Showing papers in "British Journal of Healthcare Management in 2016"
TL;DR: This article describes the setting up of a multidisciplinary, multi-agency homeless team within the King's Health Partners hospitals in South London, and outlines how the team has integrated primary and secondary care.
Abstract: This article describes the setting up of a multidisciplinary, multi-agency homeless team within the King's Health Partners hospitals in South London. The KHP Pathway Homeless team has been operating since January 2014, and works across three NHS Trusts, and five hospitals. The team is affiliated to, and forms part of a Pathway network of nine teams in acute care settings nationally. This article outlines how the team has integrated primary and secondary care (the team is GP-led and works alongside the community homeless teams); the voluntary sector with the NHS (the team has four third sector organisations providing staff within a 20-person team); mental health and physical health (one of the trusts is a mental health trust and the team has both physical and mental health care practitioners); and health and housing (the team assists patients into housing, and has built relationships to assist with this). As part of the operational detail, the highly successful homeless frequent attenders forum, which invo...
25 citations
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18 citations
TL;DR: The case for pirfenidone use in IPF was strengthened and there was a trend towards a reduction in mortality associated with the use of nintedanib, but the results failed to show a consistent reduction in the number of acute exacerbations with nintinganib.
Abstract: 110 British Journal of Healthcare Management 2016 Vol 22 No 5 © 2 01 6 M A H ea lth ca re L td many years this left the only treatment options of palliative and supportive measures for all patients, and lung transplant in highly selective cases. Hope was not lost—enter pirfenidone, a novel antifibrotic and anti-inflammatory agent designed to inhibit fibroblast activity. In the pooled analysis, two randomised control trials (RCTs), CAPACITY-1 and CAPACITY-2 (Noble et al, 2011), demonstrated that patients taking pirfenidone had less decline in their forced vital capacity (FVC) at 72 weeks (8.5% vs. 11% for placebo), and significantly fewer patients reached a decline of 10% predicted FVC, considered a prognostic marker in IPF. Pirfenidone received NICE approval in April 2013 for IPF patients with an FVC of 50–80% predicted (NICE, 2013). A subsequent primarily USA-based phase 3 RCT (ASCEND) (King et al, 2014) further strengthened the case for pirfenidone use in IPF by showing similar significant reduction in FVC decline, a lower proportion of patients having a 10% decline in predicted FVC (relative difference of 49.7%; 46 (16.5%) vs. 88 (31.8%)) and significantly more patients showing no decline in FVC (63 (22.7%) vs. 27 (9.7%)), in the pirfenidone group compared to placebo. A pre-specified pooled analysis of CAPACITY and ASCEND demonstrated a significant reduction in all-cause and IPF-related mortality with the use of pirfenidone (hazard ratio 0.52 and 0.32 respectively). Nintedanib: Future hope Nintedanib is a tyrosine kinase inhibitor, which causes intracellular inhibition of growth factor receptors, which are believed to be involved in the fibrotic process (Wollin et al, 2014). Two phase-three RCTs—the INPULSIS 1 and INPULSIS 2 trials (Richeldi et al, 2014)—demonstrated a significant reduction in the rate of decline in FVC with the pre-specified pooled analysis showing the annual rate of decline to be approximately half in the nintedanib group (113.6ml vs. 223.5ml) compared to placebo. Sub-analysis using a definition of a decline in FVC percent predicted of less than 10% as a ‘response’ to therapy, found that a significantly greater proportion of patients taking nintedanib (70.1%) responded to treatment compared to placebo (60.5%). Although these studies were not powered to detect differences in mortality, there was a trend towards a reduction in mortality associated with the use of nintedanib. The results failed to show a consistent reduction in the number of acute exacerbations with nintedanib.
18 citations
TL;DR: Health service redesign researchers from the National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care for Birmingham and the Black Country (NIHR CLAHRC BBC) investigated the process of large scale service redesign and included professional communicators who helped to connect researchers and key stakeholders.
