Healthcare assistants (HCAs) are a longstanding part of the healthcare workforce, particularly at the interface between health and social care. Healthcare assistants have been used in areas where there is pressure to cut costs for example caring for people with complex needs or who are vulnerable. In UK (DH 2012, Francis 2013) and Ireland (Health Service Executive 2016) there have been reports of poor or appalling care being administered by HCAs. Batenburg (2016) explored the HCA workforce across Europe and mapped equivalent roles across the EU, also noting where regulation was in place, with a view to developing a common educational framework. He found that entry requirements, title protection, training duration, regulations and registration differed between member states. However, little formal research has been done to examine HCAs’ contribution to the quality, safety or experience of patient care.

The healthcare assistant workforce delivers much of the fundamental care across both health and social care and is therefore in a unique position to influence the patient experience. To date, there has been little qualitative research that explores the HCA role from the perspective of the patient. A study by Morey (2016) explores patients’ perceptions of the role of the HCA within secondary care. Data was collected in a large teaching hospital in North East England between 2014 and 2015. Employing constructivist grounded theory, twenty patient interviews were coded and analysed. Three later interviews were added to give further depth to the findings.

Four core categories emerged from the data:

Expectation

Participants entered the healthcare environment with varying expectations but told a largely positive story about their experiences, reframing negative episodes within an overall positive narrative. This reframing may indicate participants were indirectly reinvesting in staff for their future care needs.

Observation

Some participants worked out “who was who” through observation, often associating tasks with uniform. Where jurisdiction and performance of the HCA was not as expected, this sometimes made participants more vigilant.

Meaningful connections

Meaningful connections involved comfort and consideration from staff and humorous interactions between participants and HCAs. These connections contributed to the patienthood experience and were employed as a trading strategy, to cement relationships and overcome difficult circumstances.

Adaptation

Participants worked out when to ask for help, recognising their dependency on staff availability and a desire not to be labelled a nuisance.

In conclusion, education and development for HCAs that enhances understanding of roles and performance and their impact on relationships with patients would enhance the patient experience. Investigation of the negative patient episodes hidden within reframed positive narratives would inform future policy and educational initiatives. Greater recognition of the jurisdictional limitations of the HCA, and the impact this may have upon their work and the patient relationship, would help to ensure patient safety is not compromised.

References:

Batenburg, Ronald (2016) Healthcare assistants in Europe: The CC4HCA project, NIVEL: (presentation to Commission Expert group on Health Workforce, November 18, 2016) accessed at https://ec.europa.eu/health/sites/health/files/workforce/docs/ev_20161122_co04_en.pdf on 17th December 2018

Department of Health (2012) Transforming care: A national response to Winterbourne View Hospital: Department of Health Review Final Report, Department of Health, Gateway Reference18348, London: The Stationery Office

Francis R (chair)(2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, London: The Stationery Office.

Health Service Executive (2016) What matters most: Report of the Áras Attracta Swinford Review Group, Dublin: Health Service Executive.

Morey, Sarah Louise (2016) Adaptation to patienthood: A grounded theory study on the contributions of Healthcare Assistants towards the patient experience. Doctoral thesis, Northumbria University.