Showing papers in "British Journal of Healthcare Management in 2013"
TL;DR: Since 1998/99 in England, there has been a rapid expansion in the proportion of total admissions arising from the elderly (aged 75 and over), and this group matches with diagnoses known to be associated with high levels of multi-morbidity.
Abstract: Since 1998/99 in England, there has been a rapid expansion in the proportion of total admissions arising from the elderly (aged 75 and over). This is exclusively due to the medical specialties, and cannot in any way be described by the demographic shift over that time period. A group of 90 diagnoses have been identified, which account for the bulk of this shift, and this group matches with diagnoses known to be associated with high levels of multi-morbidity. A potential common cause for this increase is explored.
27 citations
TL;DR: A report designed to assure everyone that the excess deaths were merely confined to a few weeks during the winter of 2012/2013 can be shown to contain methodological limitations and the case for a genuine infectious outbreak is investigated.
Abstract: In February of 2012 deaths in England and Wales showed a semi-permanent and unexpected increase which endured to around mid-2013. This increase appears to be linked to an increase in A&E attendance and emergency medical admissions. In August of 2013 Public Health England published a report designed to assure everyone that the excess deaths were merely confined to a few weeks during the winter of 2012/2013. However, this report which relies on output from the EuroMOMO methodology and can be shown to contain methodological limitations. The case for a genuine infectious outbreak is investigated.
24 citations
TL;DR: As expected, deaths in England and Wales were observed to show a step-like increase of around 430 to 480 extra deaths per week commencing in the sixth week of the 2012 calendar year, but increasing to around 1000 excess lives per week in early 2013.
Abstract: A recurring series of infectious-like outbreaks across the UK and in other Western countries has been associated with increased deaths, emergency medical admissions, GP referrals and emergency department attendances. Previous outbreaks in 2002 and 2007 suggested that an outbreak may be due again in 2012. As expected, deaths in England and Wales were observed to show a step-like increase of around 430 to 480 extra deaths per week commencing in the sixth week of the 2012 calendar year, but increasing to around 1000 excess deaths per week in early 2013. A parallel increase in emergency admissions also occurs at the same point in time. The impact at local authority level is highly granular and a genuine infectious outbreak is implicated where the method of transmission is probably by person to person contact. The ubiquitous herpes virus, cytomegalovirus, may be the causative agent but this requires validation.
23 citations
TL;DR: An assessment framework is used to quantify engagement with and uptake of collaborative methodology in 17 projects in a quality improvement collaborative in North West London and highlights the need to open the ‘black box’ both while the work is in progress to allow generative learning, and for the purposes of evaluation.
Abstract: Quality improvement collaboratives seek to address the mandate to improve healthcare quality and reduce inappropriate variations in care through the use of defined methods and change concepts. There are indications of positive effects, but less evidence of the effectiveness of the methods—the ‘black box’ of the intervention—and how to effectively implement a collaborative. This study uses an assessment framework to quantify engagement with and uptake of collaborative methodology in 17 projects in a quality improvement collaborative in North West London. The framework developed by the NIHR CLAHRC for Northwest London showed variation in uptake and use of methods within and across projects. For example, most projects involved patients and the public and disseminated learning. There was more limited engagement with the NHS Institute for Innovation and Improvement Sustainability Model. The framework provides detailed methods-related information that collaborative leaders could use for generative learning to meet participants’ needs, and identify peer exemplars. This study raises important questions about implementation fidelity and highlights the need to open the ‘black box’ both while the work is in progress to allow generative learning, and for the purposes of evaluation.
20 citations
TL;DR: It is asked whether the authors should be blaming increased accident and emergency attendances and admissions on an ageing population, or whether it is better to blame it on a combination of factors.
Abstract: Rod Jones, statistical advisor, asks whether we should be blaming increased accident and emergency attendances and admissions on an ageing population
15 citations
TL;DR: The aim of the review is to clarify the concept of the ‘care bundle’ which has emerged in modern clinical practice as a means of providing consistent clinical care of the highest quality.
