System wide learning from first wave Covid 19: A realist synthesis of what works?

Abstract

Background This paper presents a thematic analysis of 176 interview transcripts from front line staff working during the first wave of COVID-19 in the East of England. Methods Presented as a descriptive case study it reflects the complexity and numerous variables that influenced staff experiences of delivering care and support across the health and social care system between April and August 2020. Drawing upon the methodology of realist synthesis, it addresses the question “What works for whom and in what contexts and why?” to help illuminate real-world issues that people have faced. Results 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. Four tentative theories of system transformation are presented to highlight support mechanisms that are needed to enable front line teams to be effective in further waves of the pandemic, capitalising on system wide learning, patient, resident and staff wellbeing. Conclusions This paper presents a unique insight into front line staff experiences of working during the first wave of the Covid-19 pandemic using realist synthesis methods to distil key themes and tentative theories about what strategies work to enable and empower front line teams to be effective and to support system wide learning and transformation.

Contemporary Challenges of Nursing CPD: Time to change the model to meet citizens’ needs

“…The ability to mobilize and combine the experiential knowledge of practitioners, citizens and service users, with the formal evidence from research is missing in existing CPD, especially when contextual factors namely; leadership, culture and an evaluation focus are pivotal to its implementation (Rycroft‐Malone et al., 2012 ). Cultural transformation requires more than traditional approaches to CPD because this is more fundamental to how people experience their work as highlighted during the COVID‐19 pandemic (Jackson et al., 2020 ). Nationally funded projects by HEE (Illing et al., 2018 ; Jackson et al., 2015 ; Manley et al., 2018 ), informed by public consultation have demonstrated how CPD can make a difference to the workplace, patient and staff outcomes and career progression if indicators of impact at all levels of the system are developed to inform a more coherent commissioning strategy.…”

“…The COVID-19 pandemic has highlighted the challenges associated with rapid change in times of crisis and the impact on frontline staff well-being, 2 services, organizations and systems delivering health and social care globally (Chaudry & Raza, 2020;Greenberg et al, 2020;Jackson et al, 2020Jackson et al, , 2021Maben & Bridges, 2020).…”

“…The assessment, measurement and evaluation of learning outcomes from CPD are underdeveloped and inconsistent (Academy of Medical Royal Colleges, 2010; Clark et al, 2008;Fryer, 2006;Illing et al, 2018;Jackson et al, 2015;Manley et al, 2018;Mathers, 2012) and, in spite of regulatory commitment to CPD, there is a lack of sub- Cultural transformation requires more than traditional approaches to CPD because this is more fundamental to how people experience their work as highlighted during the COVID-19 pandemic (Jackson et al, 2020). Nationally funded projects by HEE (Illing et al, 2018;Jackson et al, 2015;Manley et al, 2018), informed by public consultation have demonstrated how CPD can make a difference to the workplace, patient and staff outcomes and career progression if indicators of impact at all levels of the system are developed to inform a more coherent commissioning strategy.…”

“…The COVID‐19 pandemic has highlighted the challenges associated with rapid change in times of crisis and the impact on front‐line staff well‐being, 2 services, organizations and systems delivering health and social care globally (Chaudry & Raza, 2020; Greenberg et al., 2020; Jackson et al., 2020, 2021; Maben & Bridges, 2020). Staff well‐being is an indicator of a flourishing workplace culture that impacts on staff commitment, resilience and retention, and in health care, it results in an experience of quality, person‐centred care (Maben et al., 2012).…”

Strengthening nursing, midwifery and allied health professional leadership in the UK – a realist evaluation

“…Health and social care systems are complex because of dynamic changing inter-relationships characteristic of open systems (Greenhalgh and Papoutsi, 2018). The pandemic poignantly demonstrated this, with every part of the system experiencing unforeseen consequences due to change in other parts (Jackson et al , 2021). A great deal of the published literature assumes that leadership happens within “a stable, albeit complicated, arrangement of individual elements”, “rather than a dynamic, ecological system that is multi-facetted and complex” (Cohn et al , 2013, p. 40).…”