JMIR Publications

ABSTRACT

Background:

Abstract Introduction This is a research proposal for a case study to explore how a national organization works in partnership with people with lived experience (PWLE) in national mental health improvement programmes. Quality Improvement (QI) is considered a key solution to addressing challenges within healthcare, and in Scotland there are significant efforts to utilise QI as a means of improving health and social care delivery. In 2016, Healthcare Improvement Scotland (HIS) established the improvement hub (ihub) whose purpose is to lead national improvement programmes which use a range of approaches to support teams and services. Working in partnership with PWLE is recognized as a key component of such improvement work. There is however little understanding of how this is manifested in practice in national organizations. To address gaps in evidence and strengthen a consistent approach, a greater understanding is required to improve partnership working. Methods and analysis An exploratory case study approach will be used in relation to the Personality Disorder Improvement Programme, led by HIS. This research will explore how partnership working with PWLE is described and manifested in practice outlining factors influencing partnership working. Data will be gathered from various qualitative sources and analysis will deepen an understanding of partnership working. Ethics and dissemination Ethical approval has been granted from HIS’ research oversight group, University of Stirling Research Ethics Committee (REC), and the Integrated Research Application System (IRAS). The findings will be completed with a thesis submitted to the University of Stirling and reported in an appropriate journal. Article Summary Strengths and limitations of this study • Data will be collected from a wide range of sources which will provide an indepth exploration of partnership working within one national improvement programme. • This study is led by an insider researcher and there will be opportunities to ensure recommendations from this research will have a direct impact on the national organisation involved. • Close partnership working with people with lived experience to inform the design and analysis of this study is a key strength. • This study is limited in scope and scale as it is a single researcher study. • Recruitment is limited to people who are participating in the improvement programme which is a limitation to the study.

Objective:

The aim of this study is to better understand how a national organisation works in partnership with people who have lived experience in improvement programmes in mental health services, exploring people’s experiences of partnership working in a national organisation. An exploratory case study approach will be used to address the research questions in relation to the PD Improvement Programme: 1. How is partnership working described in the PD Improvement Programme? 2. How is partnership working manifested in practice in the PD Improvement Programme? 3. What factors influence partnership working in the PD Improvement Programme? This research will consist of two phases: the first phase will address the first two research questions through document analysis and observations of meetings within the early stage of the PD Improvement Programme. Semi-structured interviews will be carried out in the second phase of this research to explore participant’s experiences of partnership working, addressing the third research question.

Methods:

Methods In order to address the research aim, it is appropriate to use case study methodology. A case study approach is appropriate when: the focus of the study is on how and why questions; behaviour of participants will not be changed; context is relevant to the phenomenon studied and when there are unclear boundaries between phenomenon and context. Partnership working sits within the wider context, and case study methodology is well placed to understand relationships between context and intervention, with partnership working conceptualised as the intervention in this research. A case study approach will enable a holistic exploration of the complex social processes and mechanisms underpinning partnership working within QI. Data will be collected from a wide range of qualitative sources – including document data, participant observations and semi-structured interviews. This study will be conducted in two phases. In phase one of this case study, data will be collected from organisational documents followed by non-participant observations of key programme meetings. This data will help explore how partnership working is described, defined, and manifested in practice. This will be followed in phase two with semi-structured interviews with key participants to explore their experiences of partnership working in the programme. Phase one: Document data In the first phase of data collection, analysis of organisational documents will be used to provide an understanding of plans, infrastructure and frameworks used to support partnership working with PWLE. It is anticipated that documents may include: commission agreements; planning papers; minutes of key meetings; presentations or diagrams describing the programme infrastructure and partnership working in the programme. Further documents relevant to the study may emerge and will be included as appropriate. Themes developed from the document review will be included in the structure of observations and used to develop the interview proforma in the second phases of the research. Phase one: Non-participant observations Following document analysis, non-participant observations of improvement programme meetings will be used to gather data on how partnership working with PWLE in the PD Improvement Programme is manifested in practice. Meetings observed will be chosen based on a purposive sample and there will be between three and six observations completed. A framework for partnership working will be used to guide observations. This framework consists of four key dimensions of partnership: process; actors (identify and position); decisions; and power relationships. Although the use of this framework provides some structure to the observations, a form of semi-structured observation will be adopted to allow for some naturalistic observations and include themes identified in the document analysis. Non-participant observation will allow observation of the environment, language, non-verbal data, and interaction in partnership working. General context will be noted for each observation including: location; time; duration; meeting roles and purpose of the event or meeting. Phase two: Semi-structured interviews The final stage of data gathering will be semi-structured interviews with participants from the PD Improvement Programme, including people across disciplines and PWLE. Interviews will be used to gain an understanding of participant’s experience and perceptions of partnership working with PWLE. A schedule for interviews will be prepared from themes developed from the document review and observations. The interview proforma will be developed with a PWLE working as a public partner in HIS to ensure questions are relevant and likely to receive meaningful responses. All interviews will follow the schedule developed as an aide memoire however, it is important to allow flexibility to adapt to each participant’s response to allow exploration of emerging and reported experiences. Interviews will be held in a location agreed by the researcher and participant and may be face to face, online via MS Teams or via telephone. All interviews will be recorded and transcribed. The population within this case will include a purposive sample of staff and PWLE who are involved and contribute to the work of the PD Improvement Programme. It is anticipated that this will be between 6-8 interviews. Participants will include clinical and improvement staff working directly on the PD Improvement Programme operating at different levels of the organisation, and PWLE working with the PD improvement programme. This should ensure diversity within perspective gained from the interviews.

Results:

As this paper is a protocol there are no results at this stage. Data will be gathered from a range of qualitative sources and data analysis will organise, find patterns, and elicit themes to help deepen an understanding of partnership working within the national PD improvement programme. Various mechanisms for quality assurance within this research including the use of a reflexive field diary, discussions with supervisor and member checking where participants can check transcriptions following observations and interviews. During analysis, there will also be regular meetings with a public partner working in HIS to review and discuss themes to check emerging findings and the researcher’s interpretation, as a form of participant validation to improve scientific rigour.

Conclusions:

This study will produce new knowledge on ways of working with PWLE and will have practical implications for all improvement focussed interventions. Though the main focus of the study is on national improvement programmes it is anticipated that this study will contribute to the understanding of how all national public service organisations work in partnership with PLWE of mental health care Clinical Trial: Ethical approval has been granted from HIS’ research oversight group, University of Stirling Research Ethics Committee (REC), and the Integrated Research Application System (IRAS) via the Queen Square Research Ethics Committee (for phase one); and Black Country Research Ethics Committee (for phase two). Registration details REC ID – 4256. IRAS ID – 318323 (phase one) 309926 (phase two).