Academic Journal
Shifting boundaries of risk-work in virtual wards in North-West England: a multisite qualitative evaluation
| Title: | Shifting boundaries of risk-work in virtual wards in North-West England: a multisite qualitative evaluation |
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| Authors: | Howells, Kelly, Bradley, Fay, Gasteiger, Norina, Whittaker, William, Vardy, Emma, Dowding, Dawn, Blakeman, Thomas, Sanders, Caroline |
| Source: | Howells, K, Bradley, F, Gasteiger, N, Whittaker, W, Vardy, E, Dowding, D, Blakeman, T & Sanders, C 2026, 'Shifting boundaries of risk-work in virtual wards in North-West England: a multisite qualitative evaluation', BMJ Quality and Safety. https://doi.org/10.1136/bmjqs-2025-020002 |
| Publication Year: | 2026 |
| Collection: | The University of Manchester: Research Explorer - Publications |
| Description: | Background Virtual Wards (VWs) (also referred to as Hospital at Home (HaH) are a key component of NHS policy in England to shift acute care from hospital to community settings. While evidence suggests these models can improve patient experience and safety, delivering acute care at home redistributes responsibility for safety across clinicians, patients, and carers. The concept of risk-work captures the relational and contextual practices through which clinicians, patients and their carers interpret and mitigate risks associated with clinical care. However, there is limited evidence as to how risk-work is enacted in remote care, particularly when patients and carers undertake elements of that work. Methods We conducted a multi-site ethnographic evaluation across four NHS VW services in North-West England (July 2024–February 2025). Data included 17 patient and 5 carer interviews, 4 patient observations, 43 staff interviews, and 10 organisational level observations. Reflexive thematic analysis was guided by risk-work and Systems Thinking For Everyday Work as sensitising frameworks. Results Three interrelated dimensions of risk-work were identified. Translating risk describes how clinicians balanced protocolised guidance with tacit and relational knowledge when assessing eligibility, with decisions further shaped by workforce models. Holding risk illustrates the shared elements of risk-work, with temporal gaps in oversight, particularly out of hours, and variation in workforce structures, shaping how risk work was distributed between clinicians, patients and carers. Living with and managing uncertainty highlighted how clinicians, patients/carers navigated the unpredictability of acute illness at home. Governance structures, multidisciplinary teams, and informal sense checking provided collective safety netting, though training and communication practices varied across sites. Conclusions To our knowledge, this is the first exploration of risk-work within the context of VWs. These findings extend the previous ... |
| Document Type: | article in journal/newspaper |
| File Description: | application/pdf |
| Language: | English |
| ISSN: | 2044-5415 2044-5423 |
| Relation: | info:eu-repo/semantics/altIdentifier/pissn/2044-5415; info:eu-repo/semantics/altIdentifier/eissn/2044-5423 |
| DOI: | 10.1136/bmjqs-2025-020002 |
| Availability: | https://research.manchester.ac.uk/en/publications/b6da2c43-4149-4268-862d-32ead766252e https://doi.org/10.1136/bmjqs-2025-020002 https://pure.manchester.ac.uk/ws/files/1940132019/bmjqs-2025-020002.full.pdf |
| Rights: | info:eu-repo/semantics/openAccess ; http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: | edsbas.5C519387 |
| Database: | BASE |
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