Showing papers in "British Journal of Healthcare Management in 2010"
TL;DR: An approach to organisational change: appreciative inquiry is presented, building on positive ideas and images emerging from individuals or groups that fosters learning and promotes the emergence of innovative ideas.
Abstract: Organisational change in health care is a complex, non-linear process that must evolve in response to shifts in social, economic and political environments. Given this constant flux, current organisational models fail to address the needs of the patients and healthcare workers, who are becoming increasingly dissatisfied. The radical changes required must influence work design and workforce management, while focusing on the interactions between actors within the systems. This article presents an approach to organisational change: appreciative inquiry. By building on positive ideas and images emerging from individuals or groups, this approach fosters learning andpromotes the emergence of innovative ideas. A review of the literature from 1990 to 2009 was undertaken to describe the application of appreciative inquiry in health care. After a brief description of the theoretical foundations and the process of appreciative inquiry, the studies and projects uncovered in the review are presented. The limits and ad...
48 citations
TL;DR: In the UK, unexplained step-like increases in total cost of approximately 6% appear to have occurred between 1962, 1966, 1974, 1979, 1986, 1990, 1998 and 2002 as discussed by the authors.
Abstract: The health insurance industry in the USA has noted a cycle of underwriting gains and losses which appeared to commence in the early to mid 1960s. After adjusting for inflation, unexplained step-like increases in total cost of approximately 6% appear to have occurred somewhere around 1962, 1966, 1974, 1979, 1986, 1990, 1998 and 2002. A similar pattern relating to medical emergency admissions has operated in the UK for at least 20 years. The implications of this behaviour tothe financial risk inherent in commissioning in England are discussed in this article. Data fromthe USA and Canada is used to complement the previous studies from the UK to explore causes for this behaviour.
28 citations
TL;DR: Analysis of changes in these costs over the past 6 years confirms that at anational level the costs follow a pattern over time consistent with that seen in the components of health care cost in the USA.
Abstract: Each year primary care trusts (PCTs) in England provide a breakdown of their expenditure intoprogramme budgets covering 23 different categories of disease such as cancer, mental health and circulatory disease. Analysis of changes in these costs over the past 6 years confirms that at anational level the costs follow a pattern over time consistent with that seen in the components of health care cost in the USA. A key event appears to have occurred across England in 2007 which affected specific programme categories to a different extent. Categories most affected appear to be related to mental health, neonates, particular cancers, respiratory and social care costs. A regional pattern is also associated with this event. Possible causes are discussed.
27 citations
TL;DR: Given the central role which demand plays in the cost of health care, Money Matters has recently been exploring the issues around forecasting demand and has serious reservations about the central assumption in NHS planning that demographic change or the ageing population is driving demand.
Abstract: Given the central role which demand plays in the cost of health care, Money Matters has recently been exploring the issues around forecasting demand (Jones, 2010e-f). Having been involved in health care planning for over 18 years, I have serious reservations about the central assumption in NHS planning that demographic change or the ageing population is driving demand (Jones, 2010k). In this respect, increases in accident and emergency (AE Zaragoza Fernandez et al, 2009; Chu et al, 2009).
25 citations
TL;DR: It is demonstrated that assessment costs must be added back into the residual A&E costs in order to arrive at a true picture for the overall emergency department costs, whereas part three looks specifically at the costs for paediatric emergency assessment.
Abstract: The cost of emergency assessment unit activities is shown to lie in the region of an outpatient attendance or the higher end of an A&E attendance. Significant economy of scale in cost is demonstrated with the larger units having lower average costs. Acute Trusts make an average profit margin of greater than £300 per zero day (or same day) stay admission. This equates to an overpayment of greater than £300M for these ‘admissions’ and this then creates £300M of compensating errors and distortions across NHS finances. Part two of the series will demonstrate that assessment costs must be added back into the residual A&E costs in order to arrive at a true picture for the overall emergency department costs, whereas part three looks specifically at the costs for paediatric emergency assessment. Both parts will discuss the additional flaws and complexities behind the tariff process relating to the wider emergency department functions.
20 citations
TL;DR: The economic cycle and its consequences to NHS funding are by now widely appreciated and the wider issue of cycles in demand may be worthy of some consideration.
