Showing papers in "British Journal of Healthcare Management in 2009"
TL;DR: How the more widely recognised factors, such as an ageing population, re-admissions and increasing expectations of medicine, only contribute to a baseline increase in emergency admissions are discussed, and current methods for estimating the size of hospitals and bed pools within hospitals are shown to be inappropriate to the real needs of emergency care.
Abstract: Part one of this series discusses how the more widely recognised factors, such as an ageing population, re-admissions and increasing expectations of medicine, only contribute to a baseline increase in emergency admissions. Seasonal variation is discussed in the context of the predictability, or otherwise of emergency admissions, in response to changes in the weather and the wider environment. However, these are unable to explain the observed cyclical events occurring in medicine every 4-6 years, and even longer cycles in surgical and trauma admissions. These cycles are discussed in part two, while part three investigates the implications on bed planning. The current methods for estimating the size of hospitals and bed pools within hospitals are shown to be inappropriate to the real needs of emergency care.
63 citations
TL;DR: The issues of bed planning for emergency admissions in light of the annual summer/winter and long-term cycles and the impact of changing to single sex wards and the provision for zero day stay admissions are discussed.
Abstract: Parts one and two of this series discussed the components of a variety of trends and longer-term cycles leading to increasing emergency admissions. This article discusses the issues of bed planning for emergency admissions in light of the annual summer/winter and long-term cycles. The impact of changing to single sex wards and the provision for zero day stay admissions is also discussed.
56 citations
TL;DR: Part one of this series discussed how the more widely recognised factors such as an ageing population and re-admissions only contribute to a baseline increase in emergency admissions, while short stay admissions account for the bulk of the increase.
Abstract: Part one of this series discussed how the more widely recognised factors such as an ageing population and re-admissions only contribute to a baseline increase in emergency admissions. Short stay admissions (mainly zero day stay) account for the bulk of the increase. Most diagnoses appear to show a roughly linear trend over time. These are unable to explain the observed cyclical events occurring about every 4–6 years in medicine, and even longer cycles in surgical and trauma admissions.
47 citations
TL;DR: Quality improvement approaches from industry are increasingly applied in health care and what evidence exists of their effectiveness and applicability is considered.
Abstract: In October 2008, the NHS Institute for Innovation and Improvement published a report which focused on the many quality improvement approaches used in health care (Boaden et al, 2008). It reviewed the Plan-Do-Study-Act (PDSA) cycle, Statistical Process Control (SPC), Six Sigma, Lean thinking, Theory of Constraints (TOC) and Mass Customisation, and drew on academic and empirical sources of information to provide a series of challenges for healthcare managers and leaders. Quality improvement approaches from industry are increasingly applied in health care and this article considers what evidence exists of their effectiveness and applicability.
35 citations
TL;DR: The erratic changes in emergency admission rates as a result of external forces, such as weather and environment, in relation to the financial risk experienced by capitation-funded commissioning groups is discussed.
Abstract: Parts one and two of this series looked at the long-term trends and cycles in emergency admissions, while part three investigated the implications to acute bed planning. This article discusses the erratic changes in emergency admission rates as a result of external forces, such as weather and environment, in relation to the financial risk experienced by capitation-funded commissioning groups.
29 citations
TL;DR: In the health services, this association has been given a number of titles including dual diagnosis, comorbidity, concurrent or coexisting problems, and all of these will appear in this article.
Abstract: Coexisting mental health and substance use problems are highly prevalent, but psychiatric and addiction services often fail to identify them or provide integrated treatment (Weaver et al, 2002; Bell, 2007). In the health services, this association has been given a number of titles including dual diagnosis, comorbidity, concurrent or coexisting problems, and all of these will appear in this article.
26 citations
TL;DR: The previous article in this series examined the evidence to support the generally smaller size of hospitals built in recent years, but it must be pointed out that genuine ‘inpatient’ LOS reduction has been minimal in the USA over the past 10 years.
Abstract: The previous article in this series examined the evidence to support the generally smaller size of hospitals built in recent years. Bed demand was roughly the same as 10 years ago (Jones, 2009a). This observation may conflict with the generally perceived notion that average length of stay (LOS) is declining and therefore hospitals need to be smaller. The issues involved in this apparent conflict of ‘reality’ must be understood, although it must also be pointed out that genuine ‘inpatient’ LOS reduction has been minimal in the USA over the past 10 years (Nataraja et al, 2009).
24 citations
TL;DR: The findings add to understanding of the factors influencing career satisfaction among nurses and therefore identify implications for managers responsible for providing opportunities for staff to progress in their careers.
