BACKGROUND:Women now make up approximately half of the GP workforce. However, many are leaving the profession. This could be because they experience higher rates of burnout, stress and anxiety, suicide, and lower rates of career progression than men. They also take on a greater load of emotional labour compared with men. Retaining this staff group is one of five priorities for future policy and research. AIM:To synthesise the available evidence on how general practice workplaces can best support women GPs to thrive at work. DESIGN & SETTING:We propose to undertake a realist review, which seeks to understand why an approach may work in specific contexts. This involves building an understanding of how contextual factors affect the activation of mechanisms (that is, changes in participant reasoning or behaviours) to produce their outcomes. METHOD:We will locate available evidence on the topic, and, using a realist logic of analysis, develop an understanding as to how, why, for whom, and in what contexts women GPs thrive at work. Evidence will include academic literature, policy documents, media items, and guidelines. RESULTS:Findings will be co-disseminated with public and patient involvement (PPI) and stakeholder members to all key groups, including policymakers, employers, the public, and academic audiences, by a wide variety of means. CONCLUSION:This review is intended to improve understanding of how working environments affect women GPs. It is anticipated that findings will support the implementation of strategies to better support this group to thrive at work.

The Covid-19 pandemic exacerbated pressures on an already strained nursing workforce, heightening poor psychological and emotional wellbeing. A two-year qualitative longitudinal study with nurses (n=50) examined these impacts. Following study completion, efforts focused on mobilising knowledge through the development strategies (outputs) to better support nurses’ psychological wellbeing during future pandemics and inform healthcare policy (outcome) that over time, could potentially lead to real-world impact from our research.In healthcare, demonstrating research impact is important yet complex. Knowledge mobilisation activities are crucial for developing impact pathways by collaborating with key stakeholders to share knowledges and find solutions to workplace challenges. This paper documents the early stages of our impact journey, where a subsample of nurses (n=10) participated in a workshop designed to mobilise knowledge through reflective discussions that would prioritise strategies to enhance nurses’ psychological wellbeing.The workshop included four knowledge mobilisation activities: a film preview, sharing biographical objects, a world ‘strategy’ café, and a celebratory event. The film resonated with nurses, uniting them through a collective narrative while biographical objects enriched reflective discussions by focussing on personal lived experiences. The world ‘strategy’ café activity was effective in facilitating reflective discussions which prioritised workplace strategies that could inform health care guidance and policy. The celebratory event allowed nurses to reflect on their participation in both the study and the workshop and indicated that knowledge mobilisation activities can demonstrate ‘soft’ impact from the study. When considering research impact, researchers could be more attentive to soft impact as one facet of knowledge mobilisation.

BACKGROUND:Globally, dementia care is under strain. Rising rates across ageing populations, coupled with overstretched health and care systems, mean that people living with dementia and their carers are missing out on crucial support. Addressing dementia care is a key priority for the UK government. This has led to a period of care transformation, including the implementation of new dementia support services across integrated care systems (ICS). However, little is known about how these new services work. This evaluation identifies how a dementia care coordinator service, implemented in the largest ICS in England, works for people living with dementia, their carers and the workforce. METHODS:A realist evaluation using mixed methods was carried out between 2022 and 2024. This involved a repeat survey with dementia care coordinators, carried out a year apart, alongside 57 interviews with coordinators, service managers, healthcare practitioners, people living with dementia and their carers. A realist logic of analysis was applied across all data sets. RESULTS:Three broad concepts were identified including (1) workforce design and organisational culture, (2) meeting the needs of people living with dementia and their carers and (3) connecting to services and integrating care. A total of 23 context-mechanism-outcome configurations (CMOCs) across these concepts highlighted that whilst tensions exist between the service and wider system, dementia care coordinators ultimately act as bridge builders, connecting people to much-needed support. However, services like this could become a victim of their own success due to increasing caseloads and the risk of staff burnout. CONCLUSIONS:The dementia care coordinator service is capable of supporting people who are pre- and post-dementia diagnosis despite the care system being under strain. This is a direct result of the bridge building work of the dementia care coordinators. Our findings support evidence-based recommendations for those wanting to implement and sustain a system-wide service and provide evidence for policy makers to consider increased funding for this service nationwide.

