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. 2019 Jul 24;9(7):e030679.
doi: 10.1136/bmjopen-2019-030679.

Patient experience and reflective learning (PEARL): a mixed methods protocol for staff insight development in acute and intensive care medicine in the UK

Olivia Brookes  1 , Celia Brown  2 , Carolyn Tarrant  3 , Julian Archer  4   5 , Duncan Buckley  6 , Lisa Marie Buckley  6 , Ian Clement  7 , Felicity Evison  8 , Fang Gao Smith  9   10 , Chris Gibbins  7 , Emma Hayton  11 , Jennifer Jones  3 , Richard Lilford  12 , Randeep Mullhi  11 , Greg Packer  11 , Gavin Perkins  13 , Jonathan Shelton  7 , Catherine Snelson  14 , Paul Sullivan  15 , Ivo Vlaev  16 , Daniel Wolstenholme  17 , Stephen E Wright  18 , Julian Bion  19 ; On-behalf-of the PEARL Collaboration
Collaborators, Affiliations

Patient experience and reflective learning (PEARL): a mixed methods protocol for staff insight development in acute and intensive care medicine in the UK

Olivia Brookes et al. BMJ Open. .

Abstract

Introduction: Patient and staff experiences are strongly influenced by attitudes and behaviours, and provide important insights into care quality. Patient and staff feedback could be used more effectively to enhance behaviours and improve care through systematic integration with techniques for reflective learning. We aim to develop a reflective learning framework and toolkit for healthcare staff to improve patient, family and staff experience.

Methods & analysis: Local project teams including staff and patients from the acute medical units (AMUs) and intensive care units (ICUs) of three National Health Service trusts will implement two experience surveys derived from existing instruments: a continuous patient and relative survey and an annual staff survey. Survey data will be supplemented by ethnographic interviews and observations in the workplace to evaluate barriers to and facilitators of reflective learning. Using facilitated iterative co-design, local project teams will supplement survey data with their experiences of healthcare to identify events, actions, activities and interventions which promote personal insight and empathy through reflective learning. Outputs will be collated by the central project team to develop a reflective learning framework and toolkit which will be fed back to the local groups for review, refinement and piloting. The development process will be mapped to a conceptual theory of reflective learning which combines psychological and pedagogical theories of learning, alongside theories of behaviour change based on capability, opportunity and motivation influencing behaviour. The output will be a locally-adaptable workplace-based toolkit providing guidance on using reflective learning to incorporate patient and staff experience in routine clinical activities.

Ethics & dissemination: The PEARL project has received ethics approval from the London Brent Research Ethics Committee (REC Ref 16/LO/224). We propose a national cluster randomised step-wedge trial of the toolkit developed for large-scale evaluation of impact on patient outcomes.

Keywords: behaviour change; empathy; medical care; patient experience; quality improvement; reflective learning; staff experience.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Conceptual model linking theories of behaviour change to those of reflective learning. COM-B, capability, opportunity and motivation influencing behaviour.
Figure 2
Figure 2
PEARL diagnostic framework using the COM-B model. COM-B, capability, opportunity and motivation influencing behaviour.
Figure 3
Figure 3
PEARL project gantt chart. AMU, acute medical unit; CPD, Continuing professional development; HS&DR, Health Services and Delivery Research; ICU, intensive care unit; SWOT, Strengths, weaknesses, opportunities, threats.
See this image and copyright information in PMC

References

    1. Dixon-Woods M, Baker R, Charles K, et al. . Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. BMJ Qual Saf 2014;23:106–15. 10.1136/bmjqs-2013-001947 - DOI - PMC - PubMed
    1. Sheard L, Marsh C, O’Hara J, et al. . The patient feedback response framework–understanding why UK hospital staff find it difficult to make improvements based on patient feedback: a qualitative study. Soc Sci Med 2017;178:19–27. 10.1016/j.socscimed.2017.02.005 - DOI - PMC - PubMed
    1. Mannion R, Davies H. Understanding organisational culture for healthcare quality improvement. BMJ 2018;363:k4907 10.1136/bmj.k4907 - DOI - PMC - PubMed
    1. Martin GP, Aveling EL, Campbell A, et al. . Making soft intelligence hard: a multi-site qualitative study of challenges relating to voice about safety concerns. BMJ Qual Saf 2018;27:710–7. 10.1136/bmjqs-2017-007579 - DOI - PMC - PubMed
    1. Armstrong N, Brewster L, Tarrant C, et al. . Taking the heat or taking the temperature? A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame. Soc Sci Med 2018;198:157–64. 10.1016/j.socscimed.2017.12.033 - DOI - PMC - PubMed

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