Showing papers in "British Journal of Healthcare Management in 2017"

Why written objectives need to be really SMART

Abstract: There is general agreement that plans without well-formulated goals lack rationale, strategies lack relevance, actions lack direction, projects lack accountability, and organisations lack purpose (Mullins, 1999; Beardshaw and Palfreman, 1990; Bratton, et al, 2007). Moreover, goals need to be properly constructed to serve as credible and usable benchmarks by which the results can be monitored and evaluated via immediate outputs, intermediate outcomes over the short term or terminal impacts in the long term (Greenbank, 2001; Fitsimmons, 2008; Bipp and Kleingeld, 2011). Thus, it is a basic requirement of effective goal setting that objective statements are formulated using a clear and logical structure or framework. This article analyses examples of objective statements drawn from the literature and concludes that none of these can be truly described as SMART1, posing the risk that organisations using them as guide will fail to attain their goals.

The reforming appeal of distributed leadership

Abstract: With a systematic literature review, this article examines the significance of distributed leadership in healthcare, assessing the extent to which it reflects a consistent set of values, meanings, practices and outcomes. It identifies key mediating factors and their importance in enabling or constraining distributive leadership processes. The findings indicate that clinicians without formal leadership titles are inspiring change and driving improvements, although countervailing pressures are limiting this in practice. Distributed leadership is evident in the way that clinical teams function, and more could be made of this for the modernisation of healthcare. At present, this potential tends to be constrained, and subject to competing interpretations that reflect distinct occupational identities. Greater attention could be given to educational and developmental programmes that claim space for distributed influence among current and aspiring leaders, and for enabling arrangements that can help ‘ordinary lea...

Mobile health (m-Health) for diabetes management

Abstract: Diabetes is a major health challenge with a global impact regardless of age, country or economic condition. The increased prevalence of diabetes is reaching alarming levels. The necessity and urgency to find innovative care delivery solutions is becoming more important, particularly in the digital age. It is expected in the near future that more people with diabetes, especially the younger generations will be empowered by their smartphones and relevant mobile health (m-Health) innovations, to take more responsibility of their condition. Clinicians and healthcare providers are increasingly likely to assume the role of ‘navigators’ and ‘advisors’ rather than simply the medical gatekeeper for their patients. In this article, we describe the general architecture of current m-Health systems and applications for diabetes management. We also discuss the clinical evidence for impact from these important and innovative approaches to diabetes self-care and management and likely future trends in their usage. The latest statistics indicate that there are more than 1200 diabetes smartphone ‘apps’ and this area is growing exponentially in terms of ideas, technologies, devices and the associated industry. M-Health for diabetes care is now a major business stream for the medical device, mobile phone and IT telecommunication industries with high expectations arising from the potential benefits to be gained by both patients and healthcare providers. However, this potential has not yet been fully developed on the clinical side. This may be due to many factors including the reluctance of clinicians to engage with these technologies due to the lack of clinical evidence for their efficacy, poor adherence of people with diabetes to long-term use of these apps and the reluctance of healthcare funders to reimburse mobile diabetes.

Positive outcomes for homeless patients in UCLH Pathway programme

Abstract: Pathway is the leading homeless healthcare charity in the UK. Established in 2009 after an audit of homeless patient admissions data, a model for holistic management was developed with the aim of improving both health and social outcomes for this vulnerable group. There are now 10 teams in hospitals across the country, where in-hospital GPs and nurses hold multidisciplinary meetings to address the housing, financial, social and health issues of patients. We conducted an audit of Pathway patients between November 2014 and November 2015 to determine if patients experienced any reduction in A&E presentation, admission or bed days following Pathway care, and explored the factors that may have contributed to this. Reductions between 38–78% were seen in these parameters, where long-distance repatriation, food and clothing donation and accommodation arrangements were likely to have played a role. This article describes some of the actions undertaken by the UCLH Pathway team to ensure comprehensive and individual...

Structural barriers to implementing open innovation in healthcare

Abstract: For many decades, the pursuit of practicable service provision has been the fundamental goal of the NHS. This article explores ‘open innovation’ as an existing force within the NHS management structures and examines the possibilities of adopting it as a tool for optimisation and strategic development. Within this context, it explores the uniformities, barriers and inconsistences that can be encountered within an innovation cycle. The authors consider the different forms of change, which are supported by appropriate innovation, as adapters that could reinforce an outcome in a favourable way. The article concludes that properly managed innovations can provide the framework necessary to better support healthcare delivery. However, importantly, it is the underpinning flexibility that allows implementation of effective solutions.

