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Background Videoconferencing has been proposed as a way of improving access to healthcare for older adults in care homes. Despite this, effective uptake of videoconferencing remains varied. This study evaluates a videoconferencing service for care home staff seeking support from healthcare professionals for the care of residents. The aim was to explore factors affecting the uptake and sustainability of videoconferencing in care homes, to establish what works for whom, in which circumstances and respects. The findings informed recommendations for commissioners and strategic managers on how best to implement videoconferencing for remote healthcare provision in care homes for older adults. Methods Realist evaluation was used to develop, refine and test theories around the uptake and maintenance of videoconferencing in three care homes across Yorkshire and the Humber, England. The care homes were selected using maximum variation sampling regarding the extent to which they used videoconferencing. A developmental inquiry framework and realist interviews were used to identify Context, Mechanism and Outcome Configurations (CMOCs) regarding uptake and sustainability of the service. Participants included care home residents (aged > 65) and staff, relatives and strategic managers of care home chains. The interviews were an iterative process conducted alongside data analysis. Transcripts of audio recordings were entered into NVIVO 12, initially coded into themes, then hypotheses developed, refined and tested. Results Outcomes were generated in relation to two main contextual factors, these were: (1) communication culture in the home and (2) the prior knowledge and experience that staff have of videoconferencing. The key facilitators identified were aspects of leadership, social links within the home and psychological safety which promoted shared learning and confidence in using the technology. Conclusions Videoconferencing is a valuable tool, but successful implementation and sustainability are dependent on care home culture and staff training to promote confidence through positive and supported experiences.

NHS vanguards, under-pressure to perform, required better contracting and data management arrangements with evaluation teams, to ensure that integrated service outcomes could be reported effectively. This communication reflects the experience of evaluating an NHS vanguard and suggests how academic teams can improve capacity for complex programme evaluation of rapid improvements in integrated services. This should be based on a shared commitment to data collection and management. Also, robust knowledge exchange processes can enable systems change and sustainability. The identifying features of the particular site have been withheld.

BackgroundSpecialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders' views and policy recommendations about optimal SARC practice.MethodsA systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted.ResultsWe included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counselling services.ConclusionsThis review suggests that there is big variation in the mental health and substance misuse provision both across and within different sexual assault service models. We found no robust evidence about how sexual assault services can achieve good mental health and substance misuse outcomes for service users. Clearer guidance for service planners and commissioners, informed by robust evidence about optimal service organisations and pathways, is required. PROSPERO registration number: CRD42018119706.

This study presents a framework for leadership of integrated, interprofessional health and\ud social-care teams (IgT's) based on a previous literature review and a qualitative study. The\ud theoretical framework for Integrated Team Leadership (IgTL) is based on contributions from\ud fifteen professional and non-professional staff, in 8 community teams in the United\ud Kingdom. Participants shared their perceptions of IgT's good-practice in relation to patient\ud outcomes. There were two clear elements, Person-focused and Task-focused leadership\ud behaviours with particular emphasis on the facilitation of shared professional practices.\ud Person-focused leadership skills include: inspiring and motivating; walking the talk; change\ud and innovation; consideration; empowerment, teambuilding and team maintenance; and\ud emotional intelligence. Task-focused leadership behaviours included: setting team direction;\ud managing performance; and managing external relationships. Team members felt that the\ud IgTL should be: a Health or Social Care (HSC) professional; engaged in professional\ud practice; and have worked in an IgT before leading one. Technical and cultural issues were\ud identified that differentiate IgTL from usual leadership practice; in particular the ability to\ud facilitate or create barriers to effective integrated teamworking within the organisational\ud context. In common with other OECD countries, there are policy imperatives in England for\ud further integration of health and social care, needed to improve quality and effectiveness of\ud care for older people with multiple conditions. Further attention is needed to support the\ud development of effective IgT's and leadership will be a pre-requisite to achieve this\ud vision. The research advances the understanding of the need for skilled interprofessional\ud leadership practice.

