'Virtually daily grief'-understanding distress in health practitioners involved in a regulatory complaints process: a qualitative study in Australia.

Protection of the public is the paramount aim for health practitioner regulation, yet there has been growing concern globally on the association between regulatory complaints processes and practitioner mental health and wellbeing. The objective was to understand the experience, particularly distress, of health practitioners involved in a regulatory complaints process to identify potential strategies to minimise future risk of distress. Semi-structured qualitative interviews were conducted with health practitioners in Australia who had recently been through a regulatory complaints process, together with a retrospective analysis of documentation relating to all identified cases of self-harm or suicide of health practitioners who were involved in such a process over 4 years. Data from interviews and the serious incident analysis found there were elements of the regulatory complaints process contributing to practitioner distress. These included poor communication, extended time to close the investigation, and the management of health-related concerns. The study found external personal circumstances and pre-existing conditions could put the practitioner at greater risk of distress. There were found to be key moments in the process-triggers-where the practitioner was at particular risk of severe distress. Strong support networks, both personal and professional, were found to be protective against distress. Through process improvements and, where appropriate, additional support for practitioners, we hope to further minimise the risk of practitioner distress and harm when involved in a regulatory complaints process. The findings also point to the need for improved partnerships between regulators and key stakeholders, such as legal defence organisations, indemnity providers, employers, and those with lived experience of complaints processes. Together they can improve the support for practitioners facing a complaint and address the stigma, shame, and fear associated with regulatory complaints processes. This project provides further evidence that a more compassionate approach to regulation has the potential to be better for all parties and, ultimately, the wider healthcare system.

The practice of complexity: review, change and service improvement in an NHS department.

PURPOSE: In the last five years more and more scholars have drawn on insights from the complexity sciences as a way of understanding the process of managing and organising in the NHS differently. This paper aims to describe working methods derived from the theory of complex responsive processes, a more radical interpretation of these insights, used by a consultancy team in one NHS setting. DESIGN/METHODOLOGY/APPROACH: The authors were invited to undertake this intervention over a two year period to bring about service improvement. The paper sets out a critique of systems theory, which underpins most management literature, as well as offering a critique of some of the ways that complexity theory gets taken up in the health literature. As an alternative it explores the theoretical underpinnings of complex responsive processes and gives practical examples of methods that the authors believe are more suitable for understanding the complex environment NHS staff work within. FINDINGS: Working with ideas of ambiguity, paradox and complexity are not easy for staff educated in a Western tradition of linear cause and effect. However, as a result of this intervention managers and staff pointed to a much greater confidence and skill in dealing with the complex daily process of organising, which they attribute to the methods used. Although the authors make no claim that service improvement arose as a direct consequence of the methods employed, significant, observable improvements in service provision did occur during and after the consultancy intervention. ORIGINALITY/VALUE: The description of working methods based on reflective and reflexive group processes, alongside more empirical data-gathering methods, is offered as a radical alternative to more orthodox ways of understanding, and attempting to work with change in the NHS.

Economic aspects of a therapy and support service for people with long-term stroke and aphasia.

BACKGROUND: This paper considers some economic aspects of a therapy and support service for people with stroke and aphasia. This material was part of a broader evaluation of the service, which is reported elsewhere (van der Gaag et al. 2005, van der Gaag and Mowles 2005). AIMS: The purpose of this part of the study was to investigate the feasibility of undertaking economic appraisal in a voluntary sector service providing therapy for people with aphasia and their families. METHODS & PROCEDURES: The costs of delivering therapy and support services were calculated. These costs were compared with the costs of equivalent services in the National Health Service (NHS). The EQ-5D health-related quality of life instrument was used to calculate quality-adjusted life years (QALYs). OUTCOMES & RESULTS: The cost of delivering therapy was lower than expected for a customized service of this nature. The study generated cost data for delivering therapy services, allowing some comparisons to be made with equivalent services in NHS settings. QALY data were generated for a sample of 25 clients on one of the programmes. CONCLUSIONS: The economics of speech and language therapy service delivery have received scant attention in the published literature. The paper argues that decision-making about methods of service delivery can be aided by the explicit consideration of the costs and consequences of different programmes.

Therapy and support services for people with long-term stroke and aphasia and their relatives: a six-month follow-up study.

OBJECTIVE: To evaluate the impact of attending an aphasia therapy centre on quality of life and communication skills in people with stroke and aphasia and their relatives. DESIGN: Before and after study, six months duration. SETTING: Community-based aphasia therapy centre in the United Kingdom. PARTICIPANTS: Thirty-eight men and women with aphasia following a stroke, and 22 of their relatives. Mean time since stroke was 33 months (SD 24.1). INTERVENTIONS: A range of group therapies for people with aphasia and their relatives and counselling for individuals and couples. OUTCOME MEASURES: Quantitative outcome measures were ratings of quality of life and communication for people with aphasia, and relatives' independent ratings of communication and coping with caring. Qualitative outcomes were perceptions of quality of life and communication skills using semi-structured interviews. RESULTS: Improvement was detected on all outcomes at six months. There were significant changes from baseline on the quality of life measure, mean difference 0.14 (95% confidence interval 0.02, 0.26); and the communication measure assessed by people with aphasia and their relatives, mean difference 12.8 (4.0, 21.5) and 9.7 (3.6, 15.7) respectively. The changes on the coping with caring measure were not significant, though the direction of change was positive. Qualitative interviews revealed a similar pattern of benefit in terms of increased levels of self-confidence and changes in lifestyle and levels of independence. CONCLUSIONS: The results suggest that this therapeutic approach has an impact on quality of life and communication for people with aphasia and their relatives.