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Table Of Contents

1.1 Introduction
1.1.1 Culture and care for older people in acute hospitals
1.1.2 Aims of the study
1.1.3 Structure of the report
1.1.4 Methodological considerations in culture research
1.2 Policy context
1.2.1 Societal, historical and policy contexts
1.2.2 Broader social context
1.2.4 Older people and the NHS: The need for culture change
1.2.5 Reflections of users, carers and national opinion leaders
Section 2: Key concepts informing the study
2.1 Organisational culture and climate
2.1.2 Organisational Climate
2.2 The Senses Framework
2.3 Other analytic frameworks
Section 3: Methodology
3.1 Aims and objectives
3.2 Ethical approval
3.3 Amendments to the original study design
3.4 Case study research on culture change
3.4.1 Case study methodology
3.4.2 Selection of the case study Trust
3.4.3 Case study Data Collection
3.4.4 Case Study Data Analysis
4.1 Introduction
4.2 Review methodology
4.3 Culture and culture change in acute environments
4.3.1 The clinical culture
4.3.2 The culture of care
4.3.3 The work culture
4.4 Effecting culture change
4.5 Dignity: A Humpty Dumpty word?
4.7 Aligning culture change and dignity – the four ‘P’s’
4.8 Culture change: Widening the context
4.9 Structuring the case studies
Section 5: Toolkit development
5.1 Introduction
5.2 Nursing team climate for care
5.2.1 Identifying climate for care factors
5.3 Assessment of quality of care and staff well-being
5.3.1 Patient experiences of care
5.3.2 Carer experiences of care
5.3.3 Nursing team outcomes
5.3.4 Matrons assessments of care
5.4 Development of questionnaires
5.4.2 Development of the patient and carer questionnaires
5.4.3 Development of the matrons questionnaire
5.5 Questionnaire distribution and analyses
5.5.1 Refining the questionnaires
5.5.2 Sample for scale development
5.5.3 Exploratory factor analysis
5.5.4 Internal consistency
5.6 Measures
5.6.1 Climate for care
5.6.2 Factors that enable climate for care
5.6.3 Patient experiences of care
5.6.4 Carer experiences of care
5.6.6 Matrons’ assessments of quality of care
5.8 Summary
Section 6: ‘Two sites; two cultures’? A Case Study
6.1 Setting the scene
6.2 The place: Trust and unit level
6.3 Shaping culture: The people and the processes
6.6 Delivering complex care: Staffs’ perceptions
6.8 Case Study: An overview
7.1 Introduction
7.1.1 The place: Trust level
7.2 Shaping the culture: The people and the processes
7.3 Maintaining an enriched environment
7.4 “The crapiest old building; crapiest old nurses”
7.4.1 The place: Ward level
7.4.2 The people
7.4.3 Processes: The impact of pace
7.5 Instituting change
7.6 Conclusions
8.1 Introduction
8.2 The Place at Trust level
8.3 The evolution and functioning of the RADS
8.4 What about the ‘rehabs’?
8.5 More space, but less contact?
8.6 Conclusions
9.1 Introduction
9.2 The Trust
9.3 Shaping culture: The people and the processes
9.3.1 Productive Ward
9.3.2 Older peoples’ rehabilitation and assessment (OPRA)
9.3.3 Data collection
9.4 Staff perspectives on The Place: Trust level
9.4.1 Reflections on culture: Trust level
9.5 Staff perspectives on processes: ‘The Productive Ward’
9.5.1 Reflections on culture: The ‘Productive Ward’
9.6.1 Reflections on culture: OPRA
9.8 Case study overview
10.1 Introduction
10.2 Climate for care and patient outcomes
10.3 Sample description
10.4 Measures
10.5 Checking the data prior to analyses
10.6 Results
10.7 Initial relationships between scales
10.7.1 Nursing team scales
10.7.2 Patient, relative/carer and matron scales
10.8 Modelling the relationships
10.8.1 Identifying measures for inclusion in the models
10.9 The modelling process
10.9.2 Relative/carer assessment of care
10.9.3 Matrons’ assessment of care on the ward
10.10 Summary
11.0 Reflections
11.1 Introduction
11.2 Culture change: A journey not a destination
11.3 ‘The urgent is the enemy of the important’
11.5 Culture change – broadening the agenda
11.6 Culture, care and older people: ‘Just like Groundhog day’
12.2 Models of culture change
12.3 Balancing metrics into relational care
12.4 Recommendations from the research
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Published by odele1

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Published by: odele1 on Feb 26, 2012
Copyright:Attribution Non-commercial


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