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An Evaluation of the Impact of Nurse, Midwife and Health Visitor Consultants

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An Evaluation of the Impact of Nurse, Midwife and Health Visitor Consultants An Evaluation of the Impact of Nurse, Midwife and Health Visitor Consultants By Professor David E Guest1 Dr Riccardo Peccei1 Dr Patrice Rosenthal1 Professor Sally Redfern2 Professor Dame Jenifer Wilson-Barnett2 Professor Philip Dewe3 Samantha Coster1 Amanda Evans1 Dr Andrea Sudbury1 King’s College, London September 2004 1 The Department of Management, King’s College London 2 The Florence Nightingale School of Nursing and Midwifery, King’s College London 3 Department of Organizational Psychology, Birkbeck College, London Acknowledgements We would like to thank all the nurse, midwife and health visitor consultants who participated in the research by completing questionnaires, by answering interview questions and by taking part in focus groups. We would like to thank those Directors of Nursing and other sponsors who agreed to be interviewed. We would also like to thank Dr Pat Oakley for helping us with contacts for some of the interviews. Finally, we would like to thank the Advisory Group who provided us with support and feedback at important points in the project. That group consisted of the following people: David Moore, Assistant Chief Nursing Officer, Department of Health Dr John Wilkinson, Department of Health Cheryll Adams, Community Practitioners' and Health Visitors' Association Dr Anne Marie Rafferty, London School of Hygiene & Tropical Medicine Dr. Susan Read, The University of Sheffield Rosaline Steele/ Sue Macdonald, The Royal College of Midwives Debbie Stubberfield, South West London Strategic Health Authority 2 Table of contents Acknowledgements ......................................................................................................2 Table of contents ..........................................................................................................3 List of tables and figures .............................................................................................5 List of appendices.........................................................................................................5 Executive Summary.....................................................................................................8 Chapter 1: Introduction ............................................................................................11 1.1 The background to the research..........................................................................11 1.2 The aims of the research.....................................................................................12 1.3 The conceptual framework for the research .......................................................12 1.3.1 The impact on patient care...................................................................................... 12 1.3.2 Consultants as leaders ............................................................................................ 13 1.3.3 Role crafting............................................................................................................ 13 1.3.4 Role socialisation and innovation ........................................................................... 14 1.4 Research methodology .......................................................................................17 1.5 Data analysis.......................................................................................................18 1.6 The samples ........................................................................................................18 1.7 Ethical approval..................................................................................................19 1.8 The structure of the report ..................................................................................19 Chapter 2: Who Are The Consultants and What Do They Do?............................20 2.1 Introduction ........................................................................................................20 2.2 Personal profile...................................................................................................20 2.3 Education and training........................................................................................20 2.4 Salary..................................................................................................................21 2.5 Work experience.................................................................................................21 2.6 Geographical/ regional location..........................................................................21 2.7 Type of consultant post.......................................................................................21 2.8 Time of appointment ..........................................................................................22 2.9 Perceived job competence ..................................................................................22 2.10 What do consultants do? Main activities.........................................................23 2.11 Summary...........................................................................................................25 Chapter 3: The Impact of the Consultant Role on Patient Care and Related Outcomes ....................................................................................................................26 3.1 Introduction ........................................................................................................26 3.2 The analytic framework for considering consultant impact ...............................26 3.3 Methods of assessing impact ..............................................................................26 3.4 The focus groups ................................................................................................27 3.4.1 Impact through leadership and consultancy ........................................................... 27 3.4.2 Impact through service development, research and evaluation.............................. 27 3.4.3 Impact through education, training and development ............................................ 28 3.4.4 Impact through expert practice ............................................................................... 28 3.5 The questionnaire survey....................................................................................29 3.5.1 Impact on processes ................................................................................................ 29 3.5.2 Differences in impact on the process items............................................................. 30 3.5.3 Impact on patient outcomes..................................................................................... 30 3.5.4 Factors associated with general impact.................................................................. 31 3.5.5 Perceived effectiveness............................................................................................ 31 3.5.6 Section summary ..................................................................................................... 32 3 3.6 Qualitative illustrations of impact from the questionnaire survey .....................32 3.7 The most significant impact to date....................................................................34 3.8 Evidence of impact from the longitudinal panel interviews...............................35 3.9 Sponsors’ views of impact..................................................................................35 3.10 Summary...........................................................................................................36 Chapter 4: Consultants as Leaders ..........................................................................39 4.1 Introduction ........................................................................................................39 4.2 Engagement in leadership activities ...................................................................39 4.3 Leadership and management ..............................................................................40 4.4 Evidence of impact through leadership ..............................................................42 4.5 Summary.............................................................................................................43 Chapter 5: “Crafting” the Consultant Role: Implications for Satisfaction and Work-Life Balance.....................................................................................................44 5.1 Introduction ........................................................................................................44 5.2 Crafting the consultant role ................................................................................44 5.3 Perceptions of the role ........................................................................................48 5.3.1 Resources and support in the role........................................................................... 48 5.3.2 Job control and job demands .................................................................................. 49 5.3.3 Role clarity, conflict and overload.......................................................................... 50 5.4 Consultants’ job satisfaction and commitment...................................................52 5.4.1 Satisfaction and met expectations ........................................................................... 52 5.4.2 Commitment ............................................................................................................ 54 5.5 Stress at work and work-life balance..................................................................55
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