Background Models of community palliative care delivery are typically dependent on specialist nursing and medical staff acting independently. This study, part of the EnComPaSS project, appraises the impact of eShift, a technological system created by Sensory Technologies. eShift supports a delegated model of care, facilitating visiting staff to remain in ongoing contact with senior team members, and supporting systematic MDT recording. Methods This was a service evaluation conducted at a Specialist Palliative Care service in the North of England, part of a real-world evaluation of a complex intervention. Prior data was collected from October 2014 to September 2015, transition to the new model began in October 2015, with data collection continuing to September 2016. Outcomes were based on prior hypotheses, including absolute numbers of patient contacts, grade of professional, number and route of hospital admissions and associated economic impact. Further evaluations over a longer time period are ongoing. Results In comparing the pre-intervention period with the follow-up period, the total number of patients on the caseload remained relatively stable (1521 vs 1501). There was a reduction in total visits (3725 vs 3285), number of consultant visits (105 vs 48) and number of senior nurse visits (3361 vs 2730). There was an increase in the number of band 5 nurse (0 vs 208) and registrar visits (89 vs 170). Furthermore, number of patients admitted to hospital reduced (1238 vs 1156), as did overall admissions (5571 vs 4548) and average length of stay in days (6.23 vs 5.99). The reduction in hospital bed-days translates to a cost saving of £2.7 m per year, based on costs during the study period. Conclusion This service evaluation supports the successful implementation of a technological solution to improving efficiency and delivery of community palliative care, with associated reductions in visits, hospital stays and service costs.

Background Compared to in-centre, home hemodialysis is associated with superior outcomes. The impact on patient experience and clinical outcomes of consistently providing the choice and training to undertake hemodialysis-related treatment tasks in the in-centre setting is unknown. Methods A stepped-wedge cluster randomised trial in 12 UK renal centres recruited prevalent in-centre hemodialysis patients with sites randomised into early and late participation in a 12-month breakthrough series collaborative that included data collection, learning events, Plan-Study-Do-Act cycles, and teleconferences repeated every 6 weeks, underpinned by a faculty, co-production, materials and a nursing course. The primary outcome was the proportion of patients undertaking five or more hemodialysis-related tasks or home hemodialysis. Secondary outcomes included independent hemodialysis, quality of life, symptoms, patient activation and hospitalisation. ISRCTN Registration Number 93999549. Results 586 hemodialysis patients were recruited. The proportion performing 5 or more tasks or home hemodialysis increased from 45.6% to 52.3% (205 to 244/449, difference 6.2%, 95% CI 1.4 to 11%), however after analysis by step the adjusted odds ratio for the intervention was 1.63 (95% CI 0.94 to 2.81, P = 0.08). 28.3% of patients doing less than 5 tasks at baseline performed 5 or more at the end of the study (69/244, 95% CI 22.2–34.3%, adjusted odds ratio 3.71, 95% CI 1.66–8.31). Independent or home hemodialysis increased from 7.5% to 11.6% (32 to 49/423, difference 4.0%, 95% CI 1.0–7.0), but the remaining secondary endpoints were unaffected. Conclusions Our intervention did not increase dialysis related tasks being performed by a prevalent population of centre based patients, but there was an increase in home hemodialysis as well as an increase in tasks among patients who were doing fewer than 5 at baseline. Further studies are required that examine interventions to engage people who dialyse at centres in their own care.

A scoping review was conducted to map the research evidence on the use of videoconferencing for remote health care provision for older adults in care homes. The review aimed to identify the nature and extent of the existing evidence base. Databases used were Embase, Medline, Web of Science, and Cochrane Library Reviews. The review identified 26 articles for inclusion, of which 14 were case studies, making the most used study design. Papers described videoconferencing as being used for assessment, management of health care, clinical support, and diagnosis, with eight of the papers reporting the use of videoconferencing for more than one clinical purpose. A further eight papers reported the use of videoconferencing for assessment alone. The literature reported the collection of various types of data, with 12 papers describing the use of both qualitative and quantitative data. The outcomes mainly addressed staff satisfaction (n=9) and resident satisfaction (n=8). Current evidence supports the feasibility of videoconferencing in care homes. However, research needs to be undertaken to establish the contexts and mechanisms that underpin the successful implementation of videoconferencing in care homes and to define useful measures for success.

