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Patient experience and reflective learning (PEARL): a mixed methods protocol for staff insight development in acute and intensive care medicine in the UK
  1. Olivia Brookes1,
  2. Celia Brown2,
  3. Carolyn Tarrant3,
  4. Julian Archer4,5,
  5. Duncan Buckley6,
  6. Lisa Marie Buckley6,
  7. Ian Clement7,
  8. Felicity Evison8,
  9. Fang Gao Smith9,10,
  10. Chris Gibbins7,
  11. Emma Hayton11,
  12. Jennifer Jones3,
  13. Richard Lilford12,
  14. Randeep Mullhi11,
  15. Greg Packer11,
  16. Gavin Perkins13,
  17. Jonathan Shelton7,
  18. Catherine Snelson14,
  19. Paul Sullivan15,
  20. Ivo Vlaev16,
  21. Daniel Wolstenholme17,
  22. Stephen E Wright18,
  23. Julian Bion19
  24. On-behalf-of the PEARL Collaboration
    1. 1 Research, Development & Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
    2. 2 Warwick Medical School (WMS), The University of Warwick, Warwick, UK
    3. 3 University of Leicester, Leicester, UK
    4. 4 Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
    5. 5 Peninsula College of Medicine and Dentistry, Plymouth, UK
    6. 6 Birmingham, UK
    7. 7 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
    8. 8 Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
    9. 9 Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
    10. 10 Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK
    11. 11 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
    12. 12 Division of Health and Population Sciences, University of Warwick, Coventry, UK
    13. 13 Clinical Trials Unit, University of Warwick, Birmingham, UK
    14. 14 Critical Care, University Hospital Birmingham, Birmingham, UK
    15. 15 CLAHRC, Imperial College, London, UK
    16. 16 Warwick Business School, Coventry, UK
    17. 17 NIHR CLAHRC Yorkshire and Humber, Sheffield, UK
    18. 18 Anaesthesia, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
    19. 19 Intensive Care Medicine, University of Birmingham, Birmingham, UK
    1. Correspondence to Ms Olivia Brookes; Olivia.Brookes{at}uhb.nhs.uk

    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.

    • behaviour change
    • empathy
    • medical care
    • patient experience
    • quality improvement
    • reflective learning
    • staff experience

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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    Footnotes

    • Contributors OB as project manager and collaborator will manage the day-to-day running of the project under the CI, managing governance and study set-up, processing, analysis and presentation of study findings. CB has a strong academic background in pedagogical research at the University of Warwick, and is the lead for medical education and reflection in PEARL, workstream 4. She will contribute to our understanding of how reflection is used to achieve learning. CT is Associate Professor in Health Psychology and Joint Group Lead of the SAPPHIRE group at the University of Leicester. She is the lead for the ethnographic workstream (workstream 3), directing a group of ethnographers making original observations of practice. JA is Professor in Medical Education Research at the University of Plymouth. He is our expert on multisource feedback, advising on how to convert feedback into effective reflection. DB and LMB are patient and relative representatives with extensive experience of the totality of the emergency care pathway. They will provide insights into patient-staff interactions. IC is an intensive care consultant at Newcastle Upon Tyne NHS Trust. He will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. FE is the statistician for the project and will oversee the quantitative analysis from the patient and staff survey instruments. FG Smith is the local lead for the intensive care unit at Heartlands Hospital. She will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. CG is consultant in Acute Medicine at Newcastle Upon Tyne NHS Trust. He will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. EH is the Acute Medicine lead at Heartlands Hospital. She will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. JJ is the ethnography research fellow, organising and collating information from interviews and near-patient observations, and responsible for the analysis of qualitative data. RL is the PEARL methodologist advising on study design. RM is the local lead for the intensive care unit at the Queen Elizabeth Hospital. She will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. GP is the trainee representative for the project, also part of the intensive care local team at Queen Elizabeth Hospital. He will analyse data from the GMC survey. GP is Professor of Intensive Care Medicine at the University of Warwick, and is the lead for debriefing and feedback in PEARL. JS is an intensive care consultant at Newcastle Upon Tyne NHS Trust. He will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. CS is the Acute Medicine lead at the Queen Elizabeth Hospital. She will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. PS represents the Society of Acute Medicine in PEARL, and provides expertise in quality improvement in acute medicine. IV is Professor of Behavioural Sciences at the University of Warwick. He advises the PEARL project on behaviour change theory and techniques, and will lead this aspect of the toolkit development. DW is the co-design facilitator who will lead the co-design workshops and help with the design of the toolkits. SEW is the senior intensive care consultant at Newcastle Upon Tyne NHS Trust. He will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. He also advises the project on the family satisfaction survey. JB is the Chief Investigator responsible for the overall design, management and conduct of the study with extensive experience in health services research, pedagogical development and intensive care medicine.

    • Funding This project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (Ref 14/156/23). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

    • Competing interests None declared.

    • Ethics approval The PEARL projecthas received ethics approval from the London Brent Research Ethics Committee(REC Ref 16/LO/224).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators The PEARL Collaboration:J Willars; C Higenbottam; F Wyton; E Fellows; K Moss; L Cooper; L Flavell; J Flavell; J Raeside; M Hawkesford; H Laugher; T Jones; S Nevitt; K Naylor; J Sampson; J Mann; S Ballinger; T Melody; G Buggy; L Linhartova; J Thompson; S Majid; P Diviyesh; P Thorpe; A Shaha; R Carvell; A Joshi; K Kneller; H Halliday; C Iles; I O’Neil; G Yeoman; C Randell; H Korovesis; C Scott; H Doherty; K Protheroe; E Swann; L Dunn; K McCourt; S Perks; T Chakravorty; C Grindell; R Bec; L Duffy; E Tracey, C Nee; S Vince; I Barrow; N Alderson; C Straughan; K Cullen; I Spencer; M Thomas

    • Patient consent for publication Not required.