Protocol for a realist and social return on investment evaluation of the use of patient-reported outcomes in four value-based healthcare programmes.

INTRODUCTION: There is growing recognition that in order to remain sustainable, the UK's National Health Service must deliver the best patient outcomes within available resources. This focus on outcomes relative to cost is the basis of value-based healthcare (VBHC) and has led to interest in the recording of patient-reported outcome measures (PROMs) to measure patient perspectives on the impact of a health condition on their lives. Every health board in Wales is now required to collect PROMS as part of routine care. We will evaluate the VBHC programme implemented in a lead health board. The study aim is to understand what works about PROMs collection, for whom, in what contexts and why in a VBHC context. In addition, we will assess the social value of integrating PROMs collection into routine care. METHODS AND ANALYSIS: A three-stage mixed-methods study comprising a realist evaluation integrated with social return on investment (SROI) analysis across four conditions; Parkinson's disease, epilepsy, heart failure and cataract surgery. Workstream 1: Development of logic models, informed by a scoping review, documentary analysis, patient and public involvement (PPI), staff and key stakeholder engagement. Workstream 2: Realist evaluation building on multiple data sources from stages 1 to 3 to test and refine the programme theories that arise from the logic model development. Workstream 3: SROI analysis using interview data with patients, staff and carers, stakeholder and PPI engagement, anonymised routinely collected data, and questionnaires to populate a model that will explore the social value generated by the implementation of PROMs. Findings across stages will be validated with key stakeholders. ETHICS AND DISSEMINATION: The study is approved by Wales Research Ethics Committee #5 (22/WA/0044). Outcomes will be shared with key stakeholders, published in peer-reviewed journals and presented at national and international conferences.This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) licence, which permits others to distribute, remix, adapt, build on this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

A novel solution to the nursing workforce crisis: recruitment of overseas nurses living locally.

Aneurin Bevan University Health Board has recruited nurses from overseas from within and outside the European economic area. This article describes an innovative recruitment initiative that has focused on nurses who trained overseas and are living and working in the local community, but cannot work in a registered nurse role without financial and practical support. It provides an overview of the robust selection processes used, which are in line with the Nursing and Midwifery Council registration requirements, and the stepwise employment offer made to successful applicants.

Virtual inpatient surgical service.

An increased number of emergency secondary care surgical admissions has intensified the challenge of meeting acute care patients' needs, while not interrupting elective admissions. Aneurin Bevan University Health Board is striving to work differently, with the introduction of an innovative nurse practitioner-led virtual inpatient (VIP) surgical service. VIP is designed to manage emergency patients safely, effectively and in a timely manner, enabling them to return home while waiting for investigations. This article describes the service and outlines the main outcomes, which include increasing the number of surgical emergency patients managed as VIPs, shortening VIP stays, providing more timely access to investigations and saving money for the health board.

Job satisfaction of registered nurses working in an acute hospital.

The links between job satisfaction and the retention of nurses are well established in the literature. Given the current difficulties experienced by the NHS in recruiting and retaining sufficient numbers of nurses, the need to understand how satisfied nurses are in their jobs becomes clear. This study set out to measure the job satisfaction of registered nurses working in adult acute medical and surgical specialties using the Mueller McCloskey (1990) Satisfaction Scale, a 31-item Likert questionnaire. Data were collected from 141 E-grade nurses working in a ward environment. In addition to providing a general outline of reported job satisfaction, the findings of this study identify key areas of reported job satisfaction around peer socialization and dissatisfaction with childcare facilities and control over work conditions. Based on these findings, recommendations are made that may affect positively nurse retention and suggestions put forward for future use of the Mueller McCloskey Satisfaction Scale.