Abstract: The aim of the review is to clarify the concept of the ‘care bundle’ which has emerged in modern clinical practice as a means of providing consistent clinical care of the highest quality. The ‘care bundle’ is essentially a process within which identified components of care are diligently applied and where the separate elements have been validated by extensive clinical practice. Specific examples of care bundles include ‘care bundle to prevent surgical site infection’, ‘care bundle for ventilated patients’ and ‘urinary catheter care bundle’. The adoption of ‘care bundles’ can be seen as a fundamental shift in thinking from the acceptance of some adverse outcomes as an inevitable result of delivered care to the concept of significant reduction or even elimination of such adverse outcomes. The philosophy of ‘care bundles’ is linked to well-established processes of ‘Plan, Do, Check, Act’ where there is monitoring of compliance of carrying out of ‘bundle’ components and also patient outcomes.
14 citations
TL;DR: The USA should not be used as a so-called efficiency benchmark for LOS, and on a like-for-like basis seems to have an average LOS which is comparable to that in England.
Abstract: In the pursuit of lower health care costs, measures of efficiency, such as length of stay (LOS) come under increased scrutiny. There is a general perception that the operation of a free market in the USA leads to higher efficiency. However, lower average LOS in US hospitals is shown to decrease in proportion to the number of beds per hospital. This is partly due to the role of hospital size and the truncating effect of Medicare diagnosis-related group (DRG) payments on costs and therefore upon average LOS. The USA should not be used as a so-called efficiency benchmark for LOS, and on a like-for-like basis seems to have an average LOS which is comparable to that in England.
13 citations
TL;DR: The approach adopted is based on unrealistic assumptions about leadership and leadership development and therefore will not make a significant difference to leadership in healthcare.
Abstract: 2014 will see the advent of a new fast-track leadership development scheme (costing some £10 million) for the NHS in England which aims to combine development for senior NHS clinicians with advancement for managers from outside the NHS. Following completion of this 10-month programme the expectation is that participants will be ‘rapidly promoted’ into senior management and chief executive roles (Lintern, 2013). This is in addition to the £46 million to be invested in leadership development through the NHS Leadership Academy in what they describe as a ‘professionalised and standardised’ approach to leadership, based upon acquisition of academic qualifications, which are intended to become essential criteria for those applying for future NHS leadership roles. This article suggests that the approach adopted is based on unrealistic assumptions about leadership and leadership development and therefore will not make a significant difference to leadership in healthcare. It also outlines what needs to be done to ...
13 citations
TL;DR: This is the author accepted manuscript and the final version is available from Mark Allen Healthcare via the DOI in this record.
Abstract: This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record
13 citations
TL;DR: The relation between doctors and nurses has changed, over the last 40 years, from being a relation based on status, to a more balanced one, based on mutual trust and leadership, resulting in the emergence of more complex psychological processes between the main actors of the healthcare system.
Abstract: The present article critically discusses how the relations and roles of doctors and nurses have changed over the last 40 years, and how these have been re-shaped by a growing focus on improving patient care while preserving and improving the economics of the health service. It suggests that the emphasis on more efficiency and more accountability has changed both the roles and span of control of doctors and nurses. Yet, it also argues that stereotypes held by doctors and nurses about one another remain difficult to change. Managers have emerged as new actors in the healthcare system, and have contributed to these role shifts. Overall, the relation between doctors and nurses has changed, over the last 40 years, from being a relation based on status, to a more balanced one, based on mutual trust and leadership, resulting in the emergence of more complex psychological processes between the main actors of the healthcare system.
12 citations
TL;DR: The NHS in England is operating on a knife edge, with the system so stretched that any perturbation to status quo will lead to rapid deterioration of performance.
Abstract: The NHS in England is operating on a knife edge. Average hospital occupancy is now so critically high that there are all manner of hidden queues to admission (see Jones 2011a,b). This has been exacerbated by well-intended attempts to close beds and save money – with highly predictable consequences (Jones 2009a-d, 2011c). The system is simply so stretched that any perturbation to status quo will lead to rapid deterioration of performance.
