Background
Methods
Design
Participants / study population
Intervention
Procedure
Planned data collection
Planned analyses
Results
Participants and intervention focus
Vanguard | Aim of new model of care | Organisation partners | Local population reach [4] | Team(s) | Health professional participants | Behavioural focus of the intervention |
---|---|---|---|---|---|---|
A | Integrated primary and acute care systems vanguard: Multi-disciplinary integrated care | 5 partners (incl city council, hospital and mental health trusts, CCGs) | 230,000 | Integrated health and social care team in an older adult acute mental health unit. | n = 36 (29 women, 7 men) 10 Trainee/qualified nurses 6 Vanguard leads/senior managers 6Nursing/activity assistants 3Trainee/qualified physiotherapists 3 Medical doctors 2Trainee/qualified psychologists 2Trainee/qualified occupational therapists 2 Ward managers 1 Speech and language therapist 1 Ward clerk | Increasing the effectiveness of multi-disciplinary integrated working: Ward team instigating more cross-disciplinary recovery-focussed activities with patients. |
B | Integrated primary and acute care systems vanguard: Multi-disciplinary integrated care | 11 partners (incl NHS trusts, ambulance services, CCGs, local authorities, GP federations) | 356,000 | Integrated children’s nursing community team | n = 10 (9 women, 1 man) 3 Vanguard leads and senior vanguard managers 3 Team leaders 3 children’s specialist nurses 1 service director | Enhancing use of a new integrated service: Increasing referrals from acute staff to a new specialist holistic children’s nursing team |
C | Multi-specialty community providers vanguard: Moving specialist care into the community | 6 partners (incl local councils, hospital trusts and CCGs) | 320,000 | Heart failure specialist team. | n = 15 (14 women, 1 man) 5 Heart failure specialist nurses (3 acute and 2 community nurses) 2 Administrators 2 Healthcare assistants 2 OD practitioners 1 Vanguard lead 1 Clinical lead doctor 1 Psychologist 1 Physiotherapist | Moving specialist care into the community: Acute heart failure team beginning to run one clinic in the community per week. Community heart failure team redirecting non-specialist referrals back to primary care to increase capacity |
D | Acute Care Collaboration Vanguard Site: New care pathways through a network for women and children’s services and engaging more with local helping people to help them better manage their own health. | 29 organisations and networks (incl CCGs, hospital providers, and an ambulance service) | Up to 2.4 million | Community midwifery team. | n = 20 (20 women) 13 Community midwives 5 Team leads /senior midwives 1 Vanguard lead 1 Clinical lead midwife | Increasing the prevention and self-management role of midwives: Community midwives starting to offer the ‘flu vaccination to every pregnant woman in their care. |
Data collected and analysed
Study time point
| |||||||||||||||||
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T1: Enrolment | T2:Intervention design | T3:Intervention implementation | T4:Post-intervention evaluation | ||||||||||||||
Vanguard
|
A
|
B
|
C
|
D
|
A
|
B
|
C
|
D
|
A
|
B
|
C
|
D
|
A
|
B
|
C
|
D
| |
Qualitative data | Discussion/focus groups | n = 6 | n = 5 | n = 14 | n = 3 | n = 14 | n = 19 | n = 1 | |||||||||
Individual interviews | n = 2 | n = 2 | n = 2 | n = 2 | n = 27 | n = 1 | n = 13 | ||||||||||
Written communication and field notes | 5 pieces | 40 pieces | 22 pieces | 26 pieces | 12 pieces | 10 pieces | 15 pieces | 4 pieces | |||||||||
Observation data | n = 32 | n = 2 | |||||||||||||||
Quantitative data | Questionnaires | n = 5 | n = 15 | n = 2 | |||||||||||||
Audit of team practice | 1 audit | 1 audit | |||||||||||||||
Routinely-collected data | 1 set | 1 set |
Intervention delivery and outcomes
Vanguard A | Vanguard C | Vanguard D | |
---|---|---|---|
Summary of intervention focus
| Integrated care in psychiatric ward | Moving heart failure care to community | Midwives offering preventive ‘flu vaccine |
Relevant psychological determinants identified (C, O or M)
| C, O and M | Community sub-team: O Acute sub-team: O and M | C and O |
Intervention functions proposed
| Persuasion Environmental restructuring Training | Enablement Environmental restructuring Persuasion | Training Environmental restructuring |
Relevant policy categories