Abstract: Dissatisfaction with career prospects and development opportunities has been shown to be highly significant in explaining nurses' job satisfaction, organisational commitment and intention to leave (Collins et al, 2000; Shields and Ward, 2001; Fochsen et al, 2005). The purpose of this article is to identify nurses' job aspirations and examine the underlying factors that influence their ambitions. The findings add to understanding of the factors influencing career satisfaction among nurses and therefore identify implications for managers responsible for providing opportunities for staff to progress in their careers.
19 citations
TL;DR: This article will examine the application of a capacity margin into understanding bed occupancy and bed numbers.
Abstract: Earlier articles in this series investigated the capacity margin dictated by the 18-week referral to treatment guarantee (Jones, 2009a; 2009b), i.e. all targets have implicit capacity implications. This article will examine the application of a capacity margin into understanding bed occupancy and bed numbers
15 citations
TL;DR: Patients’ experiences provide insights which identify opportunities and they contribute fully to the change process, leading to safer, more dignified, effective and reliable care.
Abstract: Creating a health service where we no longer do things ‘to and for’ patients, but work with them as equal partners in their own care, is at the centre of health strategy, policy and reform. The use of the experience based design approach will ensure that healthcare services truly reflect the needs of patients, carers and staff based on their actual experience. It provides a mechanism whereby patients’ experiences provide insights which identify opportunities and they contribute fully to the change process, leading to safer, more dignified, effective and reliable care.
14 citations
TL;DR: The process of streaming implies grouping patients with similar needs so that they can receive dedicated input of clinical care in the setting of accident and emergency departments.
Abstract: The process of streaming implies grouping patients with similar needs so that they can receive dedicated input of clinical care. It is best known for its application in achieving efficiency in accident and emergency departments (Cooke et al, 2002).
TL;DR: The Care Quality Commission (CQC) is the new regulator of health and adult social care in England as discussed by the authors, which is the focus of the CQC's first public consultation.
Abstract: British Journal of Healthcare Management 2009 Vol 15 No 6 297 when NHS providers will be the first to register with the CQC Adult social care and independent health care providers will be registered with the CQC from October 2010 because the Care Standards Act which applies to them remains in force until that date GPs and dental health practices will be required to register with the CQC from April 2011 We will produce guidance which makes the registration requirements clear to providers so that they know what to do to be compliant with them We are working with people who use services, providers and other stakeholders to design and develop the guidance, and it is the focus of our first public consultation as the new regulator of health and adult social care People tell us they want us to focus less on whether organisations have the appropriate policy in place, and more on whether or not people’s experiences of services are positive We have written the guidance to reflect this and it signals an important shift away from measuring systems and processes, towards measuring outcomes for people who use services Both the registration requirements and the underpinning guidance will be legally enforceable The CQC has tough new powers to force registered organisations to comply, including imposing conditions on registration, fines and in extreme cases, cancellation of registration The new registration system makes sure that essential common quality standards apply across the care sector and that providers are building a firm foundation on which to deliver care It means that all registered health and adult social care services must meet those standards, and that they are protecting and promoting the rights of people who use them You can take part in the consultation in the following ways: n By emailing us at: consultationresponses@cqcorguk n By writing to us at: Freepost RSBS-ZGCU-EZEE Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA n Online at: wwwcqcorguk/ getinvolved/consultationscfm More information about the consultation, which runs from 1 June to 24 August, can be obtained from the CQC by telephone on 03000 616161, or on the contact details above BJHCM Linda Hutchinson, director of registration at the Care Quality Commission, discusses the future of regulation of health and adult social care services in England Standards for registration
TL;DR: Some of the core conditions that are necessary for successful quality improvement in health care, regardless of the approach used, are considered.
Abstract: In the previous article in this series, the authors discussed the growing importance of quality improvement in healthcare organisations, outlined some of the approaches that have been used, and considered some of the factors that make healthcare organisations a particularly challenging setting for managers introducing quality improvement interventions. This article considers some of the core conditions that are necessary for successful quality improvement in health care, regardless of the approach used.
TL;DR: Dentists and other health professionals should be aware of the emerging risk factors for oral cancer such, as the role of human papillomavirus (HPV), decreases in risk that could be achieved by encouraging high fruit and vegetable consumption, as well as some controversies related to the aetiology of this disease that need clarification.