TL;DR: There is limited research on the type and level of content within GP referral letters to specialists that are associated with favourable patient outcomes, and researchers inferred that the quality and quantity of information relayed at the interface between primary and secondary care is poor, and that this compromises patient outcomes.
Abstract: This study aimed to identify the type and level of content within GP referral letters associated with favourable patient outcomes. Data was sourced from both PubMed and Embase, and 528 references were systematically reviewed: 30 articles were included. Information extracted included the influence of referral practices on patient outcomes. The study found that most articles reported on information flow from GPs, which was typically poor. Only two articles noted the direct effect of GP referral on patient outcomes. In conclusion, there is limited research on the type and level of content within GP referral letters to specialists that are associated with favourable patient outcomes. Researchers inferred that: the quality and quantity of information relayed at the interface between primary and secondary care is poor, and that this compromises patient outcomes.
TL;DR: The curious cycles in oncology admissions are proposed to be arising from outbreaks of a previously unrecognised infectious immune impairment and it is probable that the infectious agent is cytomegalovirus, a ubiquitous herpes virus with potent immune modulating effects.
Abstract: 606 British Journal of Healthcare Management 2013 Vol 19 No 12 © 2 01 3 M A H ea lth ca re L td Figures 2 and 3 explore the curious cycles in more detail looking specifically at medical and oncology emergency admissions. The curious thing about oncology is that the cycle lags by around 1–2 years behind the medical cycle. It has been proposed that the cycles are arising from outbreaks of a previously unrecognised infectious immune impairment (Jones, 2013a; 2013d) and that it is probable that the infectious agent is cytomegalovirus (CMV), a ubiquitous herpes virus with potent immune modulating effects (Jones, 2013a; 2013d; 2014). CMV is both oncomodulatory (stimulating tumor growth) and oncogenic (initiating tumors) and this would explain the lagged cycle in oncology admissions which has been observed to occur for new cancer registrations for specific cancers in the USA (Jones, 2012b) and affects cancer costs in England (Jones, 2010e; 2012b; f; e). These cycles have also been observed to mirror a cycle in deaths (Jones, 2012e; 2013g) and subtle changes in the gender ratio at birth (Jones, 2013f) and at local level have a more pronounced step-like increase at the start than the undulations seen at national level which arise due to relatively difficult to transmit infectious Rod Jones The funding dilemma: a lagged cycle in cancer costs
TL;DR: The era of heroic leadership styles are well and truly over and the NHS needs to shift into a model of shared/distributed leadership where staff can work interprofessionally, sharing their skills and knowledge, collectively leading to provide a better service to the patient.
Abstract: Organisations as large and complex as the NHS cannot function effectively without sufficient high-quality interprofessional leadership and development. This will only happen if managers and staff are supported with the necessary skills and have the commitment from the organisation to invest resources in creating leaders if the future vision of the NHS is to be realised. The King's Fund—among other commentators and authorities on the NHS and the Department of Health—share the view that the era of heroic leadership styles are well and truly over. The NHS needs to shift into a model of shared/distributed leadership where staff can work interprofessionally, sharing their skills and knowledge, collectively leading to provide a better service to the patient. This requires engaging with others both internally and externally to the organisation to facilitate this, and also, for the skill of influencing change in the decision-making process. Thus, enabling a better outcome in relation to the future of the NHS.
TL;DR: It is mathematically impossible to run any service at very high average occupancy without creating huge queues, which may explain why queuing theory is so widely used across multiple industries but strangely ignored especially in the NHS in England.
Abstract: Those of you with even the slightest acquaintance to queuing theory will know that it is mathematically impossible to run any service (such as inpatient beds) at very high average occupancy without creating huge queues (Bain et al 2010, Marjot 1987). Indeed the mathematics is confirmed by real life experience and this may explain why queuing theory is so widely used across multiple industries but strangely ignored especially in the NHS in England.
TL;DR: In every quality improvement initiative, leaders will face challenging problems, changing circumstances, and unforeseen difficulties as mentioned in this paper. But what sets the successful leader apart is not their superior intellect or natural ability, it's the fact that they do not give up.
