Title: Values Based Recruitment: What works, for whom, why, and in what circumstances?
Funder: Department of Health and Social Care

Abstract: Background A perceived gap between NHS workers values and the NHS constitution has led to the proliferation of models of values based recruitment (VBR). Despite high level principles (Health Education England, 2013), considerable flexibility in NHS operationalisation exists. The empirical picture of NHS impact is limited. Our Aims Understand and conceptualise VBR in healthcare education and service delivery to unpack what works, for whom and why; and Identify the active components of models of VBR, create a typology of VBR models, and propose successful models of VBR. Research plan and methods A realistic evaluation (Pawson and Tilley, 1997) using mixed methods. A three-stage, theory-driven, evaluative, approach, will unpack the relationships between context (C), mechanisms (M) and outcomes (O) and answer what works, for whom, how, and in what circumstances . Organisational cultures (Scott et al., 2003) and multi-level structure, process and context (Bate, 1999) will provide the theoretical framework. Stage 1 will generate a working theory of VBR through: (i) policy document analysis; (ii) rapid review of VBR literature; (iii) interviews with national stakeholders to explore intended advantages and disadvantages, contextual influences, mechanisms and processes by which outcomes are intended to be achieved, and how VBR differs from previous recruitment models; and (iv) use a virtual panel to increase engagement, successful dissemination and NHS utility. Stage 2 will test this theory using four, purposively selected, case studies. Relationships between espoused strategy and emergent strategy will provide the focus (Lipsky, 1980; Ferlie, 2001) for (i) comparison of case site documents against stage 1 s conjectured theory - CMOs will be tested and refined sequentially within, and finally across, cases. (ii) time series scrutiny of organisational health and performance measures; (iii) cost consequence analysis (Kaufman, Watkins and Simms, 1997) of VBR; (iv) interviews and focus groups with stakeholders to explore perceived challenges, opportunities and impacts of VBR. Stage 3 will present a cross-case analysis of costs and consequences present theory and evidence based models of successful VBR. Stage 4 will evaluate the impact of VBR over time in the HEI case sites to track students at the end of year one, two and upon completion (months 30, 42 and 54). We will conduct interviews in the case sites to follow up with participants who engaged with Stage 2 and gather data to consider performance and costs. We will conduct a national survey of HEIs (or explore use of HEE data) to explore implementation and perceptions of impact. We will submit a proposal at the end of year 2 to evaluate transition of students into their first NHS posts - Point 18 (ITT, May 2014). The research team Team expertise includes the health workforce (Spilsbury); innovation implementation (Thompson); the economics of NHS performance and productivity (Bloor); mixed methods research (McCaughan), education (Simpson) and organisational values, cultures and NHS performance (Mannion). We will employ Research Fellows and work with Firefly Research (we have successfully collaborated and completed projects with FireflyResearch). Potential Impact Dissemination of an evidence and theory based model of VBR allowing the NHS to know how it works and adapt active components to particular contexts (a key feature of innovation adoption) (Rogers, 2003). A final report and peer reviewed publications will be complemented by evidence briefings (open access via project website), a monthly updated project blog and end of project webinar. We will prepare short reports of the longitudinal follow up with HEIs and produce timely publications to inform practice, education and policy. The AHSN and CLAHRC (Yorks and Humber) will provide access to NHS/HEI decision makers able to influence recruitment. The University of Leeds and team members are participants in both networks.

Lay abstract: The National Health Service (NHS) employs over a million people, the vast majority in front-line patient care. Recent failures in care, particularly in mid-Staffordshire hospital, have raised more general concerns about quality in the NHS. One policy response to these concerns has been encouraging recruitment of students, trainees and employees whose personal values are consistent with the overall values of the NHS Constitution: values based recruitment (VBR). This research project aims to evaluate the effects of VBR, in particular to explore its implementation, how people respond, what is working well and what lessons can be learned. In our study we propose to assess how universities and NHS organisations are implementing VBR, and how this affects students, staff and patients. In the first stage, we will analyse policy documents and published literature, and talk to the individuals who developed VBR. Following this, we will examine VBR in depth in four organisations: two universities that train NHS staff, and two NHS organisations, one acute hospital and one provider of mental health services. We will analyse data to assess whether student recruitment, retention and academic performance have changed, and whether there is any change in adverse events or patient complaints in the NHS. We will interview and use focus groups to explore VBR and its implementation with students, staff, patients and relatives. Using all this information we will draw lessons on how VBR is being implemented, sharing good practice and potentially improving NHS care in future years. We will follow trainees through their programme to understand impact throughout training to transition to registered professional. We will ensure individual s views expressed in interviews and focus groups remain anonymous, and that data is protected. The researchers are all experienced in ensuring data protection and protecting confidentiality, and will be aware of this at all times in the research. The team is particularly suited to this research because we have a range of relevant expertise and experience. The project will be led by a Professor of Nursing, and the team includes other clinicians, and experts on the culture of organisations and on evaluating health policy change.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE