Browsing by Person "Baldie, Deborah"

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A realist inquiry to identify the contribution of Lean Six Sigma to person-centred care and cultures
(MDPI, 2021-10-03) Teeling, Sean Paul; Dewing, Jan; Baldie, Deborah
A lack of fidelity to Lean Six Sigma’s (LSS) philosophical roots can create division between person-centred approaches to transforming care experiences and services, and system wide quality improvement methods focused solely on efficiency and clinical outcomes. There is little research into, and a poor understanding of, the mechanisms and processes through which LSS education influences healthcare staffs’ person-centred practice. This realist inquiry asks ‘whether, to what extent and in what ways, LSS in healthcare contributes to person-centred care and cultures’. Realist review identified three potential Context, Mechanism, Outcome configurations (CMOcs) explaining how LSS influenced practice, relating to staff, patients, and organisational influences. Realist evaluation was used to explore the CMOc relating to staff, showing how they interacted with a LSS education Programme (the intervention) with CMOc adjudication by the research team and study participants to determine whether, to what extent, and in what ways it influenced person-centred cultures. Three more focused CMOcs emerged from the adjudication of the CMOc relating to staff, and these were aligned to previously identified synergies and divergences between participants’ LSS practice and person-centred cultures. This enabled us to understand the contribution of LSS to person-centred care and cultures that contribute to the evidence base on the study of quality improvement beyond intervention effectiveness alone.
Community Chaplaincy Listening in a community mental health group
(Equinox Publishing Ltd., 2019-04-26) Gibbon, Alan; Baldie, Deborah
Method: This was a pilot service evaluation, evaluating the impact of CCL on a Patient Reported Outcome Measure (PROM) with 12 participants, all of whom attended a mental health support group. All participants attended an individual CCL session and received a maximum of two sessions of CCL and a minimum of one. Participants were asked to complete the Scottish Spiritual Care PROM; a questionnaire with both preset questions and a general free text box two weeks after engaging with the CCL. Summary statistics were conducted on the PROM survey responses to understand people's experiences of the service and its perceived personal impact. CCL is evaluated as beneficial by all who received it in this study. It has the potential to increase people's positive outlook, which was a reported outcome from ten people participating in this study. Larger scale studies are required to verify the reliability for the findings from this small pilot study.
Creative reflections on Enhancing Practice 16: New explorations, insights and inspirations for practice developers
(Foundation of Nurisng Studies, 2016-11-11) Baldie, Deborah; Brown, Angela; Dewing, Jan; Dickson, Caroline; none
It began two years ago, then Arriving in Edinburgh the enthusiasm abounds. The first day arrives - oozing anticipation. Great to gather old friends, new friends; Clans and clever creativity, having fun Energy in the room, creating, innovating, Creative ways transforming minds, creating impact. The International Practice Development Collaborative (IPDC) is loose network of practice developers, academics and researchers who are committed to working together to develop healthcare practice. The IPDC believes that the aim of practice development is to work with people to develop person-centred cultures that are dignified, compassionate and safer for all. One of its four pillars of work is a biennial Enhancing Practice conference. Moving round the world, the IPDC members take it in turns to host the conference; in early September 2016 it was the turn of Queen Margaret University (QMU) in Edinburgh. This article has been created collaboratively by a number of the people who attended this three-day conference. The IPDJ team invited participants to offer 'the line of a poem' that captured or reflected their experience and/or learning. These were then collected and shared, and together we created a series of poems and a collection of haiku (a three-line Japanese poem with 17 syllables, 5-7-5). Other participants have subsequently offered reflections, which we would also like to share with you here. We offer this article to you, as a celebration of our time together; our learning, connections and creating, in the hope that there might be some learning in here for you and that you may consider joining us at our next conference in Basel, Switzerland in 2018.
Developing new methods for person-centred approaches to adjudicate context−mechanism−outcome configurations in realist evaluation
(MDPI, 2022-02-18) Teeling, Sean Paul; Dewing, Jan; Baldie, Deborah
Realist evaluation provides a general method of evaluating the application of interventions including policy, legislation, projects, and new processes in social settings such as law enforcement, healthcare and education. Realist evaluation focuses on what about interventions works, for whom, and in what circumstances, and there is a growing body of work using realist evaluation to analyse interventions in healthcare organizations, including those using Lean Six Sigma improvement methodologies. Whilst realist evaluation facilitates the analysis of interventions using both qualitative and quantitative research, there is little guidance given on methods of data collection and analysis. The purpose of this study is to address this lack of guidance through detailing the use of innovative person-centred methods of data collection and analysis in a realist evaluation that enabled us to understand the contribution of Lean Six Sigma to person-centred care and cultures. This use of person-centred principles in the adjudication of identified program theories has informed novel methods of collecting and analysing data in realist evaluation that facilitate a person-centred approach to working with research participants and a way of making the implicit explicit when adjudicating program theory.
A discussion of the synergy and divergence between Lean Six Sigma and person-centred improvement sciences
(Science Publications, 2020-04-13) Teeling, Sean Paul; Dewing, Jan; Baldie, Deborah
Background: This paper discusses if and how the improvement sciences of Lean Six Sigma and person-centred approaches can be melded or blended in the health care context. The discussion highlights the relationship between each approach to improvement science in terms of their respective purposes, intentions and probable outcomes; positioning these as either synergies or divergences. Comparison of the key theoretical and methodological principles underpinning each approach to improvement is also considered and implications for future practice, policy and research are drawn out. The discussion is informed by part of the findings of a realist review of relevant literature.
Divergence of NHS choice policy in the UK: what difference has patient choice policy in England made?
(Sage, 2013-10) Sanderson, M.; Allen, P.; Peckham, S.; Hughes, D.; Brown, M.; Kelly, G.; Baldie, Deborah; Mays, N.; Linyard, A.; Duguid, A.
Objectives To examine the types of choices available to patients in the English NHS when being referred for acute hospital care in the light of the divergence of patient choice policy in the four countries of the UK. Methods Case studies of eight local health economies in England, Scotland, Northern Ireland and Wales (two in each country); 125 semi-structured interviews with staff in acute services providers, purchasers and general practitioners (GPs). Results GPs and providers in England both had a clear understanding of the choice of provider policy and the right of patients to choose a provider. Other referral choices potentially available to patients in all four countries were date and time of appointment, site and specialist. In practice, the availability of these choices differed between and within countries and was shaped by factors beyond choice policy, such as the number of providers in an area. There were similarities between the four countries in the way choices were offered to patients, namely lack of clarity about the options available, limited discussion of choices between referrers and patients, and tension between offering choice and managing waiting lists. Conclusions There are challenges in implementing pro-choice policy in health care systems where it has not traditionally existed. Differences between England and the other countries of the UK were limited in the way choice was offered to patients. A cultural shift is needed to ensure that patients are fully informed by GPs of the choices available to them.
Evaluation of the impact of an augmented model of The Productive Ward: Releasing Time to Care on staff and patient outcomes: A naturalistic stepped-wedge trial
(BMJ, 2020-03-26) Williams, Brian; Hibberd, Carina; Baldie, Deborah; Duncan, Edward A. S.; Elders, Andrew; Maxwell, Margaret; Rattray, Janice E.; Cowie, Julie; Strachan, Heather; Jones, Martyn C.
Background Improving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of ‘releasing time’, which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design.
Exploring the impact and use of patients' feedback about their care experiences in general practice settings-a realist synthesis
(Oxford University Press, 2017-08-03) Baldie, Deborah; Guthrie, Bruce; Entwistle, Vikki; Kroll, Thilo
Background. Policy encourages health care providers to listen and respond to feedback from patients, expecting that it will enhance care experiences. Enhancement of patients' experiences may not yet be a reality, particularly in primary health care settings. Objective. To identify the issues that influence the use and impact of feedback in this context. Design and Setting. A realist synthesis of studies of the use of patient feedback within primary health care settings. Methods. Structured review of published studies between 1971 and January 2015. Results. Eighteen studies were reported in 20 papers. Eleven studies reported patient survey scores as a primary outcome. There is little evidence that formal patient feedback led to enhanced experiences. The likelihood of patient feedback to health care staff stimulating improvements in future patients' experiences appears to be influenced predominantly by staff perceptions of the purpose of such feedback; the validity and type of data that is collected; and where, when and how it is presented to primary health care teams or practitioners and teams' capacity to change. Conclusions. There is limited research into how patient feedback has been used in primary health care practices or its usefulness as a stimulant to improve health care experience. Using a realist synthesis approach, we have identified a number of contextual and intervention related factors that appear to influence the likelihood that practitioners will listen to, act on and achieve improvements in patient experience. Consideration of these may support research and improvement work in this area.
