From patient stories to changing practice : an action research study to develop models of practice that reflect the needs and aspirations of patients

Abstract

This study is an action research enquiry designed to gain a better understanding of the needs and aspirations of patients and to develop models of practice that address those needs and aspirations. The focus of the study is upon patients with complex and long-term needs and, in particular, upon patients living with long-term neurological conditions such as multiple sclerosis, stroke or Parkinson's disease. The study starts with the collection of stories from patients about their experiences of care and their views on how they would choose to experience care. The common themes from patient stories were identified using thematic analysis, narrative analysis and conversation analysis. The prevailing model of practice, multidisciplinary team working, was subjected to critical scrutiny against the experiences and desiderata articulated by the patients Through a series of "thought experiments" involving visualisation and the development of "rich pictures", the author and her colleagues developed a model of practice which she called transdisciplinary practice. This model suggests the evolution of a new kind of practitioner who would have the competences and scope of practice to address 80% of the healthcare needs of the patient without having to cross-refer to other practitioners and agencies. She suggests that this would lead to a more integrated and holistic experience of care. The author, in partnership with a University, developed a post-graduate curriculum to prepare practitioners for transdisciplinary practice. The study reports the reactions of practitioners and patients to the concept of transdisciplinary practice and identifies the organisational and attitudinal barriers that would have to be overcome to secure implementation of the model. The study also draws some general conclusions about barriers to innovation in the National Health Service and relates these to the current political context of the NHS.

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