Abstract: The economic cycle and its consequences to NHS funding are by now widely appreciated and the wider issue of cycles in demand may be worthy of some consideration. Almost all natural phenomena follow long-term cycles, from crop yields (Cantelaube and Terres, 2004) to global warming (Holbrook, 2009). This suggests that health care may also be subject to the same forces. Indeed, climate change is anticipated to have future negative and positive impacts on specific aspects of emergency medicine (Hess et al, 2009).
20 citations
TL;DR: The pressure to achieve targets and balance budgets leaves most within the NHS with little time to explore fundamental issues, such as the very long-term patterns behind demand and cost.
Abstract: The pressure to achieve targets and balance budgets leaves most within the NHS with little time to explore fundamental issues, such as the very long-term patterns behind demand and cost. For example, during 2009 most primary care trusts (PCTs) experienced huge and totally unexpected pressure on budgets. Did this really come from nowhere or could it be that our hidden/unarticulated assumptions with regard to the basis for movement in costs is flawed?
17 citations
TL;DR: The authors' perception of how health care behaves is reflected in the policies formulated to contain health care costs, and most would view length of stay as a continuously decreasing measure, reflecting increasing efficiency.
Abstract: Our perception of how health care behaves is reflected in the policies formulated to contain health care costs Therefore, most would view length of stay as a continuously decreasing measure, reflecting increasing efficiency Deviations from this assumed behaviour are therefore regarded as evidence for poor efficiency
16 citations
TL;DR: Most patients enter the doctor-patient relationship on an uanequal basis in terms of status, knowledge and access to resources (such as drug prescribing and referral to other experts).
Abstract: Forty years ago Richard Titmuss suggested that there are a range of limits (he identified at least 13) to the idea of consumerism (voice, choice and exit by patients) in relation to health care. For example, most patients enter the doctor-patient relationship on an uanequal basis in terms of status, knowledge and access to resources (such as drug prescribing and referral to other experts). And many patients do not know in advance exactly what medical procedures and drugs they will need-they rely on doctors for advice.
12 citations
TL;DR: An article on the nature of health care costs explores the possibility that a group of medical and mental health diagnoses may show a three to eight year cyclein admissions.
Abstract: In this month's BJHCM, an article on the nature of health care costs explores the possibility that a group of medical and mental health diagnoses may show a three to eight year cyclein admissions (Jones, 2010d). There will be additional knock-on effects against wider primary care and other costs.
12 citations
TL;DR: A number of priority areas have now been identified where NHS QIS support could add the most value to community and primary healthcare services.
Abstract: Background and aims: Through the implementation of a Delphi consultation survey, the aim of the study was to identify the key priorities and opportunities for NHS Quality Improvement Scotland (QIS) to support NHS boards and community health partnerships (CHPs) to improve the quality of care in primary healthcare services in Scotland. Methods: A three-stage Delphi survey was undertaken involving a panel of clinicians, managers, academics, professional bodies and voluntary organisations working in community and primary healthcare services in Scotland. Results: Following three rounds of the Delphi survey, where the panel scored their level of agreement with suggested topic areas, a number of priority areas have now beenidentified where NHS QIS support could add the most value to community and primary healthcare services. Conclusions: The Delphi process has enabled NHS QIS to gather feedback quickly and efficiently from a wide range of geographically dispersed primary care clinicians, managers and academics a...
TL;DR: A series of articles in BJHCM has suggested that the patterns in medical and mental health admissions and AE 2010a-j are similar and an increase in the proportion of female admissions is a characteristic signature associated with these outbreaks.
Abstract: A series of articles in BJHCM has suggested that the patterns in medical andmental health admissions and AE 2010a-j). It has also been suggested that an increase in the proportion of female admissions is a characteristic signature associated with theseoutbreaks (Jones, 2010a, d, e).
TL;DR: This five-year plan maps the journey for improving the NHS and focuses on improving quality, while improving productivity, using innovation and prevention, to drive and connect them.
