ObjectivesThis study explores the barriers and facilitators that impact on the motivation of practitioners to participate in a quality improvement collaborative.DesignA qualitative and formative evaluation using a participatory approach, the researcher-in-residence model which embraces the concept of ‘coproducing’ knowledge between researchers and practitioners using a range of research methods such as participant observation, interviews and documentary analysis. The design, creation and application of newly generated evidence are facilitated by the researcher through negotiation and compromise with team members.ParticipantsSenior and middle managers, doctors and nurses.SettingTwo hospitals in Southeast England participating in a Patient Safety Improvement Collaborative and the facilitator (host) of the collaborative, based in Central London.ResultsThe evaluation has revealed facilitators and barriers to motivation categorised under two main themes: (1) inherent motivation and (2) factors that influence motivation, interorganisational and intraorganisational features as well as external factors. Facilitators included collaborative ‘champions,’ individuals who drove the quality improvement agenda at a local level, raising awareness and inspiring colleagues. The collaborative itself acted as a facilitator, promoting shared learning as well as building motivation for participation. A key barrier was the lack of board engagement in the participating National Health Service organisations which may have affected motivation among front-line staff.ConclusionsCollaboratives maybe an important way of engaging practitioners in quality improvement initiatives. This study highlights that despite a challenging healthcare environment in the UK, there remains motivation among individuals to participate in quality improvement programmes as they recognise that improvement approaches may facilitate positive change in local clinical processes and systems. Collaboratives can harness this individual motivation to facilitate spread and adoption of improvement methodology and build engagement across their membership.

Abstract:Objectives: The aims of this pilot study were to evaluate treatment effects, ascertain safety and formulate best practice Chinese medicine protocols relevant for London women suffering from menopausal symptoms. Study Design:This clinical pilot study employed a case series design within a wider action-based research project. 117 perimenopausal women between 45-55 years of age recruited from the general population were treated for menopausal symptoms by six experienced practitioners of Chinese medicine at the Polyclinic of the University of Westminster. Practitioners were instructed to treat as near to their usual practice style as possible. This involved using Chinese herbal medicine and/or acupuncture along with dietary and lifestyle advice. A maximum of twelve treatments over six months was allowed per patient. Outcome Measures:The Menopause Specific Quality of Life Questionnaire (MenQoL), the Greene Climacteric Scale, and flushing diaries were used to evaluate treatment outcomes. Liver and kidney function tests were carried out at intake and after one, six and twelve treatments to evaluate the safety particularly in relation to the use of herbal medicines.

The VOICES Survey (Views of Informal Carers-Evaluation of Services) is a validated survey among bereaved carers, to develop an understanding about the care dying patients and their carers received in the last three months of a patient's life. City and Hackney Clinical Commissioning Group funded a one year evaluation of care services. The VOICES survey was administered by St Joseph's Hospice following up expected deaths under the care of Homerton University Hospital and St Joseph's Hospice between April 2015 and March 2016. Quantifiable and qualitative findings offer extensive insight into the care provided out-ofhours, in the community, care homes, GPs, hospitals and hospices. The majority of bereaved participants were pleased with the provided care they. However, the quality of care differs between care settings and patient location. It shows that females are more likely to respond. Also, respondent-patient ethnicities do not reflect the diversity of the local population. This asks for a targeted approach to overcome ethnic boundaries to understand their experience. Dignity and respect have the best ratings in hospice care (100%) followed by hospital care (89%), GP care (84%) and community care (75%). Pain relief is considerably more successful in inpatient settings (62%) compared to community care (27%). Excellence of care is rated best in hospice care (81%) and dropping to an average of 38% across other services. Feedback provided by participants offer insight into participant and patient experiences. The comments were often very positive. Nevertheless they highlighted emotional and logistical challenges patients, respondents and professionals experienced how strongly it affected their lives and the care they received. The final report will be published in September 2016. By July 2016 we expect to have invited around 450 carers and eventually received 90 completed questionnaires. So far 320 people have been invited of which 55 completed the questionnaire.