Evaluating service level outcomes from implementing Seddon’s Vanguard Method, a service improvement framework, in an occupational therapy service in England: A single case study

Background There is lack of research regarding service improvement and occupational therapy, most research is focussed on clinical intervention improvement to demonstrate service improvement, which is a narrow focus compared to the whole service improvement. This service improvement study applying Seddon’s Vanguard Method to a critical care unit occupational therapy service in England is original research, answering an empirical question that will be of interest to the occupational therapy practice community. Method Research question: How and why are service level outcomes impacted, after implementing Seddon's Vanguard Method, a service improvement framework, to an occupational therapy service in England? Case study methodology was employed as the research is novel, and, exploring the phenomenon (service improvement) in depth in a particular context as it is less known. Furthermore, case study methodology is used when there are how and why questions to be answered in the research question and offers the opportunity to use mixed data to understand the phenomenon from multiple perspectives. Mixed quantitative and qualitative data were collected to provide multiple perspectives regarding service level outcomes impacted by the chosen service improvement framework. The quantitative analysis was carried out using descriptive, one-way ANOVA and Tukey Kramer HSD statistical analyses; and the qualitative data were transcript analysis of interviews using thematic analysis. Findings 1) The research identified themes of the service level factors which formed feedback loops. Four loops that had negative impact (vicious cycles) on service delivery – staff shortages, snowball effect of staff shortages leading to more staff shortages, funding arrangements, bed flow management external to the critical care service, staff concerns and staff challenges not being heard. To interrupt the vicious cycles was a balancing loop representing the staff raising the concerns and barriers to deliver their work. Such feedback loops are related to systems thinking concept. 2) The themes that were identified were also identified to form a developing typology of struggle for the critical care staff to improve the service. The term struggle was identified as there was a power imbalance between the critical care staff and the organisation impacting their agency to improve the service. 3) The descriptive analysis of the quantitative data indicated there were some notable differences: the number of missed occupational therapy sessions between years 2022 and 2021-2019 increased by 2%; the number of days between referral to 1st contact with the patient between years 2022 and 2019, reduced to average of 0.3 days from 4.8 days respectively; counting the number of times the terms occupational therapy vs the abbreviation OT was said within the evaluation transcripts before, during, and after the research implementation period, showed occupational therapy was said 31%, 19% and 74% respectively. 4) Going through the service improvement using Seddon’s Vanguard Method intervention elucidated the challenges for the critical care staff in establishing their professional identity, but also how to improve it. Conclusion The novel contribution from the research, is that in going through the Seddon’s Vanguard Method for service improvement, it has elucidated for the sample critical care occupational therapy staff; a typology of struggle to improve their service, their legitimacy, and jurisdiction in this specialty, and ultimately how to improve their professional identity.