Thematic Analysis of Inquiries Into Concerns About Institutional Health Care

Aims Recent reports and inquiries indicate that the potential, identified from early days of asylum era, for residents psychiatric institutions to be subject abuse has not been eradicated. The findings recommendations individual are often so specific their unique context it can difficult draw general principles have wider operationalizability. aims this study thematically analyse available inquiry into health care mid-20th century present using a ‘generalisable’ framework in order (i) identify key themes underpinning concerns raised, (ii) how change (or persist) over time. Methods Inquiries relating about institutional patients past 70 years were identified. In pilot study, selection thematic analysis address first phase (identifying concerns). Results Four overarching three reflect different levels system analysis. Thus, theme, ‘ proximal dynamic ,’ describes nature interaction between staff which is influenced by experience, attitude, actions. second organisational ’, comprises processes, policy culture particularly, but exclusively, within provider organisation. third level analysis, ’ includes influence on raised way configured (e.g. commissioning arrangements, use 'out-of-area' placements). fourth cuts across three, ‘the response ranges identifying warning signs responding overt expressions (including whistleblowing). Conclusion Using examine poor patients, structure emphasises problems arise ‘dynamic’ located at (proximal, system) cross-cutting theme responded to. This used as learning current provision inpatient services potential improve institutions, will require empirical testing.