Abstract: The vision for the NHS over the next five years is to go from ‘good to great‘ (Department of Health (DH), 2009). This five-year plan maps the journey for improving the NHS andfocuses on improving quality, while improving productivity, using innovation and prevention, to drive and connect them (the QUIPP model; Farrar, 2009).
TL;DR: The Department of Health (DH) has indicated that from 2011/12 the tariff will become an uppermaximum rather than the unique price for each healthcare resource group (HRG) (DH, 2009).
Abstract: The Department of Health (DH) has indicated that from 2011/12 the tariff will become an uppermaximum rather than the unique price for each healthcare resource group (HRG) (DH, 2009). The need for such cost containment measures needs no discussion. However, notwithstanding over 15 years of development, the tariff still contains a long list of fundamental flaws (Jones, 2009).
TL;DR: This paper aims to explore managerial influence in the implementation of two NICE guidelines-obesity and chronic heart failure guidelines, using a comparative case-study design involving four organizational settings in primary and secondary care.
Abstract: Clinical governance, manifested in the form of the NICE guidelines, has become a core component of the English government's health policy directives for improving health care effectiveness. However, NICE guidelines appear to be difficult to implement. Previous research has addressed clinicians' influence on guidelines implementation, but little is known about the potential influence of NHS managers in this process. This paper aims to explore managerial influence in the implementation of two NICE guidelines-obesity and chronic heart failure guidelines. The implementation process was explored retrospectively, prospectively and longitudinally, using a comparative case-study design involving four organizational settings in primary and secondary care and 74 in-depth interviews between 2007 and 2009. National policy requirements for performance management led senior managers to be more interested in financial accountability and in demonstrating that they had the appropriate documentation related to the implemen...
TL;DR: The NHS organisation development function has adopted the PRINCE 2 approach to managing change, but thereis evidence that the function itself is not completely developmental as discussed by the authors, and a new approach to project managing change is needed based on a search for "clumsy" rather than "elegant" solutions.
Abstract: Project management based on the PRINCE 2 (Projects In Controlled Environments) methodology isthe default mode for managing organisational change in the NHS. While this approach to project management is suitable for ‘tame’ problems, it is not so for ‘wicked'problems, which are the focus of most organisational change activities in health care. The NHS organisation development function has adopted the PRINCE 2 approach to managing change, but thereis evidence that the function itself is not completely developmental. A new approach to project managing change is needed based on a search for ‘clumsy’ rather than ‘elegant’ solutions.
TL;DR: The reasons for non-compliance with prescribed medication are considered, and the way managers might help improve concordance rates among patients are discussed.
Abstract: The World Health Organization describes patient non-compliance with prescribed medication as a worldwide problem of striking magnitude. Healthcare managers will know that in the United Kingdom, 50% of older people do not take medicines as prescribed. This, in turn, leads to drug wastage, mismanagement of medical conditions and readmission to hospital. In this article, the reasons for non-compliance are considered, and the way managers might help improve concordance rates among patients are discussed.
TL;DR: Rod Jones, statistical advisor, discusses the adequacy or otherwise of the short-stay tariff for emergency admissions as discussed by the authors, and discusses the impact of short-term tariffs on emergency admissions.
Abstract: Rod Jones, statistical advisor, discusses the adequacy, or otherwise, of the short stay tariff for emergency admissions
TL;DR: Attitudes to cost containment depended on practitioners' awareness of costs, whether they were internists or family practitioners, and whether they participated in seminars on healthcare costs.
Abstract: Aim: Healthcare organisations are constantly faced with the need to contain medical costs. Healthcare institutions expect practitioners to keep costs low, while providing patients with the best possible medical care. This study examines the attitudes of doctors to considering costs, while prescribing medical tests and treatment. Methods: Investigators submitted a 55-item questionnaire to 200 primary care practitioners in health maintenance organisations in Israel, in which14 questions addressed practitioners' attitudes to cost considerations. Results: Attitudes to cost containment depended on practitioners' awareness of costs, whether they were internists or family practitioners, and whether they participated in seminars on healthcare costs. Seniority had no bearing on attitude. Practitioners born in the former USSR knew more about the costs of inpatient hospital stay, whereas Israeli-born physicians were more aware of the costs of emergency room visits. Family practitioners, interns, and gynaecologists w...