Purpose The purpose of this study is to review evidence on the nature of effective leadership in interprofessional health and social care teams. Design/methodology/approach A critical review and thematic synthesis of research literature conducted using systematic methods to identify and construct a framework to explain the available evidence about leadership in interprofessional health and social care teams. Findings Twenty-eight papers were reviewed and contributed to the framework for interprofessional leadership. Twelve themes emerged from the literature, the themes were: facilitate shared leadership; transformation and change; personal qualities; goal alignment; creativity and innovation; communication; team-building; leadership clarity; direction setting; external liaison; skill mix and diversity; clinical and contextual expertise. The discussion includes some comparative analysis with theories and themes in team management and team leadership. Originality/value This research identifies some of the characteristics of effective leadership of interprofessional health and social care teams. By capturing and synthesising the literature, it is clear that effective interprofessional health and social care team leadership requires a unique blend of knowledge and skills that support innovation and improvement. Further research is required to deepen the understanding of the degree to which team leadership results in better outcomes for both patients and teams.

Background The study objective is to assess the effectiveness and economic impact of a structured programme to support patient involvement in centre-based haemodialysis and to understand what works for whom in what circumstances and why. It implements a program of Shared Haemodialysis Care (SHC) that aims to improve experience and outcomes for those who are treated with centre-based haemodialysis, and give more patients the confidence to dialyse independently both at centres and at home. Methods/Design The 24 month mixed methods cohort evaluation of 600 prevalent centre based HD patients is nested within a 30 month quality improvement program that aims to scale up SHC at 12 dialysis centres across England. SHC describes an intervention where patients who receive centre-based haemodialysis are given the opportunity to learn, engage with and undertake tasks associated with their treatment. Following a 6-month set up period, a phased implementation programme is initiated across 12 dialysis units using a randomised stepped wedge design with 6 centres participating in each of 2 steps, each lasting 6 months. The intervention utilises quality improvement methodologies involving rapid tests of change to determine the most appropriate mechanisms for implementation in the context of a learning collaborative. Running parallel with the stepped wedge intervention is a mixed methods cohort evaluation that employs patient questionnaires and interviews, and will link with routinely collected data at the end of the study period. The primary outcome measure is the number of patients performing at least 5 dialysis-related tasks collected using 3 monthly questionnaires. Secondary outcomes measures include: the number of people choosing to perform home haemodialysis or dialyse independently in-centre by the end of the study period; end-user recommendation; home dialysis establishment delay; staff impact and confidence; hospitalisation; infection and health economics. Discussion The results from this study will provide evidence of impact of SHC, barriers to patient and centre level adoption and inform development of future interventions to support its implementation. Trial registration ISRCTN Number: 93999549 , (retrospectively registered 1st May 2017); NIHR Research Portfolio: 31566

Intention to Stay and Intention to Leave: Are They Two Sides of the Same Coin? A Cross- sectional Structural Equation Modelling Study among Health and Social Care Workers: Susan NANCARROW, et al. School of Health & Human Sciences, Southern Cross University, Australia— Objectives: "Intention to leave" (ITL) has been used interchangeably with the more positive construct "inten- tion to stay" (ITS). The implicit assumption appears to be that both constructs represent different sides of the same coin. This study challenges this assumption. The objectives were (i) to test whether these constructs were similar measures of the same construct, and (ii) to assess the strength of the relationships between ITL and ITS with work-related outcomes. Methods: The Workforce Dynamics Questionnaire (WDQ) was admin- istered to 298 staff. The WDQ included two items on ITL and was supplemented with three items on ITS. Structural equation modelling (SEM) was used. Results: The response rate was 43%. The correlation between the two constructs was negative and quite high (r=−0.84), indicating potential issues with discriminant validity. However, the constructs behaved differently in relation to job satisfaction and job integration. ITS was a strong predictor (0.95, p

