Table 3

Types, definitions and illustrations of capital

Type and definition of capitalIllustration: positive capitalIllustration: negative capital
Economic: Assets and resources such as infrastructure (including office space), equipment and materials, funding, staff capacity and time.‘Without working with the patient experience department, we wouldn’t have done half the stuff. I mean it's been the fact that we've all worked together that we've got stuff done. Because I haven’t got the time to do it’. (Interview, ward manager)
‘(Name)’d been battling for a year for four new cupboards so the nurses could do the drug round more efficiently…She felt the new Chief Exec had understood something had to be done. As I left the ward, the estates people were there putting in the new cupboards’. (Fieldnote)
‘I: Do you think it's something that can be done within working hours?
R: Not on [our unit]. I think if you're on a ward and maybe you're a Band Six and you spend some time in an office, it might be more achievable because you're sat at your desk; you're less likely to be interrupted, and…you don’t have allocated patients…whereas it would be very hard for me to get an hour where I can just be like, 'Right, I'm doing feedback now’ ‘. (Interview, nurse)
‘I ask if they’ve had a chance to sit together since the last learning community event? They haven’t. She thinks they will have to come in outside of work time to meet about the project…because it’s so busy on the shop floor’. (Fieldnote, conversation with nurse)
Social: Access to networks and alliances across different clinical and non-clinical departments‘We’ve got a good relationship with clinical areas 'cos we help them out with reporting and things. So listening to some of the other Trusts…it almost felt like they, they weren’t, they’re not like scared of the patient experience office, but…it felt like there was no relationship.…Whereas we regularly meet with, communicate with… matrons and sisters. So I don’t think there’s resistance to our office’. (Interview, patient experience project manager)
‘There is quite a lot of laughter at these meetings. The team get on well, they are all allowed to talk and contribute, everyone listens and no-one dominates it. I don’t know whether this is representative of the dynamic on the ward usually or whether these project meetings create a unique space where they feel free to relax’. (Fieldnote)
‘What I have found about certain colleagues on that team is they’re very insular. They like to keep their little achievements to themselves and they don’t like anybody else taking credit for them… I don’t think they thought I was of any relevance from the patient experience side of things. I don’t think they thought I could bring anything to it because I’m not ward-based’. (Interview, patient experience officer)
‘There’s a lot of talk about the head of patient experience and other senior managers, and how they do not communicate with the frontline staff. They’re always on Twitter, but never on the frontline…[Nurse] says it’s notable that it’s only the managers who have time to tweet – junior frontline staff wouldn’t have time during their shift to go on social media, plus they would be berated for it if they did’. (Fieldnote, meeting with frontline team)
Symbolic: Reputation and status within a given setting, influencing ability to recruit, delegate and move agendas forward‘For a lot of the discharge stuff you would be completely reliant on a doctor engaging with his colleagues and doing the legwork and gathering data…I don’t think it was their expertise that made the difference. I think it was just having them…and the role that they’re in was necessary for the project’. (Interview, senior sister)
‘I: How did they [ward team] benefit?
R: Well, they got a big pat on the back, and their picture in the staff magazine. They got the knowledge that they'd done something to improve the safety of their service, and that that was then going on…the intranet, so that people would be contacting them saying 'we've got a similar issue, could we come and have a chat'. (Interview, director of patient experience)
‘We went to this awards ceremony and…this other person said, ‘I’m up for an award because I’ve done x, y and z. I’ve got 30 000 Twitter followers’, all of that jazz… And my colleague said, ‘Oh, well, (name) does a lot of work about dementia’. So we started talking and, yeah, she had a good go at (me)…She just says, kind of in the sense of, I think her words were, ‘You’ve got a lot to learn’… Sometimes it’s a little bit frustrating…I call them 'mood hoovers'. When they suck all the goodness…and life out of you. They’re mood hoovers’. (Interview, activities coordinator)
‘It wasn’t until I went into uniform that people actually started to talk to me…to take me seriously. Because if you’re a person that’s not in uniform and you’re going on the ward…you’re asking them to do something that they see as increasing their job load or whatever, ‘you can’t possibly understand because, you know, you don’t wear a uniform’. (Interview, patient experience officer)
Cultural: Knowledge/expertise in particular forms of practice, for example, medical conditions, administration, patient experience‘(There's) a huge whiteboard on one wall of her office, completely filled with a brainstorming session on how to take forward quality improvement. It’s a great visual illustration of the energy and activity she puts into patient experience. She refers to it several times in our interview, and it’s clear this is going to be the basis of her masterplan’. (Fieldnote, interview with director of nursing)
‘I:(H)ow were you able to produce [a report to] such a high standard?
R: Just over time I guess. Just working in the Trust and working in patient experience, there’s a lot of data sort of working. I’m quite good with Excel. I did a course in it back in high school, a diploma in digital applications…So I’ve got quite a bit of knowledge…It was me that did it. You know what I mean? So it was me that brought it to the table’. (Interview, junior patient experience officer)
‘I'm not sure that the team ever really got to grips with what they were going to do…It always felt like they were doing a bit of pinching with pride from other people. And trying to base what they were going to do on what patients had said, but never really getting there…I think it was ill-thought through, erratic and inconsistent’. (Interview, team member, anonymised)
‘I: Do you feel able to ask someone like [head of patient experience] for data if there was something you wanted to know about?
R: I think we might be able to, but having not done it…they probably would question us because we're not management I think. You know, having a healthcare assistant go knocking on the door, 'Can I have information please,' then they’ll probably be like, 'Oh, what do you want information for?’ ‘ (Interview, healthcare assistant)