TL;DR: In this paper, the profile of activity across a year and methods for forecasting year-end are discussed and compared using simple twelfthsor track relative to last years' activity.
Abstract: We are at mid-year and someone from finance says we are over budget. Time to talk about the profile of activity across a year and methods for forecasting year-end. Do we use simple twelfthsor track relative to last years' activity. Neither of these approaches are the preferredoption.
TL;DR: A unique and simple event was conducted by us which made a drastic impact on the relationship between senior management and junior doctors, and provided them with a platform to bring about and implement new ideas and discuss issues.
Abstract: Medical management has recently gained importance with an increasing number of doctors tryingto learn more about it. There have been medical leadership programmes and junior doctor'smanagement workshops held by various organisations, all geared towards doctors in general and junior doctors in particular. These programmes not only provide doctors with an insight into theworking of NHS but also give them a platform to put up their ideas and get involved. This article discusses a unique and simple event conducted by us which made a drastic impact on the relationship between senior management and junior doctors, and provided them with a platform to bring about and implement new ideas and discuss issues.
TL;DR: In this article, a detailed analysis reveals that little, if any, unambiguous evidence exists to support the claims of the proponents of appreciative inquiry and that the movement has many of the characteristics of a management fad.
Abstract: Articles attesting to the positive effects of using a performance management technique known as appreciative inquiry are increasingly appearing in management literature. More detailed analysis reveals that little, if any, unambiguous evidence exists to support the claims of the proponents of appreciative inquiry and that the movement has many of the characteristics of a management fad. Despite this, the amount of anecdotal data on the benefits of appreciative inquiry suggest that future empirical investigation is warranted. Without such data gathering, appreciative inquiry risks becoming another management fad that promises much, but ultimately fails to deliver.
TL;DR: This short article will seek to address the question: which leadership model or approach is best for GPs working in primary care?
Abstract: Since High Quality Care for All (2008), the development of leadership has been seen as a priority, and this has prompted various initiatives, not least the development of a leadership competency framework for doctors. The Medical Leadership Competency Framework (2009) is the first strategic level attempt to develop the leadership competencies required by doctors at various stages in their careers. Leadership is all the more important given the recent change of government and the policy of retrenchment, major structural change, and the emergence of new organisations, for example, GP commissioning consortia. The success of these new organisations, particularly in budget holding, ‘will depend on the engagement of GPs and the leadership they provide’ (Ham, 2010). The question is: which leadership model or approach is best for GPs working in primary care? This short article will seek to address this question.
TL;DR: NHS Bournemouth and Poole is keen to ensure that local people have the chance to become engaged at a variety of different levels, and in ways and at times that suit them, as part of redesigning care.
Abstract: Not only is patient and public engagement a legislative requirement for NHS organisations (NHS Act 2006; Local Government and Public Involvement in Health Act 2007), as well as an essentialcompetency in achieving world class commissioning standards (Department of Health, 2007a), but it is also a strong and widely held belief that involving patients and carers in decisions about health care is fundamental to the improvement of health and social care services. In order to ensure that patient's needs and preferences are met and continue to do so, NHS organisations must ensure that they are involved in all aspects of redesigning care. This article presents amodel being launched by NHS Bournemouth and Poole, who are keen to ensure that local people havethe chance to become engaged at a variety of different levels, and in ways and at times that suit them. The model aims to create more opportunities for people, which will then encourage peopleto take a shared responsibility in their own health, the health of oth...
TL;DR: Today's mass of siloed information may enable reporting on prescriptive targets, but it provides limited insight into performance variations or the cost of service delivery.
Abstract: The hiatus is over. The Treasury has made it very clear-the NHS has to make tough cuts, now. And the coalition government is demanding clinician-led decisions in order to minimise the impact on the quality of front-line service delivery. Good in theory, but without rapid access to cross-functional informatics, clinicians are powerless. Today's mass of siloed information may enable reporting on prescriptive targets, but it provides limited insight into performance variations or the cost of service delivery.
TL;DR: This article outlines a framework that will help public bodies to approach engagement morestrategically and draws on the authors' experiences of cross-sectoral community engagement work to unpack the issues, methods and resources needed at every stage of the process.