Abstract: Health service redesign researchers from the National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care for Birmingham and the Black Country (NIHR CLAHRC BBC) investigated the process of large scale service redesign. In order to engage clinical staff and service users in the study, and to ensure findings were disseminated as widely as possible, the team included professional communicators who helped to connect researchers and key stakeholders. The NHS ‘communications fellows’ provided expertise in professional communication approaches and links to a wider network of communications professionals. The use of a range of communications industry techniques was vital in establishing effective communication channels to share interim and final research findings. The benefits of using a selection of key techniques is examined and recommendations are made that could help other researchers capitalise on professional communication approaches to help ensure the impact of t...
13 citations
TL;DR: A summary of the locality inpatient caseload analysis undertaken is presented, offering a new insight into the varied post-discharge needs of homeless patients.
Abstract: A needs assessment was undertaken to provide evidence to support a business case for enhanced homeless medical respite provision in South London. A literature review was undertaken, and existing homeless medical respite models were reviewed. Learning is summarised. A summary of the locality inpatient caseload analysis undertaken is presented, offering a new insight into the varied post-discharge needs of homeless patients. Service provider and service user perspectives are presented.
9 citations
TL;DR: Day surgery was noted to have a higher run rate of cases per unit of time, lower costs and subsequently a better margin generation per minute, and the additional annual profit generated by performing a single whole day trauma list in day surgery was approximately £293 000.
Abstract: The increasing trauma demands imposed by our population require innovative practice. A day surgery trauma service is a pragmatic response for those patients with less severe, more ambulatory trauma, and whose surgery has a lower risk profile. By using the principles set out in the value-based healthcare (VBHC) agenda, such a re-orientation of service offers opportunities in improving outcomes and reducing costs, this study assessed the impact of the day surgery trauma service in its current activity, the outcomes generated, its potential development and its fiscal footprint. The average patient satisfaction was very good with 92% preferring their surgery performed as day surgery rather than as an inpatient. Day surgery was noted to have a higher run rate of cases per unit of time, lower costs and subsequently a better margin generation per minute. The additional annual profit generated by performing a single whole day trauma list in day surgery was approximately £293 000. By focusing on the needs of the p...
8 citations
TL;DR: The principle observation is that different locations will experience different cost pressures, such as Essex (+5.4%) in the 2010 event versus +0.6% in Rod Jones The real reason for the huge NHS overspend?
Abstract: 40 British Journal of Healthcare Management 2016 Vol 22 No 1 © 2 01 6 M A H ea lth ca re L td behaviour is effectively removed and small number monthly variation is minimised. The periods of high unexplained death shows up in a running 12-month total as an inverted ‘V’, where the upward slope represents a step-like increase in deaths lasting for somewhere around 12 months, and the downward slope simply shows the dilution of the running total after cessation of the step-change. The magnitude of the step-change is shown by the difference from trough to peak and, as can be seen in Figure 1 can be very large or even seemingly absent on some occasions. Differences in timing between local government areas can be discerned, and these differences arise from very small area spatial spread of an as yet unidentified agent (Jones, 2015c-f). Increased medical admissions and bed occupancy mirrors the increase in deaths (Jones, 2015b; 2015h–i; 2016). Figure 1 illustrates the principle that something strange—probably infectious–is happening, which affects levels of medical admission and costs. Also note that the funding formula does not contain any correcting factors to account for this behaviour (Jones, 2013). Table 1 quantifies the magnitude of these step-like increases in death for a variety of the largest regions (in italics) and counties during a number of these suspected infectious outbreaks. Both maximum step-up and step-down are shown in the last two columns simply because the value of the step-down gives an alternative measure for the strength of each event. Immediately apparent is a wide range in percentage increases between regions for each event, with the 2004 (and to a lesser extent 2002) event being below the limit of detection (n/a) in a range of locations. Generally speaking, the 2012 and 2014 events are the highest in magnitude, with 60% of all local government areas in England and Wales having the greatest magnitude of increase in deaths (and hence medical admissions) in 2014, and as such will have the greatest impact upon NHS financial pressures. However, the principle observation is that different locations will experience different cost pressures, such as Essex (+5.4%) in the 2010 event versus +0.6% in Rod Jones The real reason for the huge NHS overspend?
7 citations
TL;DR: Findings show for every hour of lost productive time, four hours of unpaid overtime in the course of the month was accrued due to staff shortages.