BackgroundThere is a global shortage of nurses and new strategies are required to recruit, support and retain this staff group. Organisational culture can have a significant impact on staff wellbeing and commitment. Recent years have seen attempts to foster a compassionate culture across healthcare systems. However, little is known about how nurses initiate self-care and how they feel cared for by their organisation, particularly in times of acute stress and need.AimsThis paper aims to address the research question, ‘In what ways do nurses experience compassion (or not) during times of acute stress?’, identifying where and how compassionate acts were enacted by individuals, within teams or organisations.MethodsSemi-structured interviews were conducted with 50 UK National Health Service (NHS) nurses in a longitudinal qualitative study (between March 2020 and September 2022).ResultsThree themes were derived from our narrative analysis including: (1) Learning and practising self-compassion; (2) The presence and absence of interpersonal compassion; and (3) Organisational (non) compassionate acts. Findings indicate that self-compassion requires permission and discipline, often being unfamiliar terrain for nurses. Interpersonal compassion can buoy nurses during challenging times but can often be absent across teams. Nurses’ experiences of organisational acts of compassion were limited, and they often felt de-valued, unsupported and replaceable.ConclusionsCompassionate acts are enacted across three levels (self, team and organisation). To retain staff, particularly in acutely stressful or challenging situations, organisations, and those responsible for nursing management and policy need to foster a systems-based approach to compassionate culture.

Background Recent policy initiatives seeking to address the workforce crisis in general practice have promoted greater multidisciplinarity. Evidence is lacking on how changes in staffing and the relational climate in practice teams affect the experiences of staff and patients. Aim To synthesise evidence on how the composition of the practice workforce and team climate affect staff job satisfaction and burnout, and the processes and quality of care for patients. Design & setting A systematic literature review of international evidence. Method Four different searches were carried out using MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science. Evidence from English language articles from 2012–2022 was identified, with no restriction on study design. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and data were synthesised thematically. Results In total, 11 studies in primary healthcare settings were included, 10 from US integrated healthcare systems, one from Canada. Findings indicated that when teams are understaffed and work environments are stressful, patient care and staff wellbeing suffer. However, a good relational climate can buffer against burnout and protect patient care quality in situations of high workload. Good team dynamics and stable team membership are important for patient care coordination and job satisfaction. Female physicians are at greater risk of burnout. Conclusion Evidence regarding team composition and team climate in relation to staff and patient outcomes in general practice remains limited. Challenges exist when drawing conclusions across different team compositions and definitions of team climate. Further research is needed to explore the conditions that generate a ‘good’ climate.

Job seeking is a crucial yet overlooked process through which people navigate the world of work. Yet there remains limited qualitative research examining the complex and nuanced experiences of job seekers in a contemporary labour market. This article explores 38 interviews with job-seeking women in England, all of whom were interviewed over a six-month period. Using a postfeminist sensibility, findings revealed an oscillation between empowerment and success on the one hand, and disempowerment and perceived failure on the other, including wanting to: find the 'right' job, but accept any job; convey an authentic self but imitate what they think employers want; negotiate salaries, but accept pay cuts; emulate 'successful' behaviours, but experience doubt, uncertainty and negativity. This article contributes to the sociological practice of employment, identifying that through this oscillation, women experience a form of postfeminist precarity that starts from the outset of job seeking.