Abstract: Legislative and policy drivers have propelled community engagement to the top echelon of priorities for public bodies. They must now not only embed community engagement into their decision-making cycles, but also be able to demonstrate that engagement has had an influence. This means that whereas in the past engagement activity was unstructured and tended to occur typically onlyin the final phases of service commissioning and delivery planning, public bodies will now need to be systematic in ensuring that patients and the public are involved at every stage of the process. This article outlines a framework that will help public bodies to approach engagement morestrategically. It draws on the authors' experiences of cross-sectoral community engagement work to unpack the issues, methods and resources needed at every stage of the process.
TL;DR: There is a growing level of interest and activity in the wellbeing of staff in healthcare organisations in the UK, and a body of literature ranging from the NHS Health and Wellbeing Review to internationalscientific studies linking wellbeing with organisational performance is supported.
Abstract: There is a growing level of interest and activity in the wellbeing of staff in healthcare organisations in the UK. This interest is both stimulated and supported by a body of literature ranging from the NHS Health and Wellbeing Review (Boorman, 2009), to internationalscientific studies linking wellbeing with organisational performance. Also relevant is the practical experience of healthcare organisations that have begun to adopt a more strategic approach to staff wellbeing. By combining a study of these sources with the authors' own experiences of the practical application of wellbeing interventions, both within and outside the health sector, three main themes were identified: the importance of psychological wellbeing; the importance of identifying and tracking measurable benefits; and the role of management and leadership, and the need for a strategic approach. These themes are explained and discussed with reference to key research articles, the latest national reports, and examples of strategic work bei...
TL;DR: Differentials in change ratesbetween services with highly specialised service-user needs reflected clinical realities, and key performance indicators demonstrating change on global and risk-related outcome among a diverse group of patients with mental disorders, neurodevelopmental and learning disabilities, and acquired brain injury.
Abstract: St Andrew's Healthcare has pioneered the use of Health of the Nation Outcome Scales (HoNOS)data to power key performance indicators demonstrating change on global and risk-related outcome among a diverse group of patients with mental disorders, neurodevelopmental and learning disabilities, and acquired brain injury. Performance indicators based on routinely collected outcomes data for 2008 and 2009 were calculated for six specialist services (at Northampton men's, women's, adolescent, older adults secure services and our brain injury rehabilitation unit; and in our low secure adult service in Essex) to demonstrate change. Mean 90-day changerates of +0.64% and +0.52% on the risk outcomes indicator, and of +0.78% and +0.66% on global outcomes measures were demonstrated for 2008 and 2009 respectively. Differentials in change ratesbetween services with highly specialised service-user needs reflected clinical realities. St Andrew's Healthcare has now published six years of performance data demonstrating contin...
TL;DR: The majority of referrals were for issues related to clinical competence, although this frequently overlapped with behavioural, health and probity issues, and NCAS filled the ‘governance gap‘ between local and regulatory responsibility.
Abstract: Aim: To assess the impact of the National Clinical Assessment Service (NCAS) on governance activity for medical and dental practitioners in Northern Ireland. Method: Telephone interviews were conducted with a purposive sample of referrers to NCAS in Northern Ireland. Results: Twenty-two referrers agreed to take part and nineteen were interviewed. Respondents held a range of positions, including senior human resources personnel, but the majority were Medical Directors or Clinical Directors. The majority of referrals were for issues related to clinical competence, although this frequently overlapped with behavioural, health and probity issues. As well as automatically-triggered referral as part of disciplinary cases, reasons for seeking input from NCAS included seeking reassurance, expertise and objective advice. In some cases, employers reached their limits with a case, and NCAS filled the ‘governance gap‘ between local and regulatory responsibility. All respondents expressed satisfaction with the service ...
TL;DR: In this paper, the Department of Health's website has been rebooted with virtually its entire history of policy pronouncements, forward plans and press releases shoved off to the National Archives and a new Year Zero established.
Abstract: Now that the Department of Health's website has now been rebooted-with virtually its entire history of policy pronouncements, forward plans and press releases shoved off to the National Archives-and a new Year Zero established, it can be hard to put current events in their historical context. Hard, but not impossible.