PROSPERO International prospective register of systematic reviews
Improving skills and care standards in the clinical support workforce: a realist synthesis of workforce development interventions
Jo Rycroft-Malone, Christopher Burton, Brendan McCormack, Sandra Nutley, Diane Seddon, Beth Hall, Lynne Williams
Jo Rycroft-Malone, Christopher Burton, Brendan McCormack, Sandra Nutley, Diane Seddon, Beth Hall, Lynne Williams. Improving skills and care standards in the clinical support workforce: a realist synthesis of workforce development interventions.
Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013006283
How can workforce development interventions improve skills and care standards of clinical support workers within older people’s health services?
To use a realist methodology to;
1. identify support worker development interventions from different public services and to synthesise evidence of impact
2. identify the mechanisms through which these interventions deliver support workforce and organisational improvements to benefit the care of older people.
3. investigate the contextual characteristics that mediate the potential impact of these mechanisms on clinical care standards for older people.
4. develop an explanatory framework that synthesises review findings of relevance to services delivering care to older people.
5. recommend improvements for the design and implementation of workforce development interventions for clinical support workers.
The search strategy will be conducted in two phases.
In phase 1, the programme theory (i.e. the hypotheses about why particular support worker development interventions may work [or not]) is fundamental to realist review. This will be developed through stakeholder engagement, and a scope of the literature including relevant extant theory. The development of programme theory is a deliberative process including a mixture of desk work and discussion and a theory building workshop with relevant stakeholders including educators, practitioners, managers and patients to identify and prioritise the theory that will be tested in the review. The emergent theories are expressed as contexts, mechanisms and outcomes (C-M-O) threads.
In phase 2, we will review material indexed in the major health, social and welfare databases:Health and Social care:Cochrane Library, Campbell Collaboration, ZETOC, MEDLINE, EMBASE, CINAHL, AMED, National Research Register IBSS, HMIC, ASSIA, CSA Sociological Abstracts, Social Work Abstracts, Social Policy and Practice, Social Care Online;Jorum, Sociology of Education Abstracts, Teaching Reference Centre, ERIC;National Criminal Justice Reference Service Abstracts, Association of Chief Police Officers in England, Association of police officers, National policing improvement agency, Police Oracle.
Our search will be limited to material from 1986 to 2013, which includes the last two major workforce development shifts within the health and social care workforce, and references managed in Endnote.The searches will be re-run before the final analyses, and relevant literature retrieved for inclusion.
The project advisory group will be consulted in order to focus the review so that it remains relevant for project stakeholders.
Types of study to be included
The search strategy will be purposive in order to test and refine the programme theories from the first phase of the study, requiring an inclusive (all types of research and non-research, including policy and guidelines) and pragmatic approach to finding and evaluating evidence. We will include support worker role evaluations or intervention research which makes specific reference to embedded implementation, internet-based searches for grey literature, such as workforce development project reports; national inspection and regulation quality reports; evaluative information about these initiatives held in the public domain will be requested. We will also use snowballing techniques and draw on the expertise of the project steering group, other key researchers and educators, and organisations to ensure we have not missed evidence that might be relevant, but not visible through traditional and hand searching methods. The search will focus on finding evidence relevant to the following; workforce, practice and/or organisational development interventions (and also in combinations) based on a scoping search using staff development and clinical support workers within a health context examples include orientation programmes, clinical education programmes, competency frameworks, certification, nursing assistant champions, storytelling, delegation, or embedded within role evaluation and intervention research.
Recognising the age of the health care population, it would not be helpful to only sample the assistant care workforce entirely within services exclusive to older people. However, analytical approaches will prioritise those settings specific to older people and test the transferability of findings to the wider health service context. We will search for evidence from different international contexts.
Additional searches will also be conducted of assistant care worker roles in the following public service fields; social care, policing and education.
In contrast to other review processes, in a realist synthesis evidence is not excluded (unless it does not relate to the programme theory or theories), however in this review we will not search for or include evidence that may have limited transferability to the NHS such as health systems within low income countries.
Condition or domain being studied
Health and social care for older people: improve care provision for older people through enhanced training and development of the clinical support workforce in health and social care
Other public services to be studied include education and policing.
Health and social care services specific to older people and workforce development interventions in related fields that use assistant workers (police and education).
Interventions for improving skills and care standards in the assistant care workforce for older people. Workforce development interventions including the support required to equip those providing care to older people with the right skills, knowledge and behaviours to deliver safe and high quality services (Skills for Care 2011).
Settings will be prioritised if they relate specifically to older people and will include NHS Trusts and other services e.g. social care services, independent sector. Other relevant settings will include public health fields; social care, policing and education.