| Environmental/social planning Service provision Guidelines | Communication/marketing Environmental/social planning Service provision | Service provision Environmental/social planning |
1. Information about health consequences 2. Information about social and environmental consequences 3. Instruction on how to perform behaviour 4. Demonstration of behaviour 5. Action planning 6. Restructuring physical environment 7. Restructuring the social environment 8. Reviewing behavioural goals |
Community sub-team:
1. Behavioural substitution 2. Social support (practical) 3. Adding objects to the environment
Acute sub-team:
4. Feedback on behaviour 5. Behavioural experiment. 6. Action planning 7. Environmental restructuring | 1. Adding objects to the environment 2. Demonstration of behaviour 3. Instruction of how to perform the behaviour |
Feasibility themes
Qualitative data is most feasible
Making behavioural science attractive
‘I don’t think we need this programme as our teams are all fully integrated’ Vanguard lead, written communication from HEENW.
‘It will be a real help, we just need to persuade them that’s what they need and it’s not management mumbo-jumbo: clinicians have a natural distrust for behavioural methodology … also a ‘phone chat’ may be more appealing than calling it interviews’ Vanguard B lead, T1, individual interview.
‘These materials are very helpful for homing in and clarifying..we can pair the programme with an existing innovation and project’. Vanguard C Lead, T1, individual interview.
‘So this behaviour change wheel helps you make a programme to help the staff but what is going to happen and who is going to actually do it and evaluate it – is there support? We’d worry about sustainability.’ Vanguard A senior manager, T1, focus group meeting.
Key mediators: Co-development and a behavioural focus
‘It was so important that the staff wanted to focus on activities and rehab …. it came from the staff and the away days in particular helped bring out the importance of recovery for people and get their own ideas out for how to change things … it sparked new ideas that we could work on. Now everyone is spurred up and their ideas are brilliant’ Vanguard A ward manager, T4, individual interview.
“They [away days] were definitely beneficial, no doubt about it, it gave some structure and a forum in which to say that that is what everybody wants to do, everybody has got their own things that they think should be happening and it gave everybody a place to voice their ideas.” Assistant Occupational Therapist, Vanguard A, T4, individual interview.
“Teams Together helped me define what we have to do into just two or three changes” Clinical lead, Vanguard C, T3, written communication.
‘It is more about the decision making, we all know what we need to do but it’s how to get there that is a problem’. Vanguard Lead B, T1, individual interview.
Ongoing communication with teams
Support from engaged leaders
“It was quite overwhelming when you first came.. it was just me … .my thoughts about what they might say to you, whether it would be all negative when you spoke to them, whether it would work and they would be better or if it wouldn’t work and things would get worse. But in fact it’s been the opposite, it’s all been really positive” Vanguard A manager, T4, individual interview.
‘There has not been a leader … .someone more senior who would have led it and chased it up and that … .someone who is here all the time … chasing it up, making sure it is being done daily until everybody gets into that rhythm’. Healthcare assistant, Vanguard A, T4, individual interview.
“I mean I think they were actually really keen for you to do the, from a midwifery perspective, that follow-up training you were going to do with them. It has definitely been the added time pressure constraints … they’ve just been unlucky in terms of a number of things that have factored in with extra training they had to do these last few months, a lot of pressure” Vanguard D lead, T3, individual interview.
“I think it’s good to have a psychologist taking on that role. I think just because you can see things from different angles and understand … being able to engage with people and make them feel comfortable to talk to [ …] having a wider understanding I think of teams and team dynamics is useful.” Nurse vanguard A, T4, individual interview.