Using qualitative interview data (n = 142 interviews) generated with 50 nurses, over the course of the COVID-19 pandemic, this paper traces the trajectories of nurses in the UK and attempts to unpick the interplay between structure and agency in their narratives. Interviews were inductively analysed for themes and an additional narrative analysis was undertaken to preserve the form of each participant's narrative. We argue that nurses' pandemic trajectories occurred within the 'psychological vulnerability-stigma nexus' which operates within health and social care providers in the UK and whilst constraining nurses' agency at times it could also provide an impetus to act agentically. We found that the nurses' COVID-19 trajectories were characterised by: getting by, getting out (job-hopping) getting needs met and getting organised. We call for more considered systemic support to be generated and consistently provided to nurses to ensure retention of nurses and the security of society to avoid exacerbating existing workforce shortages.

This short commentary which acts as a radical, vulnerable selfie, reflects on Millennial notions of manifestation, leaning in and Girlbossing. In doing so, this selfie critically engages with how these concepts have come to organise the female protagonist of our times. By applying principles of ‘writing differently’, readers are taken on a reflective, vulnerable journey. In doing so the contribution of this article is co-constructed: you are invited to reflect on your own toxic webs of organising and may indeed feel exhausted by the end. Insights are framed inside of contemporary cultural references, positioning this text as a hybrid of academic prose that sits outside of traditional academic writing.

Unprofessional behaviours (UBs) between healthcare staff are widespread and have negative impacts on patient safety, staff well-being and organisational efficiency. However, knowledge of how to address UBs is lacking. Our recent realist review analysed 148 sources including 42 reports of interventions drawing on different behaviour change strategies and found that interventions insufficiently explain their rationale for using particular strategies. We also explored the drivers of UBs and how these may interact. In our analysis, we elucidated both common mechanisms underlying both how drivers increase UB and how strategies address UB, enabling the mapping of strategies against drivers they address. For example, social norm-setting strategies work by fostering a more professional social norm, which can help tackle the driver 'reduced social cohesion'. Our novel programme theory, presented here, provides an increased understanding of what strategies might be effective to adddress specific drivers of UB. This can inform logic model design for those seeking to develop interventions addressing UB in healthcare settings.

Background General practice is in a state of crisis in a number of countries. In the UK, a range of measures have been introduced to address the situation, including innovations such as practice networks, multidisciplinary roles, and digital technologies. However, identifying what still needs fixing could benefit from more evidence, particularly in relation to day-to-day service delivery. Aim To identify the general practice workforce’s top 10 research priorities to improve service delivery. Design and setting This priority-setting study used an adapted James Lind Alliance methodology and involved staff working in general practice across the UK. Method The study comprised four phases: an online qualitative survey issued to the general practice workforce (clinical and non-clinical groups); thematic analysis of free-text responses; generation of indicative research questions; and the undertaking of ranking exercises with responders of the original survey. An online workshop was held with participants at the final stage of prioritisation. Results In total, 93 staff completed a survey in Phase 1, from which 20 themes were categorised and developed into research questions. Twenty- two staff responded to the first ranking activity and 11 took part in a second ranking activity to discuss themes that had a tied vote. The final top 10 research priorities were: volume of work; patient behaviour; consultations; employment pay and conditions; workload dumping and care of patients on waiting list; funding; overwhelming pressure; patient health education; complex patient needs; and interfaces with secondary care. However, there was no clear ranking of these 10 priorities; instead, they carried equal weight and were closely interconnected. Conclusion Applying a marginal-gains approach, by seeking to explore all 10 priorities simultaneously as opposed to concentrating on one area at a time, may provide more noticeable improvements overall. Systems-based approaches that take account of the marked role that context has may be a particularly useful lens for future research.

This short commentary which acts as a radical, vulnerable selfie, reflects on Millennial notions of manifestation, leaning in and Girlbossing. In doing so, this selfie critically engages with how these concepts have come to organise the female protagonist of our times. By applying principles of ‘writing differently’, readers are taken on a reflective, vulnerable journey. In doing so the contribution of this article is co-constructed: you are invited to reflect on your own toxic webs of organising and may indeed feel exhausted by the end. Insights are framed inside of contemporary cultural references, positioning this text as a hybrid of academic prose that sits outside of traditional academic writing.

