POTENCIA TOTAL INSTALADA SUBCUADRO SQP1

The findings from case study 1a were mapped for evidence of professional and organisational impact using the Dimension of Impact framework (chapter 3, section 3.5). An example of the framework mapped for case study 1a is included (see Table 6.2).

Professional impact

This domain has four indicators that focus on CTR impact on other healthcare professionals:

Professional competence

Within this case study site, the CTR was perceived to impact on the competence and confidence of other healthcare professionals. Perceived impact was evident through examples such as providing encouragement and support to the Advanced Practitioner (AP) in developing their practice. The CTR’s wealth of knowledge also impacted on staff, specifically the SpR’s who perceived that the CTR’s depth of knowledge aided their learning. Furthermore, the wealth of knowledge was important for the CTR to push boundaries and be influential with others. The CTR also recognised the importance of their role in educating others.

Quality of working life

Participants perceived the CTR role could potentially impact on aspects such as, morale, motivation and job satisfaction. For example the AP perceived that the CTR role had the ability to motivate staff, drive research forward and input in decision making processes. Also, interviews with participants perceived that the CTR role has the opportunity to provide good career progression that can enhance staff morale and aid in recruitment and retention.

Professional social significance

Perceived impact on the workload by the CTR was evident in this case study site. Participants perceived the role helped ease the work pressures of the Clinical Oncologist. Furthermore, the CTR was seen to aid the overall workload by organising their own patient lists and devoting time to consider service improvements.

Professional social validity

The CTR role had a positive impact on team working; for instance participants viewed the CTR was part of the team and integral within it. In addition being established within a team setting such as a MDT, the CTR role was useful in developing key networks and relationships, for instance with the surgeons.

Organisational impact

This domain comprises of three indicators which relate to CTR impact on organisational issues.

Organisational competence

Within this case study site, the CTR role was appointed with the responsibility to identify gaps in service. Perceived impact was seen in improving services on rehabilitation and post-treatment within the department. Furthermore interview participants perceived the CTR role made a positive impact on reducing patient waiting times and increasing the number of patient consultations therefore enhancing the service. The CTR also perceived that their role was cost effective for the service.

Organisational social significance

The CTR reported perceived impact through involvement at a Cancer Network level. For example collaborating with external staff in publishing national recommendations, for the management of late effects, therefore informing practice. Furthermore, by attending conferences the CTR was perceived to impact knowledge generation by updating and informing staff through organising study days and CPD sessions on new developments in practice in other departments.

Organisational social validity

Perceived impact was evident in the CTR’s engagement in various external activities. For instance, the CTR was appointed as Chair for the local Cancer Network and was involved in collaborations with the Department of Health and local cancer charities. Overall involvement in the activities was perceived as positively raising the profile of the department.

Table 6.2 Dimensions of Impact Framework Mapping for Case Study Site 1a

Professional impact:

Domains Indicators Examples of impact

Professional Competence Impact on confidence and competence of healthcare workforce (e.g. effecting knowledge, skills, behaviour, attitudes)

“(CTR) has a wealth of knowledge and leads from the front and has pushed the boundaries every time and at every point.” (Adv.Prac1a) “I was very dependent on (CTR) to help, encourage and support me whilst I was advancing my practice and (CTR) supported me in developing my practice.” (Adv.Prac1a)

“The registrars they find it quite useful to have someone that they can go to for training that’s not their consultant,their medical consultant because they know we have quite a depth of knowledge and we know how the medical oncologists function. Uhm so, they sort of utilise, they tap into us, a lot I think” (CTR1a) “You know, I think that is very integral to our role is looking at the education of others around us” (CTR1a) Quality of

working life

Healthcare workforce on the perspective on the impact on the quality of their working life arising from the practitioner

intervention (e.g. job satisfaction, morale and motivation.

“(CTR) has the ability to motivate research, the staff and influence the decision making process within the department” (Adv.Prac1a) “You’re looking at uhm having a good career progression; it attracts people into the profession if they know there is a route to go.” (CTR1a)

“I am very supportive obviously but I think it’s more supportive of the people who are good and because there’s a career progression.” (Clin.Onc1a)

Professional social

significance

Extent to which the practitioners

interventions are important to

professional outcomes e.g. workload, work distribution, turnover across the workforce.