Growth in NHS admissions and length of stay: A policy-based evidence fiasco

Abstract: • Acute beds occupied at midnight in England have barely reduced over an 18-year period • Genuine overnight stay admissions (excluding 0 day stay) are roughly static, however this underestimates real demand due to a rapidly growing inpatient waiting list • Length of stay for ‘real’ overnight stay admissions is increasing not decreasing • Same day stay admissions (excluding day case) are showing high growth especially in medicine • Day case admissions in most specialties are showing high growth, except in the surgical group which has shown no growth since 2011/12, probably due to insufficient capacity • Plans to reduce bed numbers in the Sustainability and Transformation Plans (STPs) are seriously flawed

Expatriate health professionals in the Saudi Arabia private sector

Abstract: This study aimed to identify the differences in job satisfaction levels among expatriate health professionals (EHPs) working in the Saudi Arabian private sector, the stressors affecting their job satisfaction, and the influence of those stressors on their turnover intention. A cross-sectional design was guided by Herzberg's Theory. A convenience sample of 204 expatriate doctors, nurses, and pharmacists in Saudi Arabia were recruited from the private sector. Data were collected from four urban hospitals in regions having 74% of the bed capacity in the private sector. A four-part instrument measured dissatisfiers, job satisfaction, turnover intention, and cultural unrest. The results showed that EHPs have moderate job satisfaction. There was a difference in job satisfaction levels in terms of profession and nationality. Stressors influencing job satisfaction support Herzberg's theory. There was a significant positive correlation between dissatisfiers and job satisfaction. Cultural unrest had a very weak pos...

Community based health insurance: A case study

Abstract: This study aims to analyse the progress of a community based health insurance (CBHI) scheme over a three-year period by comparing the results of this study to an earlier study. The data collection was implemented at the identical study sites to be comparable to the previous study outcome. Two logistic regression models were included in the study. One model aims to assess the accessibility of hospitalisation; whereas the other aims to assess the financial protection against catastrophic expenditure of using health services. All independent variables were derived from the Andersen behavioural model. It was found that the scheme has made good progress in fulfilling its initial objectives. The existence of a CBHI scheme is capable of enhancing accessibility to health services and providing financial protection against excessive expenditure.

Did austerity cause the rise in deaths seen in England and Wales in 2015

Abstract: Several recent studies have suggested that austerity led to higher deaths in England and Wales in 2015. There are several key observations that argue against this conclusion. A rise in deaths also occurred in Scotland, Wales and Northern Ireland where health and social care is integrated, and did not suffer the degree of austerity imposed on adult social care in England. In addition, there is no apparent relationship between local authority deprivation score and the increase in deaths in 2015. Furthermore, austerity cannot explain those local authorities which showed a reduction in deaths in 2015. Deaths across Europe likewise displayed a significant increase in 2015, which appears linked to events leading up to a spike in deaths in January 2015. This initiated ongoing effects on mortality and morbidity. Deaths also show on/off switching in all countries so far studied, and show additional diversity at sub-local government geographies. The single-year-of-age patterns in mortality observed in one of the st...

Impact of stress and work-family conflict on the mental well-being of physicians: mediation by job and career satisfaction

Abstract: The mental well-being (MWB) of physicians is important both for patients and for the physicians themselves, positively influencing their health and patient care. The current study was undertaken to clarify the impact of perceived stress (PS) and work–family conflict on the MWB of physicians. Two satisfaction-related variables, namely job satisfaction (JS) and career satisfaction (CS), were expected to mediate between these variables. Data were collected through a survey of 102 physicians. The results show strong correlations between all study variables. Job satisfaction and CS completely mediated the link between PS and MWB. These results highlight the importance of JS and CS in ensuring the MWB of physicians. If physicians feel satisfied and empowered, then PS will not impact their MWB. Directions for future research are discussed at the end of the paper. Organisations must enact measures to enhance the satisfaction levels of physicians by providing a supportive environment, opportunities for career grow...

Research Methods for Nurses and Midwives

Abstract: A review of Harvey M, Land L (2017) Research Methods for Nurses and Midwives: Theory and Practice. Sage Publications Limited, London

Which factors influence the pursuit of a career in surgery? A national undergraduate survey

Abstract: Background: Data from the UK's Core Surgery National Recruitment Office (CSNRO) indicates a downward trend in competition for surgical training posts. This national undergraduate survey aims to evaluate the factors influencing UK medical students' decisions to pursue surgical careers. Method: A web-based survey was distributed by email to UK medical schools via their medical school administration and undergraduate surgical societies. Results: Of the 137 students that responded, 100 (73.0%) stated that they were interested in a career in surgery – 62 students were considering this as their first choice specialty. The main reasons for choice of career were longstanding interest, exposure to the job environment and working environment. Reasons students were not considering a career in surgery included surgeons' attitudes, job competition and limited opportunities for learning in theatre. Anatomy teaching, basic surgical skills teaching and attendance at surgical society events increased the likelihood of pur...

Facilitating informal learning in nursing

Abstract: This article highlights the critical importance of facilitating and sustaining informal learning in healthcare settings and discusses how distributed leadership can promote the ongoing collaboration required to enhance the way informal learning is cultivated and existing knowledge and experiences are shared. This article poses a number of challenges to traditional leadership and learning processes and highlights the critical need for more empirical research in this area.

Modern management in acute wound care

Abstract: Your skin is your body's largest organ, which when breached leads to a number of biological activities aimed at restoring normal function. Acute wounds heal spontaneously as a result of these biological functions, while those wounds stuck in a healing phase are referred to as chronic. An average Clincal Commissioning Group managed 11 200 wounds in 2012, which is set to grow to 23 000 by 2019. This article examines how wounds are classified into a common language, and collates a number of key challenges to UK healthcare managers juggling budgets with patient outcome. This includes the Commissioning for Quality and Innovation targets, Clinical Evaluation Team and the importance of measuring the true cost of care rather than unit cost alone.

Establishing face validity of the EPLIT questionnaire

Abstract: Health systems worldwide face continued pressure to produce high-quality, sustainable care. Lean management (developed in manufacturing to increase flow and reduce waste) is increasingly used by managers to improve processes, empower frontline workers and create a culture of continuous improvement. The Employee Perception to Assess Lean Implementation Tool (EPLIT) for manufacturing was developed at the The University of Alabama in Huntsville in the USA (based on five Lean Principles established by Womack and Jones), to enable managers to measure their employees' understanding and engagement with lean implementation. In this study, we adapted the EPLIT for healthcare, translated into Portuguese and established its content validity. The tool was then translated from Portuguese into English. This study also established content validity in the UK and USA. Quantitative and qualitative analysis revealed three issues related to the questionnaire: an inadequate healthcare vocabulary, doubts about lean terminology...

Developing and implementing a virtual clinic for follow-up of major joint arthroplasty in the NHS

Abstract: Introduction: Virtual clinics whereby patient information is collected remotely and then reviewed by specialists in a central location have been used previously in remote areas for ophthalmology services with good acceptability noted for patients. With removal of a face-to-face consultation efficiency for services can improve allowing focus of services where it is most needed. This is critical in orthopaedic services where, in 2014–15 over 7.5million outpatient appointments were scheduled. Methods: We introduced a virtual clinic for all major joint follow-up in our trust with patients sent ‘patient reported outcome measures’ (PROM) and invited to attend for radiology at local centres with results reviewed centrally. We then assessed reply rates and the numbers requiring normal outpatient review to assess the benefit of the virtual clinic service. Results: Over a 10-week trial period, 151 patients were eligible for virtual clinic review. Sixteen (10.6%) did not reply, although 14 of these patients had atte...

The benefits of using an online ordering service to improve efficiency in wound care services

Abstract: ONPOS is an online non-prescription ordering service (ONPOS) provided by Coloplast that enables formulary wound dressing products to be purchased from a variety of supply routes without needing a prescription or paperwork. ONPOS has been available for over a decade and is currently used in over 30 trusts throughout the UK. This article presents the need for improved access to wound dressings in the community, and outlines the proven benefits of adopting ONPOS, including reduced dressing wastage, instantly accessible dressing stock, improved formulary compliance and more appropriate use of dressings. Using ONPOS also provides real-time data that enables tracking of product usage and spend which can then be used to inform decision-making and promote a cost-effective culture within the organisation.

Pressure ulcers: Prevention and management

Abstract: This article provides an overview of pressure ulcers. It explores the current burden of pressure ulcers, outlining the current costs to the NHS, and also discusses the current challenges in how they can be effectively prevented and managed.

Combined phacovitrectomy in the UK: A lean perspective

Abstract: Background: Cataract formation is the most frequent complication associated with pars plana vitrectomy (PPV). A growing trend has emerged for surgeons to perform combined phacovitrectomy rather than a two-step approach, even in the absence of cataract. We performed a financial analysis of combined phacovitrectomy for epiretinal membrane (ERM). Methods: Patients who underwent phacovitrectomy for ERM over a three-year period were included in the study. Operating time and cost of theatre time per minute was assessed. Univariate sensitivity analysis was performed to examine the sensitivity of our findings to changes in case duration. Results: Combined phacovitrectomy was performed on 55 eyes. Theatre cost per minute was £14.91 (in addition to £197.49 surgical pack prices). The mean operating time for phacovitrectomy was 48 minutes (range 23–77 minutes) and mean theatre cost was £909 (range 540-1346). The average income for the hospital per combined phacovitrectomy was £914. The conclusion that combined phacov...

Is the weekend mortality effect real

Abstract: Rod Jones looks at weekend mortality, same day emergency admissions and other awkward issues