Abstract: Background: Leadership and productivity in nursing and midwifery have become topical issues for discussion. This is possibly due to nurses constituting the largest group of the healthcare workforce. Nurses and midwives have been held accountable for low productivity and inappropriate leadership in the past. However, there has been limited consensus in the nursing literature about the impact of nurse managers' leadership styles on nurses' and midwives' productivity levels. Method: Two hundred and seventy five nurses and midwives (response rate of 99.2%) were asked to take part in a cross-sectional survey from five hospitals in the eastern region of Ghana, to examine the impact of nurse managers' leadership styles on self-reported productivity levels. Descriptive summaries, Pearson's correlations and linear regressions are presented. Results: Findings show for every hour of lost productive time, four hours of unpaid overtime in the course of the month was accrued due to staff shortages. Nurse managers' most...
7 citations
TL;DR: The history of medicine is littered with paradigm shifts in knowledge and practice, and Dr Edward Jenner, the discoverer of small pox vaccination, was ridiculed mercilessly, but the Australian doctor who discovered the link between Helicobacter pylori and stomach ulcers was likewise disregarded.
Abstract: The history of medicine is littered with paradigm shifts in knowledge and practice. New concepts and practice are usually vehemently resisted. Dr Edward Jenner, the discoverer of small pox vaccination, was ridiculed mercilessly (Trueman 2015). The Australian doctor who discovered the link between Helicobacter pylori and stomach ulcers was likewise disregarded, eventually taking the drastic step of drinking a live culture of H. pylori to prove the link, and to establish how antibiotics could remove the symptoms arising from the infection (Explorable 2016).
6 citations
6 citations
TL;DR: There is insufficient engagement of junior doctors with the clinical coding process and widespread attitude changes are needed to change this.
Abstract: Background: Clinical coding is an integral part of the NHS and is one of the main methods of gathering clinical data. Since the introduction of payment by results (PbR) in 2004 there has been an increasing emphasis on gathering good quality data to ensure hospitals are being remunerated accurately based on their workload. Method: We conducted a survey of 100 junior doctors looking at their knowledge and awareness of clinical coding. Results: Only 39% of doctors had attended a recent induction programme, and over half felt they knew little to nothing of the clinical coding system. A questionnaire of the coding system highlighted that neither the time since induction nor a self-assessment of knowledge made any difference to the questionnaire score. Conclusion: There is insufficient engagement of junior doctors with the clinical coding process and widespread attitude changes are needed to change this.
TL;DR: In the UK, a number of strategies have been employed to deal with high-cost pharmaceuticals, and while ambiguity still remains regarding the application of a ‘value for money’ threshold, developments within NICE such as the Highly Specialised Technology evaluation programme and the transfer of responsibility for the Cancer Drugs Fund is symbolic of the commitment to the principles of cost-effectiveness.
Abstract: The era of high-priced specialty pharmaceuticals is moving towards a pivotal moment. The cascade effect from the number of high-priced pharmaceuticals coming to market both now and in the future is causing payers to experience affordability challenges in an era where economic growth and resource allocation to healthcare is increasingly strained. In the UK, a number of strategies have been employed to deal with high-cost pharmaceuticals, and while ambiguity still remains regarding the application of a ‘value for money’ threshold, developments within NICE such as the Highly Specialised Technology evaluation programme and the transfer of responsibility for the Cancer Drugs Fund is symbolic of the commitment to the principles of cost-effectiveness and the overarching mandate it has in the NHS. Driven by financial necessity, healthcare systems such as the NHS have become better equipped to manage sophisticated and complex pricing arrangements with manufacturers. However, innovative pricing arrangements, such a...
TL;DR: These observations match with the observation that poorly resourced hospitals generally have higher mortality rates and generally poorer staff to patient ratios resulting in increased business and consequent reduction in hygiene standards.
Abstract: It has been commonly observed that bed occupancy above 85% leads to increased risk of hospital acquired infection, serious errors, staff consumption of antidepressants and higher mortality (Kaier et al 2010, Jones 2011, Boyle et al 2013, Jones 2013, Teitelbaum et al 2016). The effect is not due to occupancy per se but from generally poorer staff to patient ratios resulting in increased business and consequent reduction in hygiene standards, increased errors, patient falls and never events (Kaier et al 2012, Boyle et al 2013, Kuntz et al 2014). These match with the observation that poorly resourced hospitals generally have higher mortality rates (Griffiths et al 2015, Ozdemir et al 2016).
