A grounded theory study of protected learning time

Cunningham, David Edward (2012) A grounded theory study of protected learning time. PhD thesis, University of Glasgow.

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Protected learning time (PLT) has been adopted by a number of NHS primary health care organizations throughout the United Kingdom as a resource for learning. Primary health care teams are protected from service delivery by Out-of-hours services for a small number of afternoons per year. Learning events are generally of two types: practice-based PLT events organised by the primary health care team and usually held in practice premises; and large centrally organised meetings held in large conference venues, and arranged by a PLT committee.
PLT schemes were started by NHS Ayrshire and Arran in 2002 after a pilot study in 2001 was considered successful. A quantitative evaluation of the PLT scheme in two Community Health Partnerships within NHS Ayrshire and Arran in 2004 showed a significant difference in the views of Administrative and Clerical staff (A & C staff) and practice managers compared with clinicians in the team. Only 41% of A & C staff and 51% of practice managers wanted PLT to continue in one of the areas surveyed. An additional questionnaire study answered by practice managers in 2005 in NHS Ayrshire and Arran suggested that attendance of community nurses (health visiting and district nursing teams) at practice-based PLT events had fallen sharply, and that only a few were attending regularly. The questionnaires were unable to give the reasons for the low attendance, nor could they explain why some wanted the scheme to end.
Two research questions were developed to improve the understanding of what was happening during PLT:
1. What are the perceptions and experiences of A & C staff, and of practice managers with regards to PLT?
2. What are the perceptions and experiences of the community nursing team (community nurses and nursing managers) with regards to PLT?
A Charmazian grounded theory approach was adopted, both as a method of data analysis, and as a research strategy. The data collection consisted of two phases: A & C staff, and practice managers (2005); and the community nursing team (2007). Focus groups were recruited, and the interviews were audio-recorded and transcribed. Transcriptions were coded, and themes and categories of themes were constructed from the codes. Mind mapping software was used to show the connections between the participants’ quotes and the themes and categories. A grounded theory was then constructed from the three categories.
12 focus group interviews were held with a total of 88 staff members participating. Details of the categories constructed are as follows:
Structures in primary health care
Physical structures were important. There were perceptions of the organizational schism between individual practices and the community nursing team. Community nurses valued co-location with their general practice as this improved close working. Different working patterns of district nurses meant that they could not always be protected during PLT, and they felt their managers did not provide sufficient cover. The introduction of the 2004 GMS Contract emphasized the separation of community nurses from general practices. Some nurses felt that practice-based PLT was irrelevant as it was centred on the learning needs of the practice. Some practices were strongly hierarchical resulting in separate learning events for individual staff groups during PLT.
Relationships in primary health care:
Relationships between community nurses and practices varied greatly. Some health visitors felt very isolated from the general practice. Community nurses wanted to work closely with practices and wanted their work to be visible and valued. Relationships between A & C staff and GPs varied considerably. Those practices with a high degree of hierarchy found collective learning difficult to do. Other practices had good relationships between different staff groups, and made good use of PLT.
Learning processes:
In general, participants did not feel their learning needs were identified or acted upon. As a result, learning offered to them was usually considered irrelevant, and based on the needs of others. A & C staff found some events to be dull and uninteresting, when passive learning methods were employed. Some practice managers perceived a lack of resources for learning events, and pharmaceutical representatives were keen to provide learning for clinicians. In some teams, practice-based PLT could be uncomfortable for community nurses, and some felt unwelcome by GPs. Practice managers were considered to be the natural leaders of practice-based PLT.
Grounded theory:
A theory with three elements was constructed from the findings. Proximity was an important factor in the ability of teams to learn from each other. Those teams who were not co-located, or did not work together in the provision of patient care, found PLT to be difficult. Perceptions of power affected the experiences of PLT. GPs usually had learning based on needs, and they could influence who attended PLT with them, and what was learnt. Some staff groups had little power, namely A & C staff and community nurses, and at times, the quality of learning for these groups was low. Authenticity was important. Participants wanted PLT to be for the whole team and to involve everyone in learning together. Many were disappointed when this was not achieved, and considered it to be contrary to the original aims and objectives of the scheme.
Comparisons with other theories:
The grounded theory was compared to Bourdieu’s theory of practice. This helped with the understanding of issues relating to the element of power. The element of proximity had similarities to Wenger’s theory of Communities of Practice. Those primary health care teams who displayed high levels of proximity were working as a Community of Practice.
A deeper understanding of participants’ perceptions and experiences was gained and explored by the thesis. A number of recommendations were made to improve PLT in the future. These included improved learning needs assessment and aiding practice managers with the delivery of practice-based events. Individuals within primary health care teams need to improve team-working and need learning to help them with this endeavour. Health authorities need to value teamwork more, and require to locate teams together to facilitate the delivery of primary health care.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: team learning, primary health care, NHS organisations, collective learning
Subjects: R Medicine > RZ Other systems of medicine
L Education > LB Theory and practice of education
Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing
Supervisor's Name: Kelly, Dr. Diane
Date of Award: 2012
Unique ID: glathesis:2012-3329
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 27 Apr 2012
Last Modified: 10 Dec 2012 14:06
URI: https://theses.gla.ac.uk/id/eprint/3329

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