“The role has taken a lot of pressures off the Oncologists and made their workload more manageable. And, certainly, for the service as a whole information and support, treatment, providing support for patients with problems was a gap in the service, identified by (CTR) and service developed to address this” (Adv.Prac1a) “At the new patient clinic (CTR) sees them consents them, discusses the adjuvant treatment with them and then, you know consents them so basically does it without a seeing a doctor. The patients don’t see a doctor at all. Um... and (CTR) has own list of patients” (Clin.Onc1a) “The oncologists don’t have time to look at where the gaps are but (CTR) has really evolved the service.” (Adv.Prac1a) Professional

social validity

Social importance and acceptability of the intervention for the healthcare workforce and whether the interventions address important problems that healthcare staff encounter e.g. teamwork

“We work very closely with (CTR) an integral part of the team, so yeah; (CTR) is

a central part of the team.” (SpR1a)

“(CTR) has got a very close relationship with the surgeons as in the (speciality) surgeons. (CTR) comes to the MDT, is fairly well-known in our hospital and our department with the (site) special interest (SpR1a)

Organisational impact:

Domains Indicators Examples of impact

Organisational competence

Extent to which

practitioners contribute to an efficient and effective organisation in terms of business concerns of finance, governance and legal requirements

“Uhm for me it was very clear that our (speciality) patients had a very poor service. There was more and more evidence coming out that patients did better, from a survivorship point of view, if they had information on rehabilitation, post-treatment and that wasn’t happening. So, uhm, I sort of identified this. I did a report. Sent it to the Trust and as a result of that, they allowed me to focus on the (speciality) patients. Uh, so my role really grew from a service need. So we’d identify that there was a gap in the service” (CTR1a) “New patients probably don’t have to wait as long as if (CTR) wasn’t here. Because otherwise, they would have had to just come into our new patient slots. So actually, (CTR) often has a few more free slots to see them quicker” (SpR1a) “I think from a financial costing point of view, we are actually quite cost effective in the, you know some of the roles that I do would have to be done by uhm the very least a registrar. So, if you’re looking at the balance of-of costing per session, then we do work out cheaper but it doesn’t always work like that” (CTR1a) Organisational

social

significance

This concerns policy objectives relating to organisation e.g. national and local priorities,

contributing and

developing policies and generating new

knowledge

“The vision of the CTR role being uhm network-wide responsibility. So I take on the (speciality) support, throughout the (location) Cancer Network. So it was – their vision was that the role can be rolled out if you like across all of

the whole of the Cancer Network.” (CTR1a) “I’m working with the uhm, National (speciality) nurse for their consequences

of treatment group and by the end of next– end of this year, we want to have published national recommendations on management of late effects.

(CTR1a) “In some ways (CTR) has got strong interests, and going to these conferences not only to talk but to absorb what other people are doing, it does keep us up-to-date in some ways, like the late effects. So, (CTR) arranging a one-day talk on the late effects of GI, late effects from radiotherapy. So, we then benefit from knowing what (CTR) learnt from other centres” (CTR1a)

Organisational social validity

Social importance and acceptability of

practitioner intervention for the organisation and whether the interventions address important issues for the organisation and whether the outcomes are meaningful to the

organisation in terms of achieving its core values.

“As the CTR I am also the chair of the (location) Cancer Network (speciality) Group. Uhm we look at policies and procedures across the whole of the network, information delivery, and we’re really, obviously, we’re a cancer centre so I get patients referred in from all across the region for specific information” (CTR1a) I’m working with Department of Health and (Cancer Charity) I’m looking at survivorship and late effects. I ideally like to establish is a very recognised pathway. Uhm, again, across the networks, I want to identify (speciality) within the cancer network and es-establish a multi-disciplinary team and to manage late effects. And as I say, uhm, uh, the Department of Health and (Cancer Charity) have identified this is one of their top three uhm, projects to put money into as well so, I’m working quite closely with the” (CTR1a)

6.5

CASE STUDY SITE 1B