An increasing demand for care homes in the UK, has necessitated the evaluation of innovative methods for delivering more effective health care. Videoconferencing may be one way to meet this demand. However, there is a lack of literature on the provision of videoconferencing in England. This mixed-methods study aimed to map current attitudes, knowledge and provision of videoconferencing in the Yorkshire and Humber region of England. Qualitative interviews with care home managers, a scoping review and field notes from a Special Interest Group (SIG) informed the development of a descriptive convenience survey which was sent out to care home managers in the Yorkshire and Humber region of England. The survey had a 14% (n = 124) response rate. Of those who responded, 10% (n = 12) reported using videoconferencing for health care, with over 78% (n = 97) of respondents&rsquo, care homes being based in urban areas. Approximately 62% (n = 77) of the 124 respondents had heard of videoconferencing for health care provision. Of those who reported not using videoconferencing (n = 112), 39% (n = 48) said they would consider it but would need to know more. The top ranked reason for not introducing videoconferencing was the belief that residents would not be comfortable using videoconferencing to consult with a healthcare professional. The main reason for implementation was the need for speedier access to services. Those already using videoconferencing rated videoconferencing overall as being very good (50%) (n = 6) or good (42%) (n = 5). Those who were not using it in practice appeared sceptical before implementing videoconferencing. The main driver of uptake was the home&rsquo, s current access to and satisfaction with traditionally delivered health care services.

The limited extent to which research evidence is utilised in healthcare and other public services is widely acknowledged. The United Kingdom government has attempted to address this gap by funding nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). CLAHRCs aim to carry out health research, implement research findings in local healthcare organisations and build capacity across organisations for generating and using evidence. This wide-ranging brief requires multifaceted approaches; assessing CLAHRCs’ success thus poses challenges for evaluation. This paper discusses these challenges in relation to seven CLAHRC evaluations, eliciting implications and suggestions for others evaluating similarly complex interventions with diverse objectives.

BackgroundThe establishment of the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) was the culmination of a number of policy initiatives to bridge the gap between evidence and practice. CLAHRCs were created and funded to facilitate development of partnerships and connect the worlds of academia and practice in an effort to improve patient outcomes through the conduct and application of applied health research.ObjectivesOur starting point was to test the theory that bringing higher education institutions and health-care organisations closer together catalyses knowledge mobilisation. The overall purpose was to develop explanatory theory regarding implementation through CLAHRCs and answer the question ‘what works, for whom, why and in what circumstances?’. The study objectives focused on identifying and tracking implementation mechanisms and processes over time; determining what influences whether or not and how research is used in CLAHRCs; investigating the role played by boundary objects in the success or failure of implementation; and determining whether or not and how CLAHRCs develop and sustain interactions and communities of practice.MethodsThis study was a longitudinal realist evaluation using multiple qualitative case studies, incorporating stakeholder engagement and formative feedback. Three CLAHRCs were studied in depth over four rounds of data collection through a process of hypothesis generation, refining, testing and programme theory specification. Data collection included interviews, observation, documents, feedback sessions and an interpretive forum.FindingsKnowledge mobilisation in CLAHRCs was a function of a number of interconnected issues that provided more or less conducive conditions for collective action. The potential of CLAHRCs to close the metaphorical ‘know–do’ gap was dependent on historical regional relationships, their approach to engaging different communities, their architectures, what priorities were set and how, and providing additional resources for implementation, including investment in roles and activities to bridge and broker boundaries. Additionally, we observed a balance towards conducting research rather than implementing it. Key mechanisms of interpretations of collaborative action, opportunities for connectivity, facilitation, motivation, review and reflection, and unlocking barriers/releasing potential were important to the processes and outcomes of CLAHRCs. These mechanisms operated in different contexts including stakeholders’ positioning, or ‘where they were coming from’, governance arrangements, availability of resources, competing drivers, receptiveness to learning and evaluation, and alignment of structures, positions and resources. Preceding conditions influenced the course and journey of the CLAHRCs in a path-dependent way. We observed them evolving over time and their development led to the accumulation of different types of impacts, from those that were conceptual to, later in their life cycle, those that were more direct.ConclusionsMost studies of implementation focus on researching one-off projects, so a strength of this study was in researching a systems approach to knowledge mobilisation over time. Although CLAHRC-like approaches show promise, realising their full potential will require a longer and more sustained focus on relationship building, resource allocation and, in some cases, culture change. This reinforces the point that research implementation within a CLAHRC model is a long-term investment and one that is set within a life cycle of organisational collaboration.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Background: Increasingly, it is being suggested that translational gaps might be eradicated or narrowed by\ud bringing research users and producers closer together, a theory that is largely untested. This paper reports a\ud national study to fill a gap in the evidence about the conditions, processes and outcomes related to collaboration\ud and implementation.\ud Methods: A longitudinal realist evaluation using multiple qualitative methods case studies was conducted with\ud three Collaborations for Leadership in Applied Health Research in Care (England). Data were collected over four\ud rounds of theory development, refinement and testing. Over 200 participants were involved in semi-structured\ud interviews, non-participant observations of events and meetings, and stakeholder engagement. A combined\ud inductive and deductive data analysis process was focused on proposition refinement and testing iteratively over\ud data collection rounds.\ud Results: The quality of existing relationships between higher education and local health service, and views about\ud whether implementation was a collaborative act, created a path dependency. Where implementation was\ud perceived to be removed from service and there was a lack of organisational connections, this resulted in a focus\ud on knowledge production and transfer, rather than co-production. The collaborations’ architectures were\ud counterproductive because they did not facilitate connectivity and had emphasised professional and epistemic\ud boundaries. More distributed leadership was associated with greater potential for engagement. The creation of\ud boundary spanning roles was the most visible investment in implementation, and credible individuals in these roles\ud resulted in cross-boundary work, in facilitation and in direct impacts. The academic-practice divide played out\ud strongly as a context for motivation to engage, in that ‘what’s in it for me’ resulted in variable levels of engagement\ud along a co-operation-collaboration continuum. Learning within and across collaborations was patchy depending on\ud attention to evaluation.\ud Conclusions: These collaborations did not emerge from a vacuum, and they needed time to learn and develop.\ud Their life cycle started with their position on collaboration, knowledge and implementation. More impactful\ud attempts at collective action in implementation might be determined by the deliberate alignment of a number of\ud features, including foundational relationships, vision, values, structures and processes and views about the nature of\ud the collaboration and implementation.