TL;DR: In this paper, the authors present a series of vignettes illustrating stakeholder management practices in action with the insights of a client relations manager with direct responsibility for managing stakeholder affairs.
Abstract: This article engages with stakeholder management practices from the building phase of hospital construction projects to analyse the methods employed by contractor and client in a construction project context. A series of vignettes illustrating stakeholder management practices in action are combined with the insights of a client relations manager with direct responsibility for stakeholder management affairs. The article provides practical guidance for practitioners and explores how stakeholder management issues revolve around the emerging event, with a supporting apparatus to facilitate communication and collaboration being critical to stakeholder interests and concerns being addressed. The insights are valuable for multiple health facility contexts where obtaining and maintaining stakeholder support is important.
TL;DR: It is vitally important that health service planners and policy makers understand the fundamental mechanisms lying behind the expression of inpatient demand.
Abstract: Further articles in this series can be found at http://www.hcaf.biz/2010/Publications_Full.pdf It is vitally important that health service planners and policy makers understand the fundamental mechanisms lying behind the expression of inpatient demand. Although in this respect, Whitehall has been accused of policy-based evidence, as opposed to evidence based policy – the temptation to fit the evidence to cherished policies being too strong for politicians to resist (LSE GV314 Group 2012, Press Association 2013). Figure 1: Running 12 month average acute occupancy, and total deaths in England
TL;DR: Having identified small areas with high risk of critical care admission should enable primary care organisations to target admission avoidance and/or appropriate end...
Abstract: Admissions over a three-year period to the general surgical and medical critical care unit at King's College University Hospital were allocated to the output area of residence for each patient. Each output area contains around 300 people of roughly similar social and demographic characteristics. Output area social grouping (output area classification) and deprivation (index of multiple deprivation) are shown to effect critical care admission rates. The admission rate doubles between the least and most deprived areas (excluding the effect of social group), however there is in excess of a 10-fold variation between the various deprivation-banded output area classification social groups. Particular social groups also show differing proportions of patients admitted to the critical care unit for different conditions such as sepsis or drug overdose. Having identified small areas with high risk of critical care admission should enable primary care organisations to target admission avoidance and/or appropriate end...
TL;DR: It is established that disease surveillance may be more complex that a few big name pathogens such as influenza—with surprisingly low levels of exposure in the study of Xu et al (2015), confirming a suspicion that influenza alone may not be the feared pathogen that Public Health agencies appear to believe.
Abstract: those which contradict currently accepted norms) are not possible or that they cannot evade current surveillance methods. For example, the technology has recently been developed to detect an immune response following exposure to all known 206 species of virus (> 1,000 strains), which infect humans by analysis of a single drop of blood (Xu et al, 2015). As part of the validation process for this technology blood from 569 humans from Peru, South Africa, Thailand, and the USA was screened for the extent of viral exposure. Those with HIV/AIDS registered a higher proportion of exposure to 14 common viruses as did the non-USA countries. Epstein-Barr virus, rhinovirus A & B, adenovirus C, respiratory syncytial virus and herpes simplex 1 being the most commonly detected viruses in non-HIV persons (Xu et al, 2015). Most common exposure was 10 viruses per person; and up to 62 viruses in five individuals; and 84 in two individuals. This is entirely relevant to the concept called the ‘pathogen burden’ where disease severity appears to increase with higher numbers of pathogens, i.e. combinations of pathogens may be more detrimental to health than the single pathogen studies currently indicate (see: Jones, 2015b; 2016a; 2016c). In this respect, cytomegalovirus (CMV), via its huge repertoire of immune evasive and modulating genes, may be acting as an agent provocateur to other pathogens (see Jones 2016a)— despite being widely regarded as largely innocuous. Having briefly established that disease surveillance may be more complex that a few big name pathogens such as influenza—with surprisingly low levels of exposure in the study of Xu et al (2015), confirming a suspicion that influenza alone may not be the feared pathogen that Public Health agencies appear to believe (see wider discussion in: Jones 2016c). However, returning to the issue of disease surveillance, Figure 1 presents a EuroMOMO type of analysis of a series of monthly deaths in England between January 2001 and November 2015, which was obtained from the Office for National Statistics. The raw monthly data was first corrected for the long-term trend in deaths using a second order polynomial, where all monthly deaths were corrected to the December 2015 position. This effectively linearises the time trend. Average deaths for each adjusted month were then determined (an average of 15 years), and the standard deviation for that month also calculated. The difference between the actual and expected deaths in each month was then calculated, and this difference was turned into a standard deviation difference by dividing by the standard deviation for each month. Anything greater than a ± 2 standard deviations difference (STDEV) can be Rod Jones A fatal flaw in mortality based disease surveillance
TL;DR: An audit of bronchiolitis admissions to a London children's hospital found that 52 hospital admissions did not have identified causative agents accurately represented in the coding, with inadequate clinical documentation being the leading cause.