Abstract: In every quality improvement initiative, leaders will face challenging problems, changing circumstances, and unforeseen difficulties. What sets the successful leader apart is not their superior intellect or natural ability—it's the fact that they do not give up. They stick with an idea or a concept long after the majority have given up and moved onto something easier. As important as what quality improvement leaders do is the fact that they keep doing it. They overcome problems, shrug off setbacks and remain positive. This article explores the much underrated leadership qualities of resilience, persistence and optimism, and explains why these key ingredients are essential to leading a successful quality improvement programme.
TL;DR: The collaborative approach to leadership: what it is; what it isn’t; where it adds value; and what critical skills and capacities today’s collaborative healthcare leaders should exemplify are explored.
Abstract: It’s often said if you want something done right, you have to do it yourself. After all, our society traditionally rewards individual achievement over cooperative effort; we celebrate the great leader as a charismatic heroic figure standing alone taking the tough decisions. Maybe so, but you’d be missing out on one of the greatest resources available to help you advance your agenda—other people. Leadership is changing; the coercive command and control approach with its linear, hierarchical restrictions is being replaced by a more flexible collaborative co-production. This article explores the collaborative approach to leadership; what it is; what it isn’t; where it adds value; and what critical skills and capacities today’s collaborative healthcare leaders should exemplify.
TL;DR: The results showed that trust is the central factor, having a major influence on doctors' performance and practice orientation but especially on the main outcome measure, overall patient satisfaction.
Abstract: This article examines the doctor-patient relationship from the patient's perspective and reports on the inter-relationships between patients' demographic data, continuity of care and satisfaction; and on their perceptions of their doctors' trustworthiness, practice orientation and performance. The aim is to determine how much of the variance on each (dependent) variable is accounted for by the other (independent) variables; and in particular patient satisfaction. Data were obtained from 372 patients through an anonymous questionnaire survey. Hierarchical regression and t-test techniques were applied to the demographic data and to the four main scales. The results showed that trust is the central factor, having a major influence on doctors' performance and practice orientation but especially on the main outcome measure, overall patient satisfaction. Continuity of care is the second most important factor as it is influenced by patients' perceptions of trust, doctor performance and practice orientation. More...
TL;DR: A change in the trajectory of the trends was observed to occur at the point at which deaths unexpectedly increased and it was suggested that an unrecognized infectious outbreak may be involved.
Abstract: Last month Money Matters investigated growth in total A&E attendance in England, growth in those A&E attendances which were admitted and growth in total emergency admissions which will include GP referred patients who are admitted directly via assessment units. A change in the trajectory of the trends was observed to occur at the point at which deaths unexpectedly increased and it was suggested that an unrecognized infectious outbreak may be involved (Jones 2013a,b). Figure 1: Growth by age band and attendance outcome
TL;DR: It is concluded that although performance indicators are valuable for efficiency improvement, the way they are implemented and managed in the English NHS does not assure the successes seen in the private sector but can lead to damaging defensive management actions.
Abstract: This review of the literature examines how political ideologies have converged around English health policy and why command and control management techniques using performance indicators and targets are used to achieve policy and judge its efficacy. Performance indicators and their role in an enterprise culture, which health policy has introduced to replicate the efficiency successes from the private sector, is evaluated in this article. The article concludes that although performance indicators are valuable for efficiency improvement, the way they are implemented and managed in the English NHS does not assure the successes seen in the private sector but can lead to damaging defensive management actions.
TL;DR: The modified formula makes it possible for local areas in england and Wales to project the number of falls related to visual impairment, and will help those commissioning falls and fracture pathways to factor in the effect of visual impairment.
Abstract: A large body of evidence examines the causes of falls but understanding the role of visual impairment as a cause of falls is studied less and, as a result, is less well understood. Local areas require information at local levels to accurately assess the health needs of their populations, such as understanding the impact of falls on local health services. modification of published formula to calculate how a local area can estimate its fall numbers related to visual impairment. the modified formula makes it possible for local areas in england and Wales to project the number of falls related to visual impairment. this formula will help those commissioning falls and fracture pathways to factor in the effect of visual impairment.
