A Multi-Stakeholder Engagement Process utilising the World Café method of participatory inquiry (4, 5), was conducted with 59 key stakeholders involved in the Clinical Programmes including clinicians, managers, academics and patients to access the participants’ experience and expertise of the Clinical Programmes to date to inform phase 2. An inductive approach using qualitative thematic analysis of the written material was used to determine themes for identification. This was chosen as it provides a flexible and useful research methodology, which can potentially provide a rich and detailed, yet complex account of data obtained. Participants were required to respond to 3 key questions presented during the World Café and to write their responses verbatim for submission to the investigators. Questions were designed with health system redesign in mind to elicit responses that would capture the participants’ subjective experiences of the healthcare system regarding the implementation the clinical programmes.
Participants
Participants were either national clinical leads, GP leads, programme managers, and/or members of the postgraduate medical training forum. Participants also included key stakeholders such as patients and patient advocacy organisations and representatives from academic institutions. At the time of the study, all participants were actively engaged in quality improvement work with the National Clinical Programmes.
Procedure
Purposive sampling was used to identify participants. This method was chosen because the programmes are very diverse and heterogeneous, and it was felt that participants needed to reflect the breadth of the programmes without too many participants being involved to make the running of the events and meaningful dialogue difficult. Identified participants were then invited to participate by a letter from the National Director. 2 world café events were held.
Conduct
Developed by Juanita Brown and David Isaacs the World Café is a participatory method that seeks to facilitate change by bringing together key stakeholders of a system of interest and using a highly structured movement process, enables evolutionary conversations that generates collective discoveries that are gathered and shared (4, 5). This approach recognises that answers to difficult questions often exist in the collective knowledge of networks of individuals with a shared interest. It was designed as a means of cultivating and harnessing the power of ‘conversations that matter’ and follow seven core design principles: (6)
- There must be a clear purpose and parameters in which collaborative learning will develop.
- The event must be hosted in a hospitable space
- It should explore questions that matter to participants.
- Every participants contribution is encouraged and valued
- It should facilitate cross-pollination and connect diverse viewpoints.
- There should be collective listening to identify patterns, insights and discoveries.
- The collective discoveries are harvested and shared.
The objective of the sessions was to obtain the views of the invited participants on the following three questions which were consciously orientated towards the principles of appreciative inquiry and developed as ‘provocative propositions’ (7):
- What is good about the Clinical Programmes?
- What is not good about the Clinical Programmes?
- Make one suggestion on how to improve the Clinical Programmes
The café sessions considered each of the three questions in turn.
The World Café setting created a relaxed environment where participants were grouped at tables of 6-8. A draw was used for the allocation of tables.
Only one question was presented at a time. Every table “chatted” about the question and when doing so jotted down their comments on the cards provided – one card per comment.
30 minutes per question was allocated.
Data collection
At the end of each session the cards were collected. No names or table numbers were on the cards so that feedback was totally anonymous.
The feedback comments were entered in an excel spreadsheet for analysis and reporting. The themes were not identified prior to examination of the comments. Only as the comments were analysed did the themes come together.
Ethical Approval and Consent to Participate
This activity was conceived as a collaborative inquiry with the primary purpose of developing a shared understanding of challenges to implementation to inform the next phase of the programmes. The activity was screened in accordance with HSE Research Ethics guidance and was deemed not to require research ethics committee review. The work observed the ethical principles articulated within the Belmont Report (8)
All written comments and notes were captured anonymously. Verbal consent was obtained from participants at the start of the events. Participants were informed in the invitation and at the start of the meeting that the written notes would be collected and analyzed and used to create a report from the activity. Participants were informed that they would have access to a draft report for their feedback prior to the wider circulation of the report.
Data Analysis
The 6 phases of thematic analysis according to Braun and Clarke were observed (9) . Three investigators analysed the data. The investigators familiarised themselves with the data by reading and rereading the written submissions and noting down initial ideas. Codes were initially given to certain recurring words or ideas. These codes were then simplified and expanded into interpreted categories and themes as patterns in the data emerged. The themes were then expanded on and further revised. The final stage was to refine themes and define why they were interesting and what was interesting about them. Finally, a report was produced.