Establishing Research Priorities to Improve Fundamental Care in Hospital Wards
Despite the NHS's commitment to quality care, fundamental care is not always provided to the proper standards that patients deserve. From high-profile cases to various reports, it is evident that there are substantial variations in the quality of fundamental care offered to patients in NHS hospitals. Different factors contribute to the failures of primary care, including staffing levels, leadership, motivation, training and organizational culture.
As evidenced in the fundamentals of nursing, basic care is essential and should be provided to the highest standards. Different initiatives have been proposed to improve the capacity of healthcare professionals to deliver safe and quality fundamental care; these range from guidelines of specific aspects of care to organizational initiatives such as reporting quality improvement programs like the productive ward or adverse events such as the safety thermometer. However, there is little research evidence demonstrating the impact of these initiatives. Only a few studies of nursing interventions use robust methodologies that apply the results to other contexts.
Determining research priorities
Previously, health research was left to researchers' discretion; different factors determined or influenced the choice of the research priorities. After the study, the NHS was criticized for lacking strategy and transparent leadership. To remedy this, a group of experts, normally academics, convened to establish research areas to inform funding decisions.
Other people, including the patients and healthcare providers, were absent from these discussions. As a result, the research and development funding in the NHS was still locked into the historical allocations and not focused on where it was needed. In 2006, the National Institute for Health Research was formed to improve coordination in health research funding.
The NIHR allowed the patients and public to take part in every aspect of publicly funded health research. For example, they had a voice in prioritizing research topics and awarding research funding. A major challenge in exploring research priorities in fundamental care is a lack of natural constituency of patients or providers, as there is, for example, in schizophrenia or Parkinson’s disease.
Today, there is broad agreement that research priority-setting processes can result in greater relevance, but there are still no precise methods to conduct the research. But, how priority setting is done and the methods involved can determine the process's results. In 2004, the James Lind Alliance developed an approach called priority-setting partnerships, which involved both patients and healthcare professionals. All partnerships have the same guiding principles and involve a three-step process; survey, interim priority exercise, and final prioritization exercise. The second stage is an online process, while the third stage takes face-to-face.
Although all partnerships have the same set of common principles, each Priority Setting Partnership is considered potentially different. The governing principles of priority setting partnership include exclusion of groups such as pharmaceutical companies since they have competing interests, the inclusion of patients and clinicians, exclusion of non-clinician researchers, and recognition that priority setting is a form of shared decision making and does not create new knowledge.
The JLA has guided more than 40 priority-setting partnerships between 2007 and 2014, but comparisons between identified research priorities showed a mismatch between the different stakeholders.
Developing an inclusive approach to research prioritization
For this six-phase approach, the project team consisted of an experienced patient leader, two researchers, and a Patient and Public Involvement Lead. A patient leader is a patient or service user who works with the people to influence decision-making at a certain level. Including the Patient and Public Involvement Lead and a patient ensured all aspects of the process were viewed from a patient and public perspective. The whole team had to be involved and agree before any decisions were taken. Below are the six main phases of the approach.
- The conceptual framework; involved identifying and defining terms such as fundamental care and exploring all the topics it encompasses. From this exploration, it was evident that different perspectives of fundamental care influence how we think about care and the language used to capture it.
- Consultation. We identified various issues to improve fundamental care through group and individual discussions with stakeholders and online surveys.
- Analyzing the responses to the consultation phase to identify emerging themes and develop a coding frame.
- Quantifying the most frequently mentioned theme and identifying the ones which patient-public respondents highly prioritized in contrast to service providers.
- Identifying the relative priority of the 15 shortlisted topics and considering the top five research areas more closely through small group discussions.
- Identifying how the top five research priorities can be developed as research topics.
Priority-setting exercises democratically inform the work of researchers.