TL;DR: In this article, the authors examine the two important and distinct roles of both manager and leader, and demonstrate how the manager can support and develop their own staff to become successful leaders, thereby allowing the manager to concentrate upon the vital job of managing.
Abstract: In this article the author will examine the two important and distinct roles of both manager and leader. Often, out of necessity, these two roles are performed by the same individual, but this however, is not always ideal or practical. Therefore, as a manager, it is vital to recognise the focus of your role and to support and develop those staff within your department who can and are already fulfilling their leadership potential. This article will start by demonstrating the differences between a leader and a manager. Change management will be discussed before finishing with how the manager can support and develop their own staff to become successful leaders, thereby allowing the manager to concentrate upon the vital job of managing.
TL;DR: The study found that there was some confusion regarding the degree of freedom available to local commissioners, which together with tight timescales for implementation meant that the choice of services for AQP was not always well matched to local needs.
Abstract: This paper reports findings from a study of the early implementation of ‘any qualified provider’ (AQP) that was undertaken over the summer of 2012. The aim of the study was to provide an early indication of the progress of—and issues raised by—the first phase of implementation of the AQP process so as to inform future policy implementation. Semi-structured telephone interviews were held with 26 individuals from organisations involved in the implementation of AQP. The study found that there was some confusion regarding the degree of freedom available to local commissioners. This together with tight timescales for implementation meant that the choice of services for AQP was not always well matched to local needs. Providers felt that the tariff offered in some cases was not enough to provide the service without resulting in reductions in quality. Nonetheless, support for AQP was widespread, as a method of procurement, to be used when and if local commissioners decide that it would be suitable and would bring...
TL;DR: It is argued that to increase output (represented by volumes of cases treated) and quality of care is not just necessary, but essential, and the key to addressing the future of healthcare is the maximisation of the use of human resource.
Abstract: The NHS must increase productivity by 6% per annum if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. Given that staff costs are 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforces will need to be changed to meet these targets. Healthcare management will be greatly affected by these changes. We argue that skill maximisation (e.g. increasing the responsibilities of healthcare practitioners) is the key to increasing productivity and care quality. We argue that to increase output (represented by volumes of cases treated) and quality of care is not just necessary, but essential. We therefore argue that the key to addressing the future of healthcare is the maximisation of the use of human resource.
TL;DR: This article sets out to explore the relevance of the MLCF framework as a structured approach to developing leadership and management for doctors in the context of primary care.
Abstract: Leadership has not been a core part of the undergraduate medical curriculum in UK medical schools, nor has it featured strongly in postgraduate medical training. Notwithstanding this, policy changes have encouraged doctors to become more involved in organisational leadership and clinical leadership. A medical leadership competency framework (MLCF) has been developed specifically for doctors. This has been piloted in secondary care but relatively less work has been carried out in primary care. This article sets out to explore the relevance of the MLCF framework as a structured approach to developing leadership and management for doctors in the context of primary care.
TL;DR: Rod Jones, statistical advisor, discusses volatile diagnoses in those aged 75 years and over and the importance of routine check-ups and informed consent.
Abstract: Rod Jones, statistical advisor, discusses volatile diagnoses in those aged 75 years and over
TL;DR: In this article, the authors examine the manager's role in the change process and support a strong leader and expert who will act as a change agent to see the change through to a successful conclusion.
Abstract: Within this article the author will examine the manager's role in the change process Change within the NHS is an ever-present reality, whether proposed from within your own department and identified by your own staff, or forced upon you from outside However, participating within the change process can distract managers away from the vital job of managing their service or department Therefore, as a manager it is vital to recognise the focus of your role and to then support a strong leader and expert who will act as ‘change agent’ to see the change through to a successful conclusion
TL;DR: If infectious spread is involved in some £6 billion of costs associated with each outbreak then factors relating to infectious spread may need to be incorporated into the funding formula, which assumes that all costs are largely person-related, such as sex, age, deprivation and personal disease history.