Phase 1: the identification of contexts, mechanisms and outcomes (i.e. theories) which are then tested and refined in phase 2 and 3. Submit the review protocol for open access publication
Phase 2: 1) a comprehensive evidence base related to workforce development for the assistant practitioner workforce, which will be made publicly available, 2) a set of hypotheses supported by relevant evidence to be refined in phase 3.
Phase 3: a refined set of hypotheses with acconpanying evidence-based narrative
Phase 4: a report of the review including relevant and actionable findings, and paper for open access publication.
Data extraction, (selection and coding)
A full set of key terms will be identified by the team and titles and abstracts will be searched using the search strategy to identify evidence that meets the inclusion criteria. Missing data will be requested from the authors. Consistent with Pawson (2006), the test for inclusion will be: is the evidence provided ‘good and relevant enough’ to be included (considering issues of sample size, data collection, data analysis, and claims made). Discrepancies in opinions about the relevance of articles will be resolved through discussion amongst the project team. A bespoke set of data extraction forms will be developed based on the content of the programme theory, which thereby provides a template to interrogate the theories. If the evidence meets the test of relevance (described above), data will be extracted using the bespoke form and then checked by a second member of the team. Data to be extracted will focus on context, mechanism and outcome configurations, demi-regularities and/or mid-range theories (www.ramesesproject.org).
Risk of bias (quality) assessment
The quality of individual studies will be assessed based on the criteria of relevance (can the data contribute to theory buidling/testing) and rigour (is the method used credible) (www.ramesesproject.org).
Strategy for data synthesis
The analytical task is in synthesising across the extracted information the relationships between mechanisms (e.g. underlying processes, structures, and entities), contexts (e.g. conditions, types of setting, organisational configurations) and outcomes (i.e. intended and unintended consequences and impact). Through our previous experience of realist review (Rycroft-Malone et al 2012; McCormack et al, 2013), and building on the suggestions of Pawson (2006) and principles of realist enquiry, we have developed an approach to synthesis that includes:
1. Organisation of extracted information into evidence tables representing the different bodies of literature (e.g. health, teaching, social care, policing)
2. Theming across the evidence tables in relation to emerging demi-regularities (patterns) amongst C-M-Os – seeking confirming and disconfirming evidence.
3. Linking these demi-regularities to develop hypotheses.
This aspect of the review process is resource intensive and reliant on discussion and deliberation, including consultation with a wider group of stakeholders, both of which are built into our project plan.
The resultant hypotheses act as synthesised statements of findings around which a narrative can be developed summarising the nature of the context, mechanism and outcome links, and the characteristics of the evidence underpinning them.
Analysis of subgroups or subsets
A number of products will be produced, and processes engaged in, as part of end of grant dissemination activity, including the following:
- A final and full research report, illustrated with vignettes of different practical examples / case studies to make findings relevant to NHS managers, and a new framework for skills development for the assistant care workforce for older people.
- An executive summary of the final report, suitable for use as a separate report for briefing NHS managers.
- A lay summary of the final report, suitable for use as a separate report for briefing the public.
- Benchmarking or quality assurance framework for interventions.
- 2 open access publications: 1) a review protocol, and 2) a findings paper that sets out an implementation plan of workforce development interventions training in the clinical support workforce.
- Conference presentation at a UK national conference.
- A YouTube presentation of the main findings, including a discussion with stakeholders about their relevant to practice and policy.
- Open access articles in professional and academic journals.
Contact details for further information
Professor Jo Rycroft-Malone
School of Healthcare Sciences
Organisational affiliation of the review
Professor Jo Rycroft-Malone, Bangor University Dr Christopher Burton, Bangor University Professor Brendan McCormack, University of Ulster Professor Sandra Nutley, University of St Andrews Dr Diane Seddon, Bangor University Dr Beth Hall, Bangor University Mrs Lynne Williams, Bangor University
Details of any existing review of the same topic by the same authors
Anticipated or actual start date
01 November 2013
Anticipated completion date
30 April 2015
National Institute Health Research
Project ref 12/129/32
Conflicts of interest
Prof Brendan McCormack is Chair of the Trustees for the charity Age Northern Ireland. We are not aware of any other conflicts, or potential conflicts of interest.
Other registration details
HS& DR Programme
England, Northern Ireland, Scotland, Wales
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Community Health Workers; Delivery of Health Care; Health Personnel; Health Services for the Aged; Humans; Professional Competence; Standard of Care
Stage of review
Date of registration in PROSPERO
15 November 2013
Date of publication of this revision
15 November 2013
Stage of review at time of this submission
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.