Reflective practice is used increasingly to enhance team functioning and service effectiveness; however, there is little evidence of its use in interdisciplinary teams. This paper presents the qualitative evaluation of the Interdisciplinary Management Tool (IMT), an evidence-based change tool designed to enhance interdisciplinary teamwork through structured team reflection. The IMT incorporates three components: an evidence-based resource guide; a reflective implementation framework based on Structured, Facilitated Action Research for Implementation methodology; and formative and summative evaluation components. The IMT was implemented with intermediate care teams supported by independent facilitators in England. Each intervention lasted 6 months and was evaluated over a 12-month period. Data sources include interviews, a focus group with facilitators, questionnaires completed by team members and documentary feedback from structured team reports. Data were analysed qualitatively using the Framework approach. The IMT was implemented with 10 teams, including 253 staff from more than 10 different disciplines. Team challenges included lack of clear vision; communication issues; limited career progression opportunities; inefficient resource use; need for role clarity and service development. The IMT successfully engaged staff in the change process, and resulted in teams developing creative strategies to address the issues identified. Participants valued dedicated time to focus on the processes of team functioning; however, some were uncomfortable with a focus on teamwork at the expense of delivering direct patient care. The IMT is a relatively low-cost, structured, reflective way to enhance team function. It empowers individuals to understand and value their own, and others' roles and responsibilities within the team; identify barriers to effective teamwork, and develop and implement appropriate solutions to these. To be successful, teams need protected time to take for reflection, and executive support to be able to broker changes that are beyond the scope of the team.