Abstract: November 2009 is Mouth Cancer Action Month in the UK. This campaign is run by the British Dental Health Foundation, supported by the Department of Health and the British Dental Association. The incidence of mouth cancer has risen by 41% in just 10 years to 5350 new cases annually. The 5-year survival rate of mouth cancer patients is just 50%, but early detection and diagnosis gives patients a 90% chance of survival. Major risk factors for oral cancer are cigarette smoking and alcohol misuse. Among Asian populations, regular use of betel quid (with or without added tobacco) increases oral cancer risks. Dentists and other health professionals should be aware of the emerging risk factors for oral cancer such, as the role of human papillomavirus (HPV), decreases in risk that could be achieved by encouraging high fruit and vegetable consumption, as well as some controversies related to the aetiology of this disease that need clarification. The aim of this article is to provide an opinion on these debated contr...
TL;DR: The reference cost index (RCI) is promoted by the Department of Health as the definitive measure of organisational efficiency (NHS Networks, 2008) but a somewhat more cautious approach could well be warranted.
Abstract: The reference cost index (RCI) is promoted by the Department of Health (DH) as the definitive measure of organisational efficiency (NHS Networks, 2008). A somewhat more cautious approach could well be warranted.
TL;DR: The market forces factor (MFF) is a local adjustment to the tariff, which takes ‘cost of living’ factors for staff, buildings and land into account for all NHS organisations (Wilson et al, 1996).
Abstract: The market forces factor (MFF) is a local adjustment to the tariff, which takes ‘cost of living’ factors for staff, buildings and land into account for all NHS organisations (Wilson et al, 1996). If the MFF is so important to provider costs, then why does it have an insignificant effect on the observed variation between providers at healthcare resource group (HRG) level?
TL;DR: The authors review the potential of TQM/CQI and the challenges of using this approach to improve patient care.
Abstract: Developed in Japan in the 1950s, Total Quality Management/Continuous Quality Improvement (TQM/CQI) approaches have been taken up in a variety of forms by many healthcare organisations since the early 1990s. Although TQM/CQI has several strengths, including a strong customer focus and the use of data to analyse variations in quality, its use in health care has encountered a range of practical and cultural obstacles. In the first of five articles looking at major approaches to quality improvement that have been used in healthcare organisations in the past two decades, the authors review the potential of TQM/CQI and the challenges of using this approach to improve patient care.
TL;DR: This issue has now been upgraded such that the NHS Executive have recently been informed that access to dental care is now the top priority of the NHS: apparently higher than 18-weeks and 4-hour waits.
Abstract: Away from the glare of global financial crises and political scandals, momentum is building for change in dental care. In December 2008, Alan Johnson announced the independent Steele Review ‘to help us understand what more needs to be done to ensure that every person who wants to visit an NHS dentist can do so’. This issue has now been upgraded such that the NHS Executive have recently been informed that access to dental care is now the top priority of the NHS: apparently higher than 18-weeks and 4-hour waits. The justification for this jump is that getting dental care regularly heads the issues that patients and voters say are their top healthcare concerns.
TL;DR: This article is a summary of a Kings Fund report written to help PCTs as commissioners, and their community providers, to consider the future configuration options.
Abstract: The Government wants the commissioning and provider functions of primary care trusts (PCTs) in England to be separated. By October 2009, PCTs must have outlined their plans to reconfigure their services. This article is a summary of a Kings Fund report (Imison, 2009) written to help PCTs as commissioners, and their community providers, to consider the future configuration options.
TL;DR: To understand the key structural barriers to implementation, only then can the authors address the key issues and begin to realise this untapped potential of operational research.
Abstract: Operational research embodies a wide range of techniques that can improve the way we plan and organise health services. So, why have these tools not been more widely adopted in the NHS? To answer this we need to understand the key structural barriers to implementation, only then can we address the key issues and begin to realise this untapped potential.
TL;DR: The journey undertaken for the successful implementation of Lean throughout an organisation is discussed, and how the development of a service improvement strategy-with Lean principles at its core-has promoted the provision of quality services and effective evidence-based outcomes to ensure the organisation is fit for the future.
Abstract: There have been a variety of articles on how Lean thinking has been successfully implemented within the acute sector, but very few on how it can and should be implemented within provider services across primary care. This article discusses the journey undertaken for the successful implementation of Lean throughout an organisation, and how the development of a service improvement strategy-with Lean principles at its core-has promoted the provision of quality services and effective evidence-based outcomes to ensure the organisation is fit for the future.
TL;DR: The method that the Department of Health (DH) uses to assess operational efficiency is the reference cost index (RCI).
Abstract: The method that the Department of Health (DH) uses to assess operational efficiency is the reference cost index (RCI). The DH (2008) states that
TL;DR: Some of the factors that make health care a particularly challenging environment for managers introducing quality improvement interventions are considered.
Abstract: Quality improvement in health care is highly topical, but definitions of quality are contested and many healthcare organisations struggle to achieve lasting changes in routine practice. This article, the first in a series on quality improvement, considers some of the factors that make health care a particularly challenging environment for managers introducing quality improvement interventions.
