Rod Sheaff

BackgroundDifferent dementia support roles exist but evidence is lacking on which aspects are best, for whom, and in what circumstances, and on their associated costs and benefits. Phase 1 of the Dementia PersonAlised Care Team programme (D-PACT) developed a post-diagnostic primary care-based intervention for people with dementia and their carers and assessed the feasibility of a trial.AimPhase 2 of the programme aims to 1) refine the programme theory on how, when, and for whom the intervention works; and 2) evaluate its value and impact.Design & settingA realist longitudinal mixed-methods evaluation will be conducted in urban, rural, and coastal areas across South West and North West England where low-income or ethnic minority populations (for example, South Asian) are represented. Design was informed by patient, public, and professional stakeholder input and phase 1 findings.MethodHigh-volume qualitative and quantitative data will be collected longitudinally from people with demen...

Background Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to te...

‘Dementia - Personalised Care Team’ (D-PACT) is a five-year NIHR funded programme, using realist methods to develop and evaluate a complex, person-centred intervention for people with dementia and their carers. During the early project stages, we engaged with multiple stakeholders, including people with dementia and their carers, to develop an initial programme theory (IPT) – into an elaborated programme theory (EPT), by helping to uncover intervention mechanisms leading to outcomes in specific contexts. Realist research methods for developing programme theories are under-reported. In addition, there is a paucity of practical guidance on how to engage underserved and vulnerable populations in complex interventions programme theory development. We attend to these gaps, providing a worked example of how we meaningfully engaged people living with dementia and carers, alongside field experts, as stakeholders in this process. Our IPT theory building included multi-stakeholder primary research exercises and meetings with PPI contributors and an Expert Reference Group. We adapted interview schedules, and used visual resources and scenario-based activities, to support stakeholders to think in a ‘realist’ way. Using realist and thematic analyses led to hypothesis-building of causal mechanisms. Sharing findings with stakeholders led to further refinement of the intervention design, ready for testing in a subsequent feasibility study. We found that, despite the cognitive challenges associated with dementia, innovative methods of engagement can enable this stakeholder group to understand the realist approach and provide a platform through which to share their experiences. Taking a highly flexible and unhurried approach, led to novel insights into the complexities of person-centred dementia support. We argue for more detailed methodological guidance, based on realist principles, on how to collaborate with underrepresented populations to rigorously gain insights as to what is likely to make a difference and refine initial programme theory.

This chapter presents a synthesis of a research project funded by the British National Health Service (NHS) Service Delivery and Organization (SDO) R and D Programme of Research on Organizational Form and Function that addresses the relationship between organizational form and performance (Sheaff et al. 2004) using a meta-analysis of the literature. Readers are referred to the full report for a comprehensive coverage of all sections. This chapter describes briefly the structure of the overall project paying particular attention to one analytical element — namely, what the evidence says about the nature of organizational structure and healthcare. The discursive focus concerns the issue of organizational size as a specific element of organizational structure.

Models of the health policy process have largely developed in isolation from political studies more widely. Of the models which Powell and Mannion’s editorial considers, a stages model of the policy process offers a framework for combining these specifically health-focused models with empirical findings and more general explanatory models of the policy process drawn from other political studies. This commentary uses a stages model to assemble a bricolage which combines some of these components. That identifies a further research task and suggests ways of revealing in more life-like ways the politics involved in the health policy process: that is, how that process channels wider, often conflicting, non-health interests, actors, policies, conflicts, ideologies and sources of power from outside the health system into health policy formation, and introduces non-rationality.

The first file shows the data extraction intrument used to collect data from medical records on the implementation of NICE and CQUIN norms. The second file shows the semi-structured interview schedule used to interview medical professionals about hospital compliance wit hthe 2010 NICE guidance.

Inter-organizational networks have proliferated in health systems, as has network research, but coherent explanations relating the varieties of health network to their respective structures, activities and outcomes remain lacking. Focusing on their core productive processes and their governance structures, this chapter contrasts care networks with program networks. It compares these concepts with findings from some primary research on NHS health networks during 2005–10, and notes some implications for network theory and research. NHS networks’ dense, flat structures reflect these networks’ dual function as both care and as program networks. These findings are relevant to the “integrated care” networks developing in many health systems. The development of these networks appears, partly, to be a workaround for the obstacles that market and quasi-market health systems place in the way of coordinating complex care across multiple separate providers.

Realist evaluation has become widespread partly because of its sensitivity to the influence of contexts on policy implementation. In many such evaluations, the range of contexts considered relevant nevertheless remains disparate and under-conceptualised. This article uses findings from a realist evaluation of English Patient Safety Collaboratives during 2015–2018 to develop a realist taxonomy of contexts, differentiating contexts according to how they affect the corresponding policy mechanism. By analysing the main context-mechanism-outcome configurations that made up the English Patient Safety Collaboratives, we derive a taxonomy of the contexts that affected implementation and outcomes. The categories of context were structural (network, hierarchy, market and organisational contexts); resource-based (actors, material, financial); motivational (receptivity, outcome headroom), and temporal (continuity, history and convergence). To the categories found in previous studies, this study...