The first two papers to be presented are especially salient findings of the literature review and may usefully inform the current research, due to their dual focus on the viewpoints of CPs, and the impact of the structural changes and financial difficulties that are unfortunately ongoing within the NHS.
Nutt and Keville (2016) investigated the impact of organisational change such as budget cuts and reorganisation on CPs’ ability to build alliances with colleagues and clients. This paper focused on CPs working in adult, multi-disciplinary, community mental health teams (CMHTs), and specifically reflected upon a theme titled, ‘There isn’t any time for thinking any more,’ which emerged in the lead author’s wider doctoral research.
Eight participants were recruited from different services across the country and were employed at different pay grades, which will have negated potential selection bias to a substantial degree; participants would have naturally had a range of experiences given the varied responsibility of their job roles, and the geographical locations of their service.
Qualitative, semi-structured questionnaires were utilised, and data was analysed using Narrative Analysis, drawing upon the ideas of Mishler (1997), on the construction of professional discourse. Unfortunately, however, the researchers did not provide their
theoretical orientations or personal anticipations, nor that of the chosen methodology, which would have been useful in order to disclose their approach, values, or any assumptions, to the reader. The researchers did offer a useful summary of the validity criteria of this chosen method of analysis (Yardley, 2008), though, and the credibility checks of the first author’s main research were referred to, providing an indication of the quality and reliability of the analysis process.
The theme under consideration was helpfully deconstructed into five distinct categories, which aided the paper in bringing together similar and common participant accounts, while also preserving their nuances. The analysis outlined that change within organisations can result in narratives of struggles for staff, while the impact of organisational pressures was thought to be reflected in participants’ relationships with both their colleagues and clients (Nutt & Keville, 2016). Participants also voiced a sense of feeling distant from personal values. The authors considered how shifting from short-term planning and a focus on efficiency, to long-term thinking regarding relational values, may be of benefit to both staff and service users.
In the wider research that this paper stems from, Nutt (2016) suggested that further research of this kind could explore the experiences of other professional groups in other MDT environments, to capture the experiences of those facing similar changes who could not be included in her research. This, of course, informs the current author’s view that further
research in this area would be valuable, and the current study could supplement literature of this kind from the perspective of a similar group of professionals working in an alternative setting.
Colley, Eccles, and Hutton (2015) also explored CPs’ experience of organisational change within the NHS. This qualitative study utilised a semi-structured interview schedule, which was helpfully designed with the aid of consultation with members of the profession. The authors, however, recruited their eight participants from only one area of the UK, calling into question the generalisability of their results and recommendations. They also did not state their theoretical orientation or assumptions, which would have allowed for a greater understanding of their approach to their research, and perhaps elucidated their analysis further.
The selection process, with a volunteering strategy being employed, may also have engendered a bias whereby the research may have been more attractive to potential
participants who would offer negative reports. Nevertheless, one could argue that participants with more difficult experiences of organisational change are valuable in such a study, as their experiences may be vital to voice in the context of the researchers’ aim to potentially inform and help facilitate positive adaptation to future change, for CPs and other NHS professionals.
Colley et al. (2015) chose Thematic Analysis as their method of analysis, and acknowledged their attempts to avoid their own expectations unwittingly being imprinted upon their results, for example through the use of systematic coding. Three main themes were identified and particular participant reports brought forth in a data- driven narrative ‘Results’ section, providing a sense of coherence to this section of the paper. These themes were: the
challenges the CPs experienced, how their knowledge and skills have helped them cope with change, and what they can take forward from their experiences.
Quotes were embedded within the narrative of the results, which kept the reporting of the themes grounded in the participants’ accounts. A sense of threat to their jobs and careers was reportedly expressed by participants, while ‘stress, frustration, exhaustion and tedium’ were cited as consequences of the pressure caused by needing to do more with less resources.
This seems relevant to settings across the country, including CAMHS, in the context of the previously-discussed, wide-ranging impact of austerity. The experiences of staff in such areas of the NHS therefore require exploration, especially given that they are set up to support significantly vulnerable people, young and old, and their families.
1.6.4.2 Identified papers on the experiences of team and personal factors for health