Background: International policy suggests that collaborative priority setting (CPS) between researchers and end users of research should shape the research agenda, and can increase capacity to address the research-practice translational gap. There is limited research evidence to guide how this should be done to meet the needs of dynamic healthcare systems. One-off priority setting events and time-lag between decision and action prove problematic. This study illustrates the use of CPS in a UK research collaboration called Collaboration and Leadership in Applied Health Research and Care (CLAHRC). Methods: Data were collected from a north of England CLAHRC through semi-structured interviews with 28 interviewees and a workshop of key stakeholders (n = 21) including academics, NHS clinicians, and managers. Documentary analysis of internal reports and CLAHRC annual reports for the first two and half years was also undertaken. These data were thematically coded. Results: Methods of CPS linked to the developmental phase of the CLAHRC. Early methods included pre-existing historical partnerships with on-going dialogue. Later, new platforms for on-going discussions were formed. Consensus techniques with staged project development were also used. All methods demonstrated actual or potential change in practice and services. Impact was enabled through the flexibility of research and implementation work streams; ‘matched’ funding arrangements to support alignment of priorities in partner organisations; the size of the collaboration offering a resource to meet project needs; and the length of the programme providing stability and long term relationships. Difficulties included tensions between being responsive to priorities and the possibility of ‘drift’ within project work, between academics and practice, and between service providers and commissioners in the health services. Providing protected ‘matched’ time proved difficult for some NHS managers, which put increasing work pressure on them. CPS is more time consuming than traditional approaches to project development. Conclusions: CPS can produce needs-led projects that are bedded in services using a variety of methods. Contributing factors for effective CPS include flexibility in use and type of available resources, flexible work plans, and responsive leadership. The CLAHRC model provides a translational infrastructure that enables CPS that can impact on healthcare systems.

Background and designThis research was based on a reanalysis of a merged data set from two intermediate care (IC) projects in order to identify patient characteristics associated with outcomes [Nancarrow SA, Enderby PM, Moran AM, Dixon S, Parker SG, Bradburn MJ,et al.The Relationship Between Workforce Flexibility and the Costs and Outcomes of Older Peoples’ Services (COOP). Southampton: National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO); 2010 and Nancarrow SA, Enderby PM, Ariss SM, Smith T, Booth A, Campbell MJ,et al.The Impact of Enhancing the Effectiveness of Interdisciplinary Working (EEICC). Southampton: NIHR SDO; 2012]. Additionally, the impact of different team and staffing structures on patient outcomes and service costs was examined, when possible given the data sets, to enable identification of the most cost-effective service configurations and change over time with service provision. This secondary analysis was placed within updated literature reviews focused on the separate questions.Research objectives(1) To identify those patients most likely to benefit from IC and those who would be best placed to receive care elsewhere; (2) to examine the effectiveness of different models of IC; (3) to explore the differences between IC service configurations and how they have changed over time; and (4) to use the findings above to develop accessible evidence to guide service commissioning and monitoring.SettingCommunity-based services for older people are described in many different ways, among which are IC services and community rehabilitation. For the purposes of this report we call the services IC services and include all community-based provision for supporting older people who would otherwise be admitted to hospital or who would require increased length of stay in hospital (e.g. hospital at home schemes, post-acute care, step-up and step-down services).ParticipantsThe combined data set contained data on 8070 patient admissions from 32 IC teams across England and included details of the service context, costs, staffing/skill mix (800 staff), patient health status and outcomes.InterventionsThe interventions associated with the study cover the range of services and therapies available in IC settings. These are provided by a wide range of professionals and care staff, including nursing, allied health and social care.Outcome measures(1) Service data – each team provided information relating to the size, nature, staffing and resourcing of the services. Data were collected on a service pro forma. (2) Team data – all staff members of the teams participating in both studies provided individual information using the Workforce Dynamics Questionnaire. (3) Patient data – patient data were collected on admission and discharge using a client record pack. The client record pack recorded a range of data utilising a number of validated tools, such as demographic data, level of care (LoC) data, therapy outcome measure (TOM) scale, European Quality of Life-5 Dimensions (EQ-5D) questionnaire and patient satisfaction survey.Results(1) The provision of IC across England is highly variable with different referral routes, team structures, skill mix and cost-effectiveness; (2) in more recent years, patients referred to IC have more complex needs associated with more severe impairments; (3) patients most likely to improve were those requiring rehabilitation as determined by levels 3, 4 and 5 on the LoC (> 40% for impairment, activity and participation, and > 30% for well-being as determined on the TOM scale); (4) half of all patients with outcome data improved on at least one of the domains of the TOM scale; (5) for every 10-year increase in age there was a 6% decrease in the odds of returning home. The chance of remaining or returning home was greater for females than males; (6) a high percentage of patients referred to IC do not require the service; and (7) teams including clinical support staff and domiciliary staff were associated with a small relative improvement in TOM impairment scores when compared with other teams.ConclusionsThis study provides additional evidence that interdisciplinary teamworking in IC may be associated with better outcomes for patients, but care should be taken with overinterpretation. The measures that were used within the studies were found to be reliable, valid and practical and could be used for benchmarking. This study highlights the need for funding high-quality studies that attempt to examine what specific team-level factors are associated with better outcomes for patients. It is therefore important that studies in the future attempt empirically to examine what process-level team variables are associated with these outcomes.FundingThe NIHR Health Services and Delivery Research programme.

