NIHR Advisory Group Consider ‘Super Themes’

At the second NIHR Advisory Group meeting, attendees were asked to choose their preferred ‘super themes’.

These are the theories behind the MCP model that will be subject to in-depth analysis in the next stage of the MCP Synthesis project.

The meeting  provided important stakeholder input to focus the review and ensure end-user relevance and impact. We also invite you to get involved – there’s more information at the end of this blog.

Using the Vanguard’s own logic models, along with associated documentation, the review team initially extracted 1,500 statements which describe how the MCP is expected to work.  All these statements were ‘coded’  to four key improvement areas ( patient experience, staff experience, population health and cost effectiveness) and our best fit framework.

From these statements, reviewers identified 12 themes which describe how MCPs will work:

• Innovative services deliver sustainable care
• Community based coordinated care is more accessible
• Collective responsibility improves quality and safety outcomes
• Multi-Disciplinary Teams provide continuity of care
• Local MCP contracting delivers accountable care organisations
• Pooled budgets incentivise integrated care providers
• Fostering relational behaviours build resilient communities
• Integrated care navigators increase workforce capacity
• Engaged and trained staff lead cultural change
• New ways of working enable staff resilience
• Evaluation activities sustain transformational change
• Information sharing enables effective collaboration.

As it’s not possible to do justice to all 12 themes in the time we have available, our aim was to prioritise the themes which warrant in-depth review, using realist methods.  The role of the advisory group was therefore to help us distil these themes into three or four ‘super themes’ for realist review.

The process of engaging with external stakeholders to focus the review is a recognised ‘best practice’ approach to ensuring end-user – that’s both staff and patient – relevance.

We won’t be losing the remaining themes which will be mapped to existing evidence and literature.

Around the table were a mix of clinicians, managers and patient representatives. The researchers remained objective throughout and offered only supplementary information so as not to lead the group to any conclusions.

Following a lively discussion we were able to reach a general consensus with remarkable ease.  Our task now is to refine our theories following feedback from the group.

Have your say

The review team welcome comments on the ‘super themes’ from patients, carers, healthcare professionals and the public. In the interests of openness and transparency, we are sharing the 12 candidate theories presented to the NIHR Advisory Group.  Although these are being prioritised and refined, it would be helpful to hear your views.  If you would like to comment, please contact us at strategy.unit@nhs.net by the end of December.

Our aims and objectives

Our aim is to provide decision makers with a practical evidence base to support implementation of the MCP Vanguards.  Our synthesis will develop a conceptual framework which articulates what works, why and in what circumstances, by using an innovative combination of best fit framework synthesis and realist synthesis to yield unique insights. This synthesis will inform design and implementation of future iterations of the MCP model, by:

• articulating underlying programme theories behind the MCP model;
• identifying sources of theoretical, empirical and practice evidence to test programme theories;
• appraising, extracting and analysing evidence, reconciling confirmatory and contradictory evidence;
• producing a “blueprint” to explain how mechanisms in different contexts contribute to outcomes and process variables;
• consulting with key stakeholders to validate findings and test applicability in different contexts;
• disseminating findings through a series of practical tools to support knowledge mobilisation.

Scouten, CC BY-SA 3.0, https://commons.wikimedia.org/wiki/File:Jigsaw_puzzle_01_by_Scouten.jpg

The synthesis will employ “best fit” framework synthesis, as a rapid tool by which to facilitate the data extraction and analysis process. The methodology was developed by Carroll et al. (2011) as a pragmatic variation on framework synthesis and is “especially suitable in addressing urgent policy questions where the need for a more fully developed synthesis is balanced by the need for a quick answer” Dixon-Woods (2011).  The methodology introduces the deductive step of developing an a priori framework, thus “harnessing the recognised strengths of both framework and thematic synthesis” (Carroll et al., 2013).  Best fit framework synthesis will be combined with realist synthesis principles to maximise the value of the interpretative process resulting in practicable and feasible recommendations for practice. Recently, methods have been proposed for rapid approaches to realist synthesis (Saul et al., 2013) and the methods proposed in this review (i.e. synthesis and analysis of logic models and use of a best fit framework) offer an alternative systematic route to harnessing the exploratory potential of the realist lens within an accelerated timescale.