Living and working in hospital wards
After Hospital Information Systems came Electronic Patient Records. The Department of Health commissioned evaluation research from a multidisciplinary consortium; the Bayswater Institute's task was to look at human and organisational aspects. Our research questions concerned a) the experience of living and working at the implementation sites, and b) the impact on roles, the organisation of work and work satisfaction of staff.
We observed the life and work of four hospital wards: at Burton Hospital (later Queen’s Hospital, Burton-on-Trent) an orthopaedic and a general medical and coronary care ward; at Winchester and Eastleigh two wards for the care of the elderly. And at Wirral Hospitals NHS Trust we observed consultant ward rounds and followed what the consultant arranged through into departments: pathology, radiology, endoscopy, etc. Some findings were:
The computer system
- was more exciting in prospect than in reality
- made many tasks easier
- made you tick categories devised by someone else
- made uncomfortable demands on spelling and grammar
- had a synthesising function
- affected where and when work was done
- was itself subject to various contexts.
Other influences were stronger:
- the clinical condition of the patient (its implications for organisation not always recognised);
- differences in professional cultures;
- the behavioural styles of senior people.
A group of evaluation studies around the professional development of clinicians
- GPs in transition
This was a whole-system evaluation of a scheme to support general practices, young GPs and established GPs in South East London, carried out twice.
The scheme aimed to recruit and attract high-calibre young general pracitioners and develop their commitment to work in local inner city practices; also to provide continuing professional development for both the young and established GPs. Their time was spent working in two or more practices; undertaking a research or teaching project; and taking part in weekly peer support group meetings in the academic home base. Within the practices they replaced an existing partner to enable these to have ‘time out’ for related activities.
The evaluation explored the perspectives of all key stakeholders. The final report was written jointly with the client.
- Evaluation of an inter-professional mentoring scheme within an academic department of a medical school and local Primary Care Trusts
- A study of the evaluation procedures used to assess the quality of medical student teaching in a major teaching hospital
Exploring the impact of digital technology on the success of substance use treatment
Public Health England have commissioned substance use recovery services in Bradford and Darlington as pilot sites to test the benefits of using a customised mobile phone: At each site, participants in an intervention group (n=49) will be allocated a mobile phone through which they will receive daily personalised text messages, and participants in a control group (n=49) will not receive an intervention. This randomised control trial will aim: i) to determine whether digital engagement technology can be implemented within the setting of drug treatment, and ii) to evaluate the impact of this intervention on attendance for treatment, progress, successful completion of treatment and re-presentation to services.
Our role in this pilot study is to oversee the recruitment and randomisation processes for the study in Darlington and to qualitatively explore clients' and staff views about the usefulness and acceptability of using mobile phones as part of the treatment process. We are working with a number of organisations, including Public Health England, NECA Integrated Drug and Alcohol Services, D2Digital by Design, Bradford Bridge Recovery Service and Bradford University. The study is due to finish in summer 2015, with a report due shortly after.
Zetoc is an electronic bibliographic reference system that searches the journal holdings of the British Library. We undertook several studies to evaluate how academics and students made use of the system. The findings made it clear that what users most wanted was a ‘joined-up’ service: an easy way of getting from a reference and an abstract to the full text of an article. The findings have important implications for publishers, libraries and providers of electronic systems.
The Delivery of Integrated Health and Social Care to the Elderly at Home
In an ageing society it is increasingly important that elderly people, often with multiple long-term conditions, are able to live safely at home. There is widespread agreement that the health and social service agencies that support people at home need to work closely together to provide integrated care. But at an operational level this is proving difficult to achieve because it involves many different agencies and disciplines, the development of ‘virtual working’ forms of cooperation and the use of remote technology to facilitate the sharing of information.
The Institute has worked on a number of projects, in part funded by the Mulberry Trust, to identify the challenges of delivering integrated care and to evaluate specific efforts being made to meet this challenge. Our aims are twofold. First, to demonstrate the kind of virtual sociotechnical systems that are capable of delivering integrated care and, second, to provide evidence of the facilitators and barriers in the achievement of this ambition. This is an on-going programme of work that to date has included a survey of the strategies being adopted by 25 local health and social service communities to identify the different approaches being taken. The survey points to strategies that involve organisational change and the Institute has evaluated, for example, the creation of a ‘frail elderly’ pathway in a West Midlands town that seeks to care for people at home who would otherwise need hospital treatment. The strategies being developed for integrated care also include the adoption of telehealth and related technologies for the remote monitoring of patients and the Institute has been associated with the evaluation of several applications of these technologies.
The following publications give details of the work undertaken so far in this programme.
Eason K. D., Waterson P. and Davda P. (2013) The Sociotechnical Challenge of Integrating Telehealth and Telecare into Health and Social Care for the Elderly International Journal of Sociotechnology and Knowledge Development 5(4) 14- 26 http://www.igi-global.com/article/the-sociotechnical-challenge-of-integrating- telehealth-and-telecare-into-health-and-social-care-for-the-elderly/106014
Eason K. D. and Waterson (2014) P.E Patient Safety in Community Care: e-health systems and the care of the elderly at home In Michell V., Gulliver S., Rosenorn-Lang D. and Currie W. (eds) Patient Safety and Quality Dimensions of Health Informatics. IGI Global 198-213
Hoare A. and Eason K.D (2014) ‘A Socio-technical Approach to Evidence Generation in the Use of Video Conferencing in Care Delivery’ International Journal of Sociotechnology and Knowledge Development 6(2) 36-52 April-June: http://www.igi-global.com/article/a-socio-technical-approach-to-evidence- generation-in-the-use-of-video-conferencing-in-care-delivery/114107
Eason K.D. and Waterson P.E. (2013) The Implications of e-health system delivery strategies for integrated healthcare: lessons from the UK and elsewhere. International Journal of Medical Informatics. 85(5) 96-106: Doi:10.1016/j.ijmedinf.2012.11.004
Eason K.D. and Waterson P.E. (2014) Fitness for purpose when there are many different purposes: who are electronic patient records for? Health Informatics Journal 20 (3) 189-198 1460458213501096
Eason K. D. (2014) ‘Afterword: The past, present and future of sociotechnical systems theory’ Applied Ergonomics 45(2A) 213-220 DOI:10.1016/j.apergo.2013.09.017