Abstract: Background: At least 14.6% of paediatric hospital episodes in England were due to infections in 2014/15. The clinical coding of infection aetiology is required for healthcare planning, epidemiology and financial reimbursement. The degree to which causative agents are recorded in infection coding datasets is unknown, and its importance for remuneration and other secondary uses has not been studied. Methods: An audit of bronchiolitis admissions to a London children's hospital was performed between 1 August 2014 and 31 July 2015. The agreement between the discharge documentation, coding reports and results of a Respiratory Virus Molecular Panel was assessed by clinicians and a coding professional. The impact of errors on data quality and finances was reviewed. Results: Of the 74 admissions, 52 (70.3%) did not have identified causative agents accurately represented in the coding, with inadequate clinical documentation being the leading cause (53.8%). In total, 29 hospital admissions were assigned to an incorr...
TL;DR: This review sought to constructively harmonise and differentiate each definition using a thematic framework, finding two terms, ‘goal’ and ‘aim’, are thematically similar as broad objects of immeasurable terminal impact, with a long-term timeframe.
Abstract: Introduction: Most academic literature uses ‘goal’, ‘aim’, ‘objective’ and ‘target’ as synonymous terms, but development and healthcare sectors define them as distinct etymological entities with varied and confusing interpretations. This review sought to constructively harmonise and differentiate each definition using a thematic framework. Method: An inductive synthesis of definitions of the goal terms collected from 22 literature sources selected through a systematic internet search. Thirty-three specific definitions were reduced through serial category-building to single general definitions, and a set of theoretical themes generated as characteristic framework of each goal. Results: Seven conceptual themes evolved from the synthesis, including the object, scope, hierarchy, timeframe, measurability, significance and expression of each goal term. Two terms, ‘goal’ and ‘aim’ are thematically similar as broad objects of immeasurable terminal impact, with a long-term timeframe. They signify organisational su...
TL;DR: The complaint rate in the foot and ankle unit of a tertiary referral centre is low and good communication and a professional attitude will significantly reduce complaints.
Abstract: Complaints in the NHS have significant legal and financial implications. We performed an investigation to identify the causes, incidence and outcome of complaints in the Foot and Ankle unit of a tertiary referral centre. We found the complaint rate in the foot and ankle unit is low. Good communication and a professional attitude will significantly reduce complaints. The majority of complaints have local resolution, but there is potential for significant cost with every complaint.
TL;DR: In this article, the authors report changes in mindset and attitudes of a cohort of 798 NHS managers in relation to the implementation of a new NHS trust-wide performance appraisal system, measured through two methods: the statistical analysis of data collected before and after an intensive training/orientation intervention by means of χ2 tests; and a corpus linguistic analysis of word associations and text comments.
Abstract: This article reports changes in mindset and attitudes of a cohort of 798 NHS managers in relation to the implementation of a new NHS trust-wide performance appraisal system. This was measured through two methods: the statistical analysis of data collected before and after an intensive training/orientation intervention by means of χ2 tests; and a corpus linguistic analysis of word associations and text comments that is novel to the literature.
TL;DR: This month’s analysis is intended to give insight into that core of the hospital sector, the acute overnight stay bed pool, and the reality presented in Table 1 is somewhat sobering.
