Report of a mixed methods systematic review of literature to inform the development of ‘sustainable safe staffing’ improvement resource in learning disability (LD) services for NHS Improvement

Mafuba, Kay, Gates, Bob ORCID: 0000-0001-7822-6905 and Sivasubramanian, Madhini (2016) Report of a mixed methods systematic review of literature to inform the development of ‘sustainable safe staffing’ improvement resource in learning disability (LD) services for NHS Improvement. Project Report. NHS Improvement, London, UK.

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Abstract

Purpose
The purpose of this mixed methods systematic review of literature is to summarise the best evidence available on sustainable safe staffing levels for multi-disciplinary learning disability teams in order to inform the development of setting-specific sustainable safe staffing guidance for the NHS Improvement National Safe Sustainable Staffing Guidance Programme Board for England. Firstly, the systematic literature review sought to uncover and synthesise any evidence on, sustainable safe staffing levels in learning disability services. Secondly, the review sought to identify themes of relevance to learning disability teams, and the delivery of sustainable, safe, and effective care for people with learning disabilities could be surfaced from national and international literature. Finally, the review sought to assess if any of the emerging evidence affirm or negate the context of care tool as an MDT model of care.

Methods
The Joanna Briggs Institute’s (JBI) systematic review protocols were used to appraise studies. The PRISMA process was used to select the literature for review. Empirical (quantitative, qualitative, mixed methods) studies, synthesised evidence (literature reviews) and opinion papers, (n = 37) were included in the review. A mixed methods approach to the review and synthesis was used due to the heterogeneous nature of the evidence. Quantitative data was converted into themes and presented with qualitative data through meta-aggregation using a narrative approach. JBI tools were used to pool findings and rate them for quality. Meta-synthesis was used to produce the synthesised findings. Foundational coding families of cause, context and process were used as a framework (Glasser 1978) for presenting the findings.

Findings
No empirical evidence was located that directly relate to sustainable safe staffing. Three core themes emerged from the review. The first theme; service models, is underpinned by three categories (service design and implementation strategies; clarity of professional roles and service collaboration / integration mechanisms; stakeholder and service user engagement). Four categories underpin the second theme; standards of care (understanding of the context of care; delivering effective care; ensuring effective communication; ensuring high standards of care). The third theme; resources, is made up of three categories (processes for managing resources; developing professional competence; values-based recruitment and retention practices).

Conclusions
The conclusions from this review leave a number of questions unanswered. The concept of sustainable safe staffing in LD services must be clearly understood from the very complex nature of the models of care, the extent of the number professionals and healthcare agencies involved in meeting the healthcare needs of people with LD.

Implications for practice
Without an appropriate service model of healthcare provision, clear standards of care, and adequate processes for deploying resources sustainable, safe, effective and efficient staffing may be challenging or unachievable.
Implications for research
The lack of robust empirical evidence regarding sustainable safe staffing in LD services mean the need for robustly designed research in this area cannot be overemphasised. Research needs to focus on the context of care, the relationships between sustainability, safety, effectiveness, efficiency and staffing levels, the hub and spoke model of healthcare service provision, and hospital communication passports.
Recommendations
Although the level and quality of evidence from all the literature included in this review is low, we have made appropriate recommendations given the significance and rationale of the topic under consideration.

Item Type: Report (Project Report)
Subjects: Medicine and health > Nursing > Learning disabilities nursing
Depositing User: Kay Mafuba
Date Deposited: 18 Jun 2018 07:36
Last Modified: 25 Jun 2018 14:37
URI: http://repository.uwl.ac.uk/id/eprint/5193

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