Extending the assessment of patient centredness in NHS Tayside
(NHS Tayside, 2011) Jones, M. C.; Baldie, Deborah; Williams, B.; Rattray, J.; MacGillivray, S.; Abubakari, R.; McKenna, Eileen; Mackie, Susan
Extending the assessment of patient-centredness in health care: Development of the updated Valuing Patients as Individuals Scale using exploratory factor analysis
(Wiley-Blackwell, 2017-07-03) Jones, Martyn; Williams, B.; Rattray, Janice; MacGillivray, S.; Baldie, Deborah; Abubakari, R.; Coyle, J.; Mackie, Susan; McKenna, Eileen
Aims and objectives To update and re-validate the Valuing Patients as Individuals Scale for use as a patient appraisal of received healthcare. Background Healthcare in the United Kingdom and beyond is required to deliver high quality, person-centred care that is clinically effective and safe. However, patient experience is not uniform, and complaints often focus on the way patients have been treated. Legislation in United Kingdom requires health services to gather and use patients' evaluations of care to improve services. Design This study uses scoping literature reviews, cognitive testing of questionnaire items with patient and healthcare staff focus groups, and exploratory factor analysis. Methods/Setting/Participants Data were collected from 790 participants across 34 wards in two acute hospitals in one National Health Service Health Board in Scotland from September 2011-February 2012. Ethics and Research and Development approval were obtained. Results Fifty six unique items identified through literature review were added to 72 original Valuing Patients as Individuals Scale items. Face validity interviews removed ambiguous or low relevance items leaving 88 items for administration to patients. Two hundred and ninety questionnaires were returned, representing 37% response rate, 71 were incomplete. Thus 219 complete data were used for Exploratory Factor Analysis with varimax orthogonal rotation. This revealed a 31 item, three factor solution, Care and Respect; Understanding and Engagement; Patient Concerns, with good reliability, concurrent and discriminant validity in terms of gender. A shortened 10 item measure based on the top 3 or 4 loading items on each scale was comparable. Relevance to clinical practice The short scale version is now being routinized in real-time evaluation of patient experience contributing to this United Kingdom, National Health Service setting meeting its policy and legislative requirements. What does this paper contribute to the wider global clinical community? -The updated Valuing Patients as Individuals Scale; -Is a reliable and valid measure specifically designed to capture the issues that matter most to people receiving secondary care. -Has been developed based upon current conceptualisations of person-centred care and the clinical practices required to deliver this. -May be used within service improvement work as a trigger to ensure person-centred care delivery.
Medical students volunteering in hospital: a novel method of exploring and recording the patient experience
(2017-05-17) Hytiris, Monica Lorraina; Prentice, Fraser; Baldie, Deborah
Background: Patient experience is increasingly recognised as an important feature of healthcare quality improvement. However, many of the methods implemented for its collection have significant limitations and reliability issues. This article describes how a UK healthcare organisation worked with medical student volunteers to build capacity for the collection of patient feedback in evidence-informed ways, and summarises student reflections on this process. Aims: To improve the quantity and quality of inpatient feedback, and in doing so provide new learning opportunities for medical students. Conclusions: Patient feedback gathered by volunteers is beneficial to the service and to medical student volunteers. As the feedback gathered is ward-specific, opportunities are created for practice improvements to be identified and acted on. It is feasible for medical students to be trained effectively as volunteers in gathering patient care experiences with adequate support mechanisms in place. Implications for practice: - Healthcare services should consider the use of personnel independent of the care team for thecollection of patient feedback - Patient feedback needs to be shared with practitioners in a timely manner - Medical schools should consider this type of volunteering as a unique opportunity for medicalstudents to improve understanding of patients' experiences of healthcare, and of how care canbe person-centred
Testing Realist Programme Theories on the Contribution of Lean Six Sigma to Person-Centred Cultures: A Comparative Study in Public and Private Acute Hospitals
(MDPI, 2025-09-04) Teeling, Sean Paul; Baldie, Deborah; Daly, Ailish; Pierce, Anthony; Wolfe, Nicola; Fagan, Gillian; Garry, Catherine
Person-centred cultures are increasingly recognised as essential to the delivery of compassionate, safe, and effective healthcare. While Lean Six Sigma (LSS) is widely adopted as a process improvement methodology, its application is often critiqued for lacking alignment with relational or values-based care. This study aimed to test the transferability of three previously developed Programme Theories (PTs), generated through realist inquiry in a public hospital setting, within a large private acute hospital. Realist-informed adjudication workshops were conducted with interdisciplinary staff who had completed university-accredited training in LSS. Structured workbooks, visual artefacts, and thematic synthesis were used to identify how context–mechanism–outcome configurations (CMOCs) held, shifted, or evolved in the new setting. All three PTs were confirmed, with six CMOCs refined, and eight new configurations generated. Key refinements included the role of strategic intent, informal improvement communities, and intrinsic motivation. These findings suggest that values-based mechanisms underpinning person-centred LSS are not confined to public systems and may be equally active in private settings. The study confirms the explanatory strength of the original PTs while contributing new insights into their adaptability. It offers practical guidance for healthcare leaders seeking to embed person-centred improvement approaches across diverse systems, regardless of sectoral funding or governance structures.
