A single qualitative case study of how the introduction of an AEC unit influenced the experiences of patients, carers and NHS staff
BackgroundThe urgent and emergency care spectrum in the National Health Service (NHS) in the United Kingdom (UK) has changed over the last few years in response to the population's changing needs. In response, Ambulatory emergency care (AEC), which offered a different way of providing medical daycare, was introduced (Department of Health [DH], 2010c). The introduction of AEC was based on the supposition that it can prevent short-stay admissions and improve patients’ experiences. There are currently several AEC units across the UK, but up to date, there are no published studies of the impact of these units on the experiences of patients, carers and NHS staff.Statement of intentThis interpretive case study aimed to answer the research questions about how introducing an AEC unit influenced patients, carers and NHS staff’s experiences and what factors affected their experiences. Research design and methodsThe experiences of patients, carers, and NHS staff in an AEC unit were explored through a single, qualitative, intrinsic case study. The intrinsic case study was conducted over fourteen months at an NHS Trust in the North West of England. Qualitative data were collected through participant observations, a staff focus group and semi-structured interviews with patients, carers and NHS staff. A purposeful sample of six patients, four carers, six AEC staff members, four senior NHS managers, two GPs and two ANP’s were recruited for semi-structured interviews. Participant observations were undertaken on the unit over four weeks. One focus group with six members of the AEC team occurred. Data was analysed through thematic analysis (Braun & Clarke, 2006) and using the analytical techniques (direct interpretation, categorical aggregation and naturalistic generalisation) proposed by Stake (1995). FindingsFour major themes emerged from the data collected: discourse, misalignment, safety and power. Through a sense-making lens, the influences of power differentials, discourse communities, misalignment of values and concerns regarding psychological safety on participants perceptions of experiences were brought to the fore. The framework provided insight into how they dealt with the challenges and how misalignment between power, discourse and values can create psychologically unsafe environments which negatively impact experiences and hamper transformation efforts. ConclusionThe study findings demonstrated that AEC’s introduction positively impacted the experiences of participants. However, meanings and interpretations about experiences are simultaneously context-dependent and context-renewing, thus formed and sustained by the broader social, political and organisational context. Furthermore, the study findings highlighted the importance of intersubjectivity in the mutual shaping, reciprocity and bi-directionality of viewpoints about the experience.
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