Research

From April 2013, the Prime Minster wants to see ‘doctors in charge’, with new Clinical Commissioning Groups paving the way. But there has been widespread scepticism about whether GPs and other clinicians are ready for this root-and-branch challenge.

New research results from the OU funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme offers some much-needed answers. Drawing on data from actual service redesign attempts in the two challenging areas of sexual health services and dementia, researchers found that clinicians who did demonstrate leadership were capable of being open to new ideas and new knowledge while also having the political wisdom to carry their colleagues with them.

Dementia services were refashioned to make early diagnosis more accessible and sexual health reworked so that everything most patients needed could be provided in one visit to a high street clinic.

These gains were not easily won. The research also found extensive evidence of the scale of the challenges when seeking to overcome inertia. Notably, the obstacles are often to be found among their peers. Trust boards and hierarchies were also seen as frequent drags on innovation. In this context, the research sheds new light on the elusive idea of clinical leadership.

Those hospital doctors and senior nurses showing leadership in service redesign had begun to master a range of political and managerial skills. They developed informal links with staff working in related services, developed ideas for simplifying patient journeys and sought out innovation-minded managers and commissioners to help smooth the way for new more patient-centred arrangements.

The research project identifies and clarifies the kind of skills which will hold the key to successful delivery of the new regime, as well as ways of dealing with colleagues and trust managers who resisted new ideas. However, in all but one of the case studies, the clinicians and managers behind the creation of new service models felt it had been difficult to involve GPs. Clinical leadership was thus coming from the hospital sector. This has implications for the new Clinical Commissioning Groups which will take charge of the largest part of the NHS budget from April.

Talking about how the obstacles can be overcome, Dr Richard Holti a co-researcher on the project said: “Formal project planning is not enough; rather, informal, lateral, leadership is important. This is needed in order to bring along clinical colleagues, to reassure them and to win their cooperation and ideas. The most effective service redesigns were achieved when both of these processes worked in tandem”.

Professor John Storey, who led the project, added: “In general, clinical leadership was found to occur at multiple levels and the role of clinicians in shaping national policy should not be underestimated. Many of the important changes required national endorsement – and often funding – in order to put traction behind good ideas.”
 

An Open University research centre which trains and supports children to research topics of importance to them has been shortlisted in The Guardian University Awards’ outstanding research impact category.

The Children’s Research Centre (CRC) which empowers children as active researchers was announced as one of three nominated projects on the Higher Education Network site on Tuesday 18 December and winners will be announced at the awards ceremony on Wednesday 27 February 2013.

The CRC, which is led by Founder Director Mary Kellett, Professor of Childhood and Youth at the OU, has been at the forefront of child-led research since 2004. It encourages children to research areas which are important to them. This work is an important development within the university’s Centre for Research in Education and Educational Technology.

Outputs reflect findings pertinent to children’s lived experiences and to society more generally. Examples include: internet safety; cultural and race identity issues; bereavement; children’s worries; children’s rights; mobility issues for children of wheelchair users; children’s views about the Police; looked-after children; young Travellers; young carers; TV and gaming; diet and exercise; substance abuse; staying safe; life on housing estates.

Some of this research has influenced policy e.g. a 10 year-old’s research on social isolation factors for children with Graves disease changed practice at Great Ormond Street Hospital; CRC children’s research contributed to Joseph Rowntree’s flagship Education and Poverty programme. Youth-led cyberbullying research, in partnership with Diana Award, hit 72 media outlets and impacted significantly on national anti-bullying week.

Commenting on the award nomination: Professor Kellett said: “It is a great honour to be shortlisted for such a prestigious award and I am delighted that children’s own research is being recognised in this way.”

Find out more:

• Full list of shortlisted awards in The Guardian University awards
• For information about Professor Mary Kellett’s research

 

Contrary to the commonly held belief that technology hampers real world conversations, OU researchers have found that it can in fact aid classroom discussions and help students talk together effectively in order to problem solve and learn.

A new research paper Talk Factory: Supporting 'exploratory talk' around an interactive whiteboard in primary school science plenaries has been produced by Dr Lucinda Kerawalla, Lecturer in Childhood and Youth Studies in the OU’s Faculty of Education and Language Studies, following the creation of a new piece of classroom software called Talk Factory.

Dr Kerawalla, together with colleagues Professor Eileen Scanlon and Dr Marilena Petrou, designed Talk Factory as a tool which teachers and students can use to support their understanding of the useful features of classroom discussions, and to provide immediate feedback on how well each child is contributing.

The technological support of classroom plenaries has remained relatively unexplored until now. By using Talk Factory, children can learn how to problem solve through dialogue with each other, using ‘prompts’ on an interactive whiteboard rather than simply responding to questions from the teacher. Talk Factory can put children in the driving seat while their teacher becomes a facilitator.

Positive, managed and measured
Dr Kerawalla explains: “A dialogic approach to teaching, focusing on the development of children’s oracy throughout all curriculum subject areas, is very much on the agenda at the moment but shifting teaching styles and the student’s responses towards this approach can be extremely challenging for any teacher or school. This is where Talk Factory comes in, software designed to help teachers encourage debate and conjecture and problem solving in their classrooms in a positive, managed and measured way.”

Then, as the class begins to discuss a topic, the teacher will record their progress by tapping on the rules displayed on the  interactive whiteboard, effectively evaluating how each child’s utterance contributes to the overall discussion (in line with the above rules) and facilitating reminders to pupils of the rules that will help them discuss more positively and constructively. This in turn generates real time graphical representations of the content of students' whole class discussions in, for example, a bar chart, which teachers and pupils can use to help them evaluate how well they are doing, and make any adjustments if necessary.

Dr Kerawalla adds: “The public and dynamically-evolving nature of the graphical representations on the classroom whiteboard means that this can be used by students to elicit instant feedback on their conversations. In this way, the teachers’ use of Talk Factory plays a central role in opening up a dialogic space where ideas could be put forward, respected, scrutinised and challenged in a supportive discursive environment.

"Overall, where Talk Factory was used in the recent study, we found that teachers adopted a more facilitative role focussing on prompting students for explanatory responses and drawing students into the debate, rather than taking a lead role in steering the direction of the dialogue towards the production of outcomes set by themselves.”

'Dramatic leap in self-realisation'
The Talk Factory software was showcased at an Open University/UK Literacy Association (UKLA) workshop in 2011 and as a result new versions, designed to support discussion in any subject area, have already been adopted by Cornwall Learning and is in use in primary and secondary school throughout Cornwall.

Katie Fitzsimmons, Assistant Head Teacher at Fowey Community College in Cornwall, has supported the development of Talk Factory in classrooms, working with it across a range of subjects from maths to geography.  She says this was done through the explicit teaching of rules for group talking supported by the Talk Factory software.

She said: “Talk Factory yielded some excellent results in engaging our students in more effective talking in lessons. This in turn has enabled students to see how they can expand their written responses and build on input from others in their group, linking speaking with writing. As one member of staff commented ‘The development of the class within one 100 minute lesson was nothing short of phenomenal. It was the quickest and most dramatic leap in self-realisation that I have ever seen in 11 years in the classroom.’”

Talk Factory is a tool that has a dual role: it helps teachers to model and encourage the positive features of discussion and argumentation, and it enables students to take part more effectively in argumentation by increasing their understanding of how to talk together effectively.

• Get a free download of the Talk Factory software