Abstract: The ‘Money Matters’ series is intended to be a pragmatic view of the forces regulating NHS activity and costs. This month’s analysis is intended to give insight into that core of the hospital sector, the acute overnight stay bed pool. As you will be aware overnight bed numbers have substantially declined between 2002/03 and 2014/15 (-71% Learning Difficulty, -35% Mental Illness, -22% General & Acute, -16% Maternity), and zero day stay emergency admissions have increased to around 1.6 million ‘admissions’ per annum leading to significant corruption of the average length of stay (LOS), and creating the illusion that LOS is plummeting (thereby justifying the large reduction in overnight stay beds). However, the reality presented in Table 1 is somewhat sobering.
TL;DR: A series of articles in BJHCM and elsewhere has been investigating potential flaws in the measurement of hospital mortality, used to detect instances of poor care such as occurred in the Mid Staffordshire Hospital.
Abstract: Further articles in this series can be found at http://www.hcaf.biz/2010/Publications_Full.pdf A series of articles in BJHCM and elsewhere has been investigating potential flaws in the measurement of hospital mortality (Jones 2015a,b, 2016a-d). Hospital mortality models have been used to detect instances of poor care such as occurred in the Mid Staffordshire Hospital. However, shall we start with the assumption that all models are flawed; some are just more flawed than others. Figure 1: Relationship between activity and SHMI score at Northern Devon Healthcare
TL;DR: The scale of impact of a combined intervention using telehealth (Clinitouch system) in parallel with clinical health coaching and specialist nurse interventions, triggered by biometric data from a redesigned service for patients with chronic obstructive pulmonary disease, was evaluated.
Abstract: Aims: To evaluate the scale of impact of a combined intervention using telehealth (Clinitouch system) in parallel with clinical health coaching and specialist nurse interventions. This was triggered by biometric data from a redesigned service for patients with chronic obstructive pulmonary disease (COPD). Eligible patients had a history of two or more prior unscheduled COPD admissions in the previous 12 months. Methods: Admissions data from University Hospitals of Leicester NHS Trust and interventions from Leicester Partnership Trust and Totally Health were received from Leicester City Clinical Commissioning Group (LC CCG). Data were analysed relating to the impact on admissions and overall resource use and compared to the previous 12 months with patients acting as their own controls. Results: The number of admissions decreased from 3.13 to 1.02 admissions per patient over the 12-month period (p < 0.001). The overall net saving to the LC CCG over the 12-month period was £117 550. Conclusions: All of the i...
TL;DR: While the event in 2015 was large it is simply a further example of a long-term series of similar events, and interaction between the agent causing the earlier increase in deaths and influenza appear highly likely.
Abstract: Changes in the absolute number of deaths (all-cause mortality) act via their impact on end-of-life care to affect marginal changes in NHS medical admissions, bed occupancy and costs. These effects are poorly understood. A very large and unexpected increase in deaths in 2015 offers the opportunity to explore the reasons for this and previous examples of periods of increased deaths. While the event in 2015 was large it is simply a further example of a long-term series of similar events. An influenza outbreak in early 2015 did make an additional contribution, however deaths had already begun to increase around mid-2014. Interaction between the agent causing the earlier increase in deaths and influenza appear highly likely. The resulting complex short-term trends in death imply that health and social care costs will show far higher volatility than that implied by simple demographic change.
TL;DR: In Gwent, South Wales, different models of community-based chronic obstructive pulmonary disease (COPD) care were developed in different local health boards (LHB) leading up to the year 2009, giving a unique opportunity to compare the efficacy of different models among patients with similar demographic characteristics.
Abstract: Introduction: In Gwent, South Wales, different models of community-based chronic obstructive pulmonary disease (COPD) care were developed in different local health boards (LHB) leading up to the year 2009. This gave a unique opportunity to compare the efficacy of different models among patients with similar demographic characteristics. Methods: Hospital admission data were compared for the three years before and after the introduction of COPD services around 2006. Primary care practices without access to services served as control populations. Results: Long-term conditions services where community nurses worked in isolation (Caerphilly), or that were based around primary care practices (Newport and Monmouthshire), showed an increase in COPD hospital admission of 12.3%, 43.4% and 20.8% respectively. This corresponded to an increase of 5.2% and 1.0% respectively in control practices (p < 0.01 for each LHB). In Blaenau Gwent and Torfaen, services integrated between primary and secondary care were associated ...