I sat in today on a talk given by Catriona Kennedy.
Catriona is Reader and School Director for Research
and Knowledge Transfer in the School of Nursing, Midwifery and Social Care
Catriona presented a summary of work undertaken at the Edinburgh Napier University in nursing. I was very interested in her discussion of the Cochrane Review process and outputs. I liked the diversity of methods she and her team had used and are using. I noted in particular her use of emotional touchpoints in qualitative research.
I was intrigued by the possibilities of emotional touchpoints for my growing interest in deliberation and conversation. I think too these touchpoints might help in exploring learning biographies and coaches’ stories.
Paul Bate and Glenn Robert (2007) provided the stimulus for Catriona and her colleagues’ use of emotional touchpoints. The 2007 paper reports on an original experience-based design (EBD) intervention methodology “designed and tested by the authors and colleagues in a cancer clinic within the National Health Service”. Joanna Goodrich and Jocelyn Cornwell (2008) report that:
Experience-based design (EBD) is a methodology for working with groups of patients and staff to improve services developed for health care settings by Paul Bate and Glenn Robert. Drawing on the knowledge and ideas of the design sciences and design professions, where the aim of making products or buildings better for the user is achieved by making the users integral to the design process itself, the focus is on how patients and staff move (or are moved) through the service and interact with its various parts. Patients work with staff to ‘co-design’ improvements in the experience of using the service (mapping the subjective as well as the objective pathway of care). The involvement of patients and staff on an equal footing is much deeper than that in ‘patient involvement’ projects where patients are often treated as objects for study, rather than partners. How the service ‘feels’ or is experienced is seen as equally important as how fit for purpose it is (functionality) and how safe it is. Bate and Robert have given a step-by-step guide to the methodology and illustrated it with the case of a 12-month pilot, funded by the NHS Institute for Innovation and Improvement, in head and neck cancer services at Luton and Dunstable NHS Foundation Trust.
During the pilot, patients and staff worked together to identify the key ‘touch points’ (or ‘moments of truth’) which had shaped their personal experiences of the head and neck service. This then enabled them to work together to prioritise and then implement – through 70 separate actions – a total of 43 improvements. Two of these improvements have directly increased the efficiency of the head and neck service (for example, the throughput of patients at the outpatients clinic), four have improved patient safety (eg, expanding staff competencies on the post-surgical ward), while the remainder – the majority (37 improvements) – have improved the experience of the service (eg, giving patients a choice as to when their feeding tube should be fitted). Of these, 12 related to better information provision at various points of the patient journey, 11 related to changes in the physical environments experienced by the patients, 9 related to changes in staff behaviour and 4 related to a desire for greater support mechanisms (particularly involving other patients).
Belinda Dewar and Richard Mackay (2009) used an emotional touchpoint approach to their work to learn more about the experience of compassionate care. They report that using emotional touchpoints:
has been a powerful experience. They are easy to use and it’s really hard not to be driven to action from the story. Hearing the positive things about practice has been a real insight – we often don’t know the small things that matter so much to the patient and perhaps we take for granted. One example: “My mum needed the loo and I told somebody – they said it wasn’t a problem and asked me to wait outside. I could hear them outside the room and they were chatting away to mum at her level – they were having a laugh together and sharing things. I felt proud as the staff had probably heard what she was saying so many times already but they reacted as if they had heard what she was saying for the first time. This felt good.”
Belinda and Richard suggest that this approach has improved practice in the following ways:
- Seeking feedback based on the person’s emotional response to a situation cannot be disputed and it has helped us challenge assumptions about what we think the patient/family feels and wants.
- Staff are more at ease about hearing negative aspects of a patient/family experience as the method doesn’t directly focus on blaming the service.
- Better relationships have been developed with patient and family members especially if they have been involved in shaping the service.
- Actions taken forward are based on real and meaningful evidence and staff feel moved and motivated to have another look at what we do.
I think this approach has a great deal to offer a range of qualitative research approaches. I do want to explore these touchpoints in the context of deliberation and conversation. I think they will become powerful connections in inter-professional learning and practice.