BACKGROUND:A dementia care coordinator (DCC) service has recently been implemented across Kent and Medway Integrated Care Board (ICB). DCCs are provided at the primary care network (PCN) level and work closely with GP practice teams. The service is intended to help service users navigate the care system and provide proactive support to mitigate crisis points. However, the value of this service from key stakeholder perspectives is not yet known. AIM:To understand: 1) how the DCC service works, for whom, and in what circumstances; and 2) identify outcomes, resource implications, and costs. METHOD:The study uses mixed-methods realist evaluation with an embedded economic component. Data collection includes: questionnaires, service provider metrics, and qualitative interviews with healthcare practitioners and service users. Interpretive comparative analysis and narrative synthesis including evaluation of service costs against outcomes will produce a refined final programme theory. Patient and public involvement have been consulted throughout. RESULTS:Preliminary results indicate that when embedded in a local practice, healthcare practitioners including GPs welcome DCC involvement. DCCs act as community lynchpins, bridging service users to appropriate care pathways. The service may be capable of increasing diagnosis rates and reducing crisis points. However, caseloads are currently untamed. Therefore, the service and its workforce are becoming over-stretched. CONCLUSION:This evaluation describes preliminary findings from a recently implemented DCC service in Kent and Medway ICB. There is a crucial need to enhance the support of this workforce in order to ensure sustainability of this service. These findings will inform service development and future investment decisions.

OBJECTIVE:To understand views of staff in relation to attitudes, enablers, and barriers to implementation of environmentally sustainable surgery in operating theatres. This will ultimately help in the goal of successfully implementing more sustainable theatres. BACKGROUND:Global health care sectors are responsible for 4.4% of greenhouse gas emissions. Surgical operating theatres are resource intensive areas and improvements will be important to meet Net-Zero carbon emissions within health care. METHODS:Three databases were searched (Web of Science, Ovid, and PubMed), last checked January 2024. We included original manuscripts evaluating staff views regarding sustainable operating theatres. The Mixed Methods Appraisal Tool was used for quality appraisal and data analysed using thematic synthesis. RESULTS:A total of 2933 articles were screened and 14 fulfilled inclusion criteria, using qualitative (1), quantitative (2), and mixed methods (11). Studies were undertaken in a variety of clinical (Department of Anaesthesia, Surgery, Otolaryngology, Obstetrics and Gynaecology and Ophthalmology) and geographical settings (Australia, Canada, France, Germany, New Zealand, United States, United Kingdom, and Ireland). Across studies there was a lack of evidence exploring enablers to implementation, but barriers mainly related to the following themes: education and awareness, leadership, resistance to change, facilities and equipment, time, and incentive. CONCLUSIONS:This systematic review identified attitudes and barriers perceived by clinicians towards improving environmental sustainability within operating theatres, which may inform future strategy towards sustainable surgery. Most studies used a survey-design, whereas use of interviews may provide deeper insights. Future work should be extended to wider stakeholders influencing operating theatres. In addition, implementation studies should be carried out to examine whether barriers do change in practice.

This working paper presents on the conceptualisation and development of an initial programme theory (IPT) underpinning the realist evaluation of a Dementia Care Coordinator service in Kent and Medway ICB. The IPT and its related process of emergence are discussed to provide transparency into the research process.