TL;DR: The recent report Transforming community services: Ambition, Action, Achievement (Department of Health (DH), 2009), is the second to be authored by Lord Ara Darzi and follows in the wake of his review of the NHS in England, High Quality Care for All (DH, 2008).
Abstract: The recent report Transforming community services: Ambition, Action, Achievement (Department of Health (DH), 2009), is the second to be authored by Lord Ara Darzi and follows in the wake of his review of the NHS in England, High Quality Care for All (DH, 2008).
TL;DR: Quality, Innovation, Productivity, and Prevention, or QIPP (Department of Health (DH), 2008; Nicholson, 2009), is the new landscape in which the NHS operates; both from the perspective of planning and the delivery of clinical services in the NHS.
Abstract: Quality, Innovation, Productivity, and Prevention, or QIPP (Department of Health (DH), 2008; Nicholson, 2009), is the new landscape in which we operate (Farrar, 2009). These four tenets will be familiar to all involved in health care; both from the perspective of planning and the delivery of clinical services in the NHS. The implications for the delivery of a quality service have been considered for nursing in general and tissue viability in particular (Hinchcliffe, 2009; Ousey and White, 2009a, 2009b).
TL;DR: The practitioner-led ‘rapid cycle change’ approach uses the Plan-Do-Study-Act cycle widely promulgated by the US Institute for Healthcare Improvement (IHI), which has been used in many healthcare organisations, particularly as a key component of quality improvement collaboratives.
Abstract: The practitioner-led ‘rapid cycle change’ approach uses the Plan-Do-Study-Act cycle widely promulgated by the US Institute for Healthcare Improvement (IHI). It has been used in many healthcare organisations, particularly as a key component of quality improvement collaboratives. As a small-scale, bottom-up approach, rapid cycle change has several advantages over other quality improvement approaches, but like them it runs into a range of obstacles in healthcare settings. Further studies are needed to establish its impact on practice patterns and outcomes.
TL;DR: There is an urgent need for NHS commissioners to reappraise their fertility pathways, concluding that the role of primary care in investigation, diagnosis, obesity management, ovulation induction and referral is reviewed.
Abstract: It has only been over 30 years since the birth of Louise Brown, the first in vitro fertilisation (IVF) success. Since then, there has been a rapid rise in assisted reproductive technologies and the routine use of IVF in clinical practice. However, the ‘whole patient’ journey from presentation to final outcome has largely been ignored or served by outdated commissioning arrangements. This article reviews the role of primary care in investigation, diagnosis, obesity management, ovulation induction and referral, concluding that there is an urgent need for NHS commissioners to reappraise their fertility pathways.
TL;DR: The need for NHS trusts and social care organisations to embrace interprofessional learning and working in a more unified and coordinated way will need extensive investment with controlled change management programmes from central government.
Abstract: The NHS provides a rich culture of innovation, change and opportunities to improve patient care This article will discuss the setting required to enable the inclusion of interprofessional learning (IPL) and interprofessional working (IPW) to become an inherent part of an organisation's learning and working strategy The focus of activity in relation to IPL and IPW is currently associated with academia and delivery of programmes for pre- and post-registration learners in universities, from all areas of the healthcare team, including nurses, physiotherapists, occupational therapists, and social workers This article argues the need for NHS trusts and social care organisations to embrace interprofessional learning and working in a more unified and coordinated way This will need extensive investment with controlled change management programmes from central government
TL;DR: Five of the major organisation-level approaches to quality improvement in health care in the past two decades are examined: Total Quality Management/Continuous Quality Improvement, Business Process Reengineering, practitioner-led rapid cycle change, Lean thinking and Six Sigma.
Abstract: In this series of articles, the authors have examined the research evidence on the use and impacts of five of the major organisation-level approaches to quality improvement in health care in the past two decades: Total Quality Management/Continuous Quality Improvement, Business Process Reengineering, practitioner-led rapid cycle change, Lean thinking and Six Sigma. But how much do the approaches differ, and does it matter which approach is used?
TL;DR: Its most enduring legacy is likely to be its emphasis on processes, which has contributed to the growing interest in redesigning patient pathways and clinical processes.
Abstract: Developed in the US in the 1990s, Business Process Reengineering (BPR) soon filtered into health care, and was the focus of several high-profile NHS initiatives in the late 1990s. However, the radical ‘fresh start’ approach of BPR, and many of its underlying principles, did not fit well into healthcare settings. Its most enduring legacy is likely to be its emphasis on processes, which has contributed to the growing interest in redesigning patient pathways and clinical processes.