Abstract: A recent series of articles in BJHCM has investigated the possibility that recurring outbreaks of a persistent infectious immune impairment may be having a profound effect upon medical admissions, GP referral, AE 2012a–i). An accompanying article in this edition investigates potential implications to the funding formula, which assumes that all costs are largely person-related, such as sex, age, deprivation and personal disease history. If infectious spread is involved in some £6 billion of costs associated with each outbreak then factors relating to infectious spread may need to be incorporated into the funding formula. In this respect population density is an obvious factor which would be relevant. In the USA there is a reasonable log-linear correlation between population density (at state level) and the use of hospital beds (Figure 1), expressed as bed days per death, to reflect the important contribution of end of life to bed utilisation (Jones, 2011b–e). This is consistent with the fact that population density and related household crowding are known to increase admissions for mental health, alcohol and drug abuse and respiratory conditions (Schweitzer and Su, 1977; Morris and Munasinghe, 1994; Sundquist and Frank, 2004). High population density is usually associated with higher levels of noise and air pollution which are both related to increases in emergency admission (Tobias et al, 2001: Sauerzopf et al, 2009). Regarding the mental health aspects of population density it should be of no surprise that London (rightly) has a higher proportion of these beds than in other parts of England (author’s calculations). In the 34 largest urban areas in the US the weighted population density per square mile ranges from 2360 in Atlanta to 33 030 in New York and only five cities have a weighted density above 10 000 per square mile (see: http://austinzoning.typepad.com/ austincontrarian/2008/03/weighteddensit.html). This implies that around 14% of the US population lives at a density above 10 000 compared to 40% in England (Figure 2). In this respect the raw average for London is slightly above 12 000, while the weighted average is around 22 000 per square mile. Four small areas with a density greater than 100 000 per square mile are all in London. It should therefore come as no surprise that London appears to bear the financial and operational brunt of each outbreak (Jones, 2011a; 2012a; 2012i) and may partly explain why bed use in London appears to be disproportionately high (Jones, 2011c; 2011e). The use of bed days per death as a measure of bed utilisation is not infallible and in London this measure is skewed by the high outward migration Figure 1. Bed utilisation and population density in the USA
TL;DR: This project aimed to establish whether social media, could be used to raise the profile of AHPs—three members of the AHP Directors Scotland Group (ADSG) and one AHP national lead.
Abstract: Social media is reshaping healthcare and the way healthcare professionals and patients interact. In Scotland, few allied health professionals (AHPs) use these media to connect with policy makers, service users, the public, or colleagues. We aimed to establish whether social media, could be used to raise the profile of AHPs—three members of the AHP Directors Scotland Group (ADSG) and one AHP national lead. Training in the use of social media tools was supplemented by support by a subject matter expert throughout the 12-week project. Each AHP used social media in support of their own area of expertise. Over 1348 tweets and 8 blogs were posted, 753 followers attracted. Various audiences were reached; including UK and international AHPs; other healthcare professionals, professional bodies, the public, third sector and patient representative organisations. Working within an ethical framework, AHPs can use social media to promote greater awareness of their role and impact. It can also be used to forge new relat...
TL;DR: The ease and flexibility offered by pen devices into a busy lifestyle aims to improve diabetes management with much less effort without impacting on people's quality of life.
Abstract: The global incidence of diabetes mellitus has reached an alarming epidemic proportion. Of this large proportion, 5–10% are affected by type 1 diabetes while the remaining 90% with type 2 diabetes. In the UK, estimates suggest that this condition affects 2.9 million people. Insulin therapy is vital in the former category while this therapeutic mode is often included at a stage of the latter category to prevent respective hyperglycaemia and related micro and macrovascular complications. The modern pre-filled and re-usable pen devices used as insulin delivery system hold many advantages over the conventional approach which was often associated with dosage errors. The ease and flexibility offered by pen devices into a busy lifestyle aims to improve diabetes management with much less effort without impacting on people’s quality of life. Despite the promise of future developments in insulin delivery, serious considerations to cost implications should always be given in the management of diabetes.