane Ball, Deputy Director of the National Nursing Research Unit at King’s College London, said:
“The results provide clear evidence of the links between nurse staffing and the quality of care patients receive. On wards with poorer Registered Nurse staffing levels, nurses were more likely to say that care had been left undone due to lack of time. Working with inadequate staffing not only puts patients at risk, but places immense pressure on staff, and this has a knock effect on morale. Nearly half of the nurses we surveyed would leave their current job if they could. At a time when the number of nurses being trained is being cut, the service can ill-afford to lose this valuable expertise.
“We have now given the results to all the participating trusts and urge them to look at what their staff have said about staffing issues at ward level, and the effect this has on their working environments and patient care.”
For more information please see following link: https://www.kcl.ac.uk/nursing/newsevents/News/2012/RN4CAST-nursing-workforce.aspx