How to find and promote brilliant palliative care

THIS MONTH’S EDITOR’S CHOICE FROM PALLIATIVE MEDICINE …

Dr Aileen Collier PhD, School of Nursing, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand, and Associate Professor Ann Dadich, Human Resources and Management, Western Sydney University School of Business, Australia, explain the background to their longer article selected as ‘Editor’s Choice’ in the January 2019 issue of Palliative Medicine.

Dr Aileen Collier (left) and Associate Professor Ann Dadich.

Understanding how best to provide safe and high-quality palliative care is one of the greatest societal challenges. No setting is perhaps quite as complex as community-based palliative care with its complexity of patients, technology, organisations, and environments.

The seeds of our research programme on brilliant palliative care were sown at a video-reflexive ethnography (VRE) workshop in Australia. Video reflexive ethnography is a ‘collaborative visual methodology used by researchers and/or health professionals to understand, interpret, and optimize health professionals’ work practices and patients’ experiences’. (1) During a brainstorming session, A/Prof. Ann Dadich and I quickly recognised the synergies of our scholarship. We share an interest in the study of health services, we value the expertise of individuals who deliver, receive, and/or manage health care, and we are committed to trusting relationships of reciprocity with research participants.

Greenhalgh and Papoutsi argued that new research designs encompassing ‘generative learning, and pragmatic adaptation to changing contexts’ (2) are needed to augment conventional methods. Ms Janeane Harlum, Professor Gregory Crawford and their colleagues joined our participatory research journey. They knew that frontline staff often tire of hearing all that goes wrong in healthcare. The elusive gap between empirical evidence and practice seemed forever out of reach.

For this reason, we worked with teams to untangle the complexities of community-based palliative care. With funding from the Agency for Clinical Innovation, our study innovatively combined positive organisational scholarship in healthcare (POSH) with VRE to transform current understandings and advance scholarship. (3)

Visit to the South Australian research site (left to right): Cathie Jeffs, Ann Dadich, Aileen Collier and Gregory Crawford.

Despite their initial reservations, clinicians came to appreciate the filming of their day-to-day work. Ms Womsley, a senior palliative care clinician who contributed as a co-researcher, said:

‘Because our staff typically work in isolation as they visit patients in their homes, it gave them a rare opportunity to stand back and watch themselves and their colleagues in action.’

Patients and family members valued the opportunity to share what mattered most to them, so others might learn from their expertise. As one family member expressed:

‘[We hope clinicians can] get to know the patients as a normal human being, not a number … [and] have respect because [patients] … have put life in their hands.’

Ms Catherine Jeffs, a senior palliative care clinician and co-researcher, was nominated for an Excellence in Innovation in Research Award. She said,

‘Observing, reflecting, and witnessing… palliative care [via the video-recordings]… enabled our multidisciplinary team to respect, admire, and appreciate each other’s roles and value their everyday work. We have found this study to be an excellent teaching opportunity.’

Our study reveals what constitutes brilliant community-based palliative care. As a point of difference from previous research, brilliance was not solely determined by clinical practice guidelines, key performance indicators, or other superimposed definitions. Instead, and guided by previous research (4-7), it was determined by the co-researchers and participants. Specifically, they considered experiences that exceeded their expectations, brought joy, and enable individuals and the groups they are part of to flourish. Guided by this understanding, the study suggests that brilliant community-based palliative care is contingent on context and is conceptualised as a variety of actions, people, and processes. Palliative care is more likely to be deemed brilliant when it epitomises: anticipatory aptitude and action; a weave of commitment; flexible adaptability; and/or team capacity building.

Research is seldom straightforward – and similarly, POSH VRE is not for the faint hearted. It can be time-consuming, emotionally demanding, and replete with ethical quandaries. It requires researchers to embrace their own vulnerabilities. Nevertheless, the impact is well worth it!

Links

To find out more, watch the video, How to promote brilliant palliative care: An Australian interstate study.
Contact us by email at Dr Aileen Collier and A/Prof. Ann Dadich.
Read more Editor’s Choice posts on the EAPC blog.

References

Carroll K, Mesman J. Multiple researcher roles in Video-reflexive ethnography. Qualitative Health Research. 2018; 28(7): 1145-56.
Greenhalgh T, Papoutsi C. Studying complexity in health services research: desperately seeking an overdue paradigm shift. BMC Medicine. 2018; 16 (95).
Dadich A, Collier A, Hodgins M, Crawford GB. Using Positive Organizational Scholarship in Healthcare and Video Reflexive Ethnography to Examine Positive Deviance to New Public Management in Healthcare Qualitative Health Research. 2018.
Dadich A, Fulop L, Ditton M, Campbell S, Curry J, Eljiz K, et al. Finding brilliance using positive organizational scholarship in healthcare. Journal of Health Organization and Management. 2015; 29 (6): 750-77.
Fulop L, Kippist L, Dadich A, Hayes K, Karimi L, Smyth A. What makes a team brilliant? An experiential exploration of positivity within healthcare. Journal of Management & Organization. 2018; Epub-ahead-of-print.
Karimi L, Dadich A, Fulop L, Leggat S, Rada J, Hayes K, et al. Empirical exploration of brilliance in health care: Perceptions of health professionals. Australian Health Review. 2016; Epub-ahead-of-print.
Karimi L, Dadich A, Fulop L, Leggat SG, Eljiz K, Fitzgerald JA, et al. Brilliant health service management: Challenging perceptions and changing HR practices in health services. Asia Pacific Journal of Human Resources. 2018; Epub-ahead-of-print:1-17.

Editor’s note: This post is among the Top Ten most-viewed posts for the first half of 2019.

READ THE FULL ARTICLE IN PALLIATIVE MEDICINE
This post relates to the longer article,‘What does it take to deliver brilliant home-based palliative care? Using Positive Organisational Scholarship and Video Reflexive Ethnography to explore the complexities of palliative care at home’ by Aileen Collier et al. published in Palliative Medicine 2019 Volume: 33 issue: 1, page(s): 91-101. https://doi.org/10.1177/0269216318807835. Article first published online: October 26, 2018. Issue published: January 1, 2019.

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