Background: In July 2021, Kent and Medway ICB (UK) funded nine Dementia Care Coordinator (DCC) posts to improve care for people with dementia and their families. This as a pilot project where each DCC was assigned to a Primary Care Network (collection of GP practices covering 30,000 -50,000 people). Following the end of the pilot, DCCs were invited to participate in a focus group to explore successes and challenges. This report presents findings from the focus group. Methods: Nine DCCs were invited to engage in this study. Three DCCs provided informed consent and attended a 90 minute online focus group. Data were subsequently transcribed and analysed using thematic analysis which is a rigorous analytical approach to qualitative data. Findings: Findings indicate that, according to DCCs, the service appears to reduce anxiety and worry amongst people living with dementia and their carers across all points of the dementia journey. Knowing that a key point of contact is available to them means that when they notice a change in their wellbeing, they may feel more inclined to contact an impartial, non-clinical individual for signposting. In the meantime, DCCs weave webs of care around people living with dementia so to provide the best possible support. DCCs found it challenging at times to: (1) work with GPs; (2) to support people living with dementia whilst also living alone; (3) manage service user and carer expectations about their role and: (4) to manage their growing patient lists and workload. Conclusions: Overall, to ensure a sustainable service, key recommendations in need of further exploration include: (1) ensuring buy in from key stakeholders, specifically GPs; (2) facilitating staff support and training including clinical supervision/ observations, and: (3) ensuring the service is adequately staffed to protect staff workload and ensure sufficient capacity to enable delivery of high-quality care to service users.A larger scale evaluation is currently underway, due to be completed in October 2024 (see Abrams et al., 2023 for further details).

A dementia care coordinator (DCC) service has recently been implemented across Kent and Medway Integrated Care Board (ICB). DCCs are provided at the Primary Care Network (PCN) level and work closely with GP practice teams. The service is intended to help service users navigate the care system and provide proactive support to mitigate crisis points. However, the value of this service, from key stakeholder perspectives is not yet known. The University of Surrey is conducting a realist evaluation into the service to explore what works, for whom, how, why and under what circumstances. This working paper reports on interim findings from an analysis of: (1) staffing and key performance indicators at the 12 month point in the project (October 2023); and (2) responses to an initial questionnaire sent to coordinators. Findings indicate DCCs enjoy being people-focused in their approach, and value being empathetic, well organised and effective. This may facilitate their ability to make a difference, provide individualised support, advocate for service users, and achieve job satisfaction. Working to high standards, in a joined-up way, with embedded knowledge and networks are important components to this. There is now a crucial need to enhance the support of this workforce (e.g. through formal, recognised training, caseload management, time, and knowledgeable management) in order to ensure sustainability of this service. This evaluation is on-going.

BACKGROUND:There have been significant achievements in controlling COVID-19 in Saudi Arabia (SA), but as in most healthcare settings worldwide, health services have been seriously disrupted. Also, with pandemic control measures such as lockdowns and curfews, and innovations such as digital health services, the delivery of primary healthcare (PHC) services has dramatically changed. However, little is known about patients' experiences of PHCs during the pandemic, their views on the pandemic-related interventions in SA, and patient views on impact on their medical care.METHODS:Qualitative semi-structured online interviews were conducted for twenty-four Saudi patients across SA aged 18 and above who were diverse in terms of age, gender, education and health status. Data were analysed using thematic analysis yielding four major themes as an impact of COVID-19 on patient engagement with PHCs.RESULTS:The COVID-19 pandemic has had profound mixed impacts on patient engagement with PHC in SA. Fear of infection or of breaking lockdown rules has negatively impacted the utilisation of PHCs but positively changed patients' attitudes towards seeking medical help for self-limiting conditions. The pandemic has also negatively impacted routine preventive care at PHCs, especially for patients with long-term health conditions. The mandatory use of some digital health services in SA that existed pre-pandemic has provided patients with a perception of better care during the pandemic. Yet, a lack of awareness of optional digital health services, such as virtual clinics, hindered optimal use. Despite pandemic-related disruption of patient engagement with PHCs, the reduced waiting time in PHC centres and healthcare providers' communication and empathy during the pandemic contributed to patients' perceptions of better care compared to pre-pandemic. However, patients living outside the main cities in SA perceived care quality as less good during the pandemic compared to PHCs in the main cities in SA.CONCLUSION:The lessons learned from patients' experiences and views of PHCs during the pandemic were beneficial in promoting patient engagement with PHCs. The digital health services mandated in response to the pandemic have accelerated digital health innovation in SA and allowed patients to recognise the benefits of digital health. This has huge potential for increasing continuous patient engagement with PHCs. Yet, patients' experiences of digital health services during the pandemic are essential for informing appropriate implementation and utilisation of e-health services. Patients' positive experiences of PHCs during the pandemic, such as the reduction in waiting times and the perception of improved healthcare providers' professionalism, communication and empathy, can be built on to sustain engagement with PHC services. These findings might have significance for clinicians and policymakers to support patient engagement with PHCs, particularly in healthcare systems like SA that struggle with the overuse of emergency departments (EDs) for PHC-treatable conditions.