Background: Interdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes.Method: This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over 253 staff from 11 community rehabilitation and intermediate care teams in the UK. These data sources were merged using qualitative content analysis to arrive at a framework that identifies characteristics and proposes ten competencies that support effective interdisciplinary team work.Results: Ten characteristics underpinning effective interdisciplinary team work were identified: positive leadership and management attributes; communication strategies and structures; personal rewards, training and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles.Conclusions: We propose competency statements that an effective interdisciplinary team functioning at a high level should demonstrate. © 2013 Nancarrow et al.; licensee BioMed Central Ltd.

Background: The English National Health Service has made a major investment in nine partnerships between\ud higher education institutions and local health services called Collaborations for Leadership in Applied Health\ud Research and Care (CLAHRC). They have been funded to increase capacity and capability to produce and\ud implement research through sustained interactions between academics and health services. CLAHRCs provide a\ud natural ‘test bed’ for exploring questions about research implementation within a partnership model of delivery.\ud This protocol describes an externally funded evaluation that focuses on implementation mechanisms and\ud processes within three CLAHRCs. It seeks to uncover what works, for whom, how, and in what circumstances.\ud Design and methods: This study is a longitudinal three-phase, multi-method realistic evaluation, which\ud deliberately aims to explore the boundaries around knowledge use in context. The evaluation funder wishes to see\ud it conducted for the process of learning, not for judging performance. The study is underpinned by a conceptual\ud framework that combines the Promoting Action on Research Implementation in Health Services and Knowledge to\ud Action frameworks to reflect the complexities of implementation. Three participating CLARHCS will provide indepth\ud comparative case studies of research implementation using multiple data collection methods including\ud interviews, observation, documents, and publicly available data to test and refine hypotheses over four rounds of\ud data collection. We will test the wider applicability of emerging findings with a wider community using an\ud interpretative forum.\ud Discussion: The idea that collaboration between academics and services might lead to more applicable health\ud research that is actually used in practice is theoretically and intuitively appealing; however the evidence for it is\ud limited. Our evaluation is designed to capture the processes and impacts of collaborative approaches for\ud implementing research, and therefore should contribute to the evidence base about an increasingly popular (e.g.,\ud Mode two, integrated knowledge transfer, interactive research), but poorly understood approach to knowledge\ud translation. Additionally we hope to develop approaches for evaluating implementation processes and impacts\ud particularly with respect to integrated stakeholder involvement.

Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

Research aims To document and analyse current operating practices for community palliative care services prior to the introduction of new technologies and changed working practices. Background In line with national priorities, one UK hospice is introducing new technologies to support the redesign of their community services; improve patient experience; and expand service provision. Rather than the existing model of 1:1 community-based nursing by senior specialist nurses, junior nurses will be delegated to deliver palliative care plans under online supervision by specialist palliative care nurses. The technologies provide online access to up-to-date clinical records to support effective team interaction and decision-making, enable point-of-care documenting of observations and care delivery, and immediate access to support from specialist clinicians. This initial study has benchmarked existing community palliative care delivery in preparation for the subsequent operational and financial evaluation of the new service and has: Identified and documented current working practices; Identified and isolated the key costs and benefits of the service; Established current data input and data use; and Assessed current patient outcomes. Methods A mixed methods approach was used to understand a wide range of organisational, economic, and patient-level factors; examine the barriers to, and facilitators of, the implementation of this innovative service modeland explain how and why specific changes are expected to occur. Data has been collected using interviews, focus groups, observation, routinely collected data and documents. Results This presentation will report on the study, including development of an organisational model incorporating proposed changes from the introduction of new technologies. This model will guide the gathering and analysis of evidence to describe the actual changes achieved and explain any differences between these and the anticipated model. Conclusions Developing and evidencing improved efficiency in community-based services poses a number of challenges for providers, requiring significant changes to current practice, together with technology-based enablers.