The contribution of a person-centred model of Lean Six Sigma to the development of a healthful culture of health systems improvement
(Frontiers Media, 2025-08-18) Teeling, Sean Paul; Baldie, Deborah; Daly, Ailish; Keown, Anne Marie; Igoe, Aileen; Dowling, Ciara; McNamara, Martin
Background: A failure to distinguish between person-centredness, person-centred care, and person-centred cultures can result in improvement initiatives focusing solely on improvement initiative metrics and outcomes, excluding the authentic experiences of patients and staff. Building on the foundational work of Dewing and McCormack, we have designed, piloted, and implemented the Person-centred Lean Six Sigma (PCLSS) model in public and private acute and community healthcare settings across Ireland. This model uses Lean Six Sigma, a widely adopted improvement methodology, through a person-centred lens with which improvement practitioners and healthcare staff can inspect their Lean Six Sigma practice and critically evaluate whether, to what extent, and how it is synergistic with person-centred approaches. Aim: This paper explores the deployment of the PCLSS model across four clinical study sites and examines its alignment with McCance and McCormack's conceptual work on healthful cultures, evaluating its contribution to creating cultures that support sustainable improvement, compassion, and respect. Methods: The PCLSS model was embedded within a university-accredited education programme for healthcare staff. The model was applied across four distinct healthcare settings in Ireland: a public acute teaching hospital, a private full-service acute hospital, an integrated ophthalmology service bridging hospital and community care, and a public rehabilitation hospital. A case study methodology was used to examine implementation and impact. Results: Across all four sites, the PCLSS model facilitated improvements in operational efficiency, staff and patient engagement, interprofessional collaboration, and reflective practice. The model supported leadership at all levels, fostered sustainable change, and successfully mapped onto key domains associated with healthful cultures, as articulated in the work of McCance and McCormack. Conclusion: The PCLSS model represents a sustainable, values-based approach to improvement that aligns operational excellence with person-centred principles. Its application contributes meaningfully to the development of healthful cultures in healthcare organisations.
The seldom heard-- Using evidence to inform patient feedback programmes
(Te Arai Research Group, 2017-07-24) Baldie, Deborah
Until recent years many patients have been excluded from research and from service initiatives aimed at understanding and/or improving patients' experiences of care. Often those that go unheard are termed the minority- and /or hard to reach-.- Wh
Using quality improvement science to reduce the risk of pressure ulcer occurrence - a case study in NHS Tayside
(Sage, 2014-11) Mackie, Susan; Baldie, Deborah; McKenna, E.; O'Connor, P.
Pressure ulcer prevention is core to nursing practice and as such is often overlooked as a safety risk. A multifaceted quality improvement initiative guided by both Felgen's Model and the Model for Improvement delivered implemented in a systematic way led to significant improvements in the prevalence and incidence of pressure ulcers. Prevalence of all ulcers was reduced from 21% to 7% and to 3.1% when grade 1 ulcers are removed from analysis. Incidence (i.e. ulcers acquired in hospital) was reduced from 6.6% to 2.4% and 1.4% when grade 1 ulcers are removed from the analysis. Furthermore, improvements have been sustained for more than 2 years. This paper presents a case study of framework for change developed across a healthcare region NHS Tayside in Scotland.