In this editorial, we tell the story of how the Special Issue on Critical Perspectives in Work and Organizational Psychology (CWOP) came about, how it fits within the broader agenda of building a critical community within Work and Organizational Psychology, and how future research and thought may be inspired by the collection of critical papers related to work and organizational psychology. We introduce the term “criticalizing” as a key concept in how the Special Issue was developed by the editorial team and the authors. Criticalizing moves beyond fixed static notions of “critical” scholarship toward a process of engaging in more fluid, expansive, and creative perspectives on the scholarship within work and organizational psychology. We illustrate how the set of papers within the Special Issue engages in such criticalizing of the field and offer new ways of thinking about and researching relevant topics in work and organizational psychology.

AIM To critically examine nurses' experiences of speaking up during COVID-19 and the consequences of doing so. DESIGN Longitudinal qualitative study. METHODS Participants were purposively sampled to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi-structured interview topic guide. RESULTS Three key themes were identified inductively from our analysis including: (1) Under threat: The ability to speak up or not; (2) Risk tolerance and avoidance: Consequences of speaking up; and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses' opportunities to speak up were frequently thwarted. CONCLUSION Accounts presented in this article include nurses' feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a 'deaf' or hostile response, leaving nurses feeling disregarded by their organization. This points to missed opportunities to learn from those on the front line. IMPACT Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. PATIENT OR PUBLIC CONTRIBUTION Nurses working clinically during COVID-19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial survey helped to shape the study design.

BACKGROUND:Unprofessional behaviours (UB) between healthcare staff are rife in global healthcare systems, negatively impacting staff wellbeing, patient safety and care quality. Drivers of UBs include organisational, situational, team, and leadership issues which interact in complex ways. An improved understanding of these factors and their interactions would enable future interventions to better target these drivers of UB. METHODS:A realist review following RAMESES guidelines was undertaken with stakeholder input. Initial theories were formulated drawing on reports known to the study team and scoping searches. A systematic search of databases including Embase, CINAHL, MEDLINE and HMIC was performed to identify literature for theory refinement. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories. RESULTS:We included 81 reports (papers) from 2,977 deduplicated records of grey and academic reports, and 28 via Google, stakeholders, and team members, yielding a total of 109 reports. Five categories of contributor were formulated: (1) workplace disempowerment; (2) harmful workplace processes and cultures; (3) inhibited social cohesion; (4) reduced ability to speak up; and (5) lack of manager awareness and urgency. These resulted in direct increases to UB, reduced ability of staff to cope, and reduced ability to report, challenge or address UB. Twenty-three theories were developed to explain how these contributors work and interact, and how their outcomes differ across diverse staff groups. Staff most at risk of UB include women, new staff, staff with disabilities, and staff from minoritised groups. UB negatively impacted patient safety by impairing concentration, communication, ability to learn, confidence, and interpersonal trust. CONCLUSION:Existing research has focused primarily on individual characteristics, but these are inconsistent, difficult to address, and can be used to deflect organisational responsibility. We present a comprehensive programme theory furthering understanding of contributors to UB, how they work and why, how they interact, whom they affect, and how patient safety is impacted. More research is needed to understand how and why minoritised staff are disproportionately affected by UB. STUDY REGISTRATION:This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .