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Creating Learning Environments for Compassionate Care (CLECC) in mental health settings: an implementation study

Nursing staff

Principal Investigator: Dr Michelle Myall

Team members:  Dr Michelle Myall (Senior Research and Implementation Fellow, School of Health Sciences, University of Southampton), Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton), Dr Melinda Taylor (Senior Research Fellow, School of Health Sciences, University of Southampton), Dr Jane Frankland (Senior Research Fellow, School of Health Sciences, University of Southampton), Anna Badley (Research Nurse, Solent NHS Trust).

Duration of study: 18 months (from 1st October 2020)

Project partners: Solent NHS Trust, Southern Health NHS Foundation Trust, Sussex Partnership NHS Foundation Trust, NHS Improvement, Wessex AHSN, Centre for Implementation Science, University of Southampton.

Co-funded by: NHS Improvement

Lay summary

Background

There is some public concern about NHS hospital nurses’ capacity to provide compassionate care, but very little research about how to improve this situation. We have developed and piloted a programme called Creating Learning Environments for Compassionate Care (CLECC). In CLECC, all registered nurses and health care assistants from participating wards attend a study day, with a focus on team building and understanding patient experiences. A nurse educator (who is not usually part of the ward team) supports the team to try new ways of working on the ward, including regular supportive discussions on improving care. Ward managers attend learning groups to develop their leadership role. Volunteer team members receive training in observations of care and feeding back information to colleagues.   

In an earlier study, we piloted CLECC on four wards in two NHS hospitals, with two other wards continuing with business as usual.  We found that CLECC could be put into practice on NHS hospital wards and that staff felt it improved their capacity to be compassionate. However, we found variations between the four nursing teams and two hospitals, in whether or not, staff felt able to take part in CLECC and to carry on with CLECC after the nurse educator left. We followed up the wards two years later and found that some wards had carried on using CLECC and shared the ideas with other teams.  But some wards had stopped using CLECC and we found that this was influenced by amongst other factors: staffing levels, work priorities, staff turnover and managers’ support.  

The research findings to date suggest that each team differed in the ways they used and responded to the CLECC ideas.  If we want programmes like CLECC to make a difference to patient care, we need more research to test it out in other settings.  This will help us to better understand the conditions in which CLECC is most likely to make a positive difference and about how these conditions can be developed, supported and maintained.  

Aims of study

This study will follow up to four nursing teams in mental health hospital settings who are using CLECC for the first time. We will use questionnaires, staff interviews and documentary evidence to gather data on the characteristics of organisations and teams, and the factors that influence CLECC’s progress in the first few months. We will look carefully at these data, working out the connections between the characteristics, the influencing factors and what happens when CLECC is used. We will develop a theory about how different organisational conditions affect the journey of programmes like CLECC.  We will also use the study to test the best way to measure the impact of CLECC on staff well-being. 

How will findings be used?

This research will help us understand what changes might be needed to get organisations ready for using CLECC. It will also mean we can identify in advance teams who are likely to benefit from CLECC, improving its value for money. We will use the findings to develop a guide for hospital managers to assess and improve their organisations and teams for their receptiveness to quality improvement activities like CLECC. We will share our findings with a wide range of people including patients and families, NHS managers, health and social care staff and other researchers.