Systems whose design is primarily aimed at ensuring efficient, effective and safe working, such as control rooms, have traditionally been evaluated in terms of criteria that correspond directly to those values: functional correctness, time to complete tasks, etc. This paper reports on a study of control room working that identified other factors that contributed directly to overall system safety. These factors included the ability of staff to manage uncertainty, to learn in an exploratory way, to reflect on their actions, and to engage in problem-solving that has many of the hallmarks of playing puzzles which, in turn, supports exploratory learning. These factors, while currently difficult to measure or explicitly design for, must be recognized and valued in design.
This article provides an organizational case study using exploratory qualitative and visual research methods. We address the research question: What are the experiences of service users who use a novel in‐reach rehabilitation and recovery service for people with severe and enduring mental health needs? Fifteen purposefully sampled service users were recruited from across a Service that is novel in embedding community sectors within inpatient provision. The sample reflects approximately the demographic of the Service and comprises: 10 men, 5 women; 12 white British, 3 ethnic minority; aged 18–60 years; and across inpatient care and supported community living. Photo‐elicitation was used to enrich data collection through lightly structured interviews focused on the images brought by participants. Interview transcripts were analysed using interpretative phenomenological analysis. Analysis indicates that participants oriented towards four ‘meta‐questions’: What does mental well‐being mean to you? What difficulties have you encountered? What do you appreciate about the Service? What do you need for change to occur? We also identified six themes which told the story of a journey. The journey begins with challenge and moves towards making connections with others. Here, power dynamics are often experienced and addressed in the development of a greater sense of independence. This then provides opportunities for raised awareness around possibilities of recovery and a new‐found hope. Our three main conclusions are all relevant to clinical practice: service users (a) place great importance on building relationships; (b) aspire to make informed choices throughout their recovery journey; and (c) desire greater transparency regarding treatment options.
This organizational case study addresses the research question: What are the experiences of staff who work in a novel in‐reach rehabilitation and recovery service for people with profound and enduring mental health needs? Fifteen purposefully sampled staff were recruited from across a novel mental health service that embeds the community sector within inpatient provision. The sample comprises twelve National Health Service and three community voluntary organization staff (four men and eleven women). Data were generated via photo‐elicitation in which interviews focused on the photographs participants brought to help convey their experiences of the Service. Interpretative phenomenological analysis was used to analyse the transcripts. The analysis demonstrates that participants are oriented towards five ‘meta‐questions’: What is recovery? Who is valued and how is it demonstrated? Why are you frustrated in doing the best job you can and what support do you need? How can change occur in staff practices and approaches in an environment embedded in history? and How do we make the Service work in the context of constraints? Eight paired themes were also identified regarding staff experience of the Service: hope and individuality; culture and power; communication and confidence; accountability and limitations. The conclusions of this organizational case study have wide relevance to clinical practice: staff (i) place importance on promoting and developing greater awareness of different approaches to care; (ii) aspire to develop better communication across multidisciplinary teams and (iii) desire greater awareness of the complexities of risk to improve staff confidence.
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