The NHS Plan: nurse satisfaction, commitment and retention strategies.

The NHS Plan envisages a paradigm shift from a centralized, producer-led National Health Service (NHS) to a devolved, patient-centred health care service, fuelled by a substantial investment in human resources, beds, hospitals and infrastructure. The planned net increase of 20,000 nurses by 2004 is examined in the light of findings from a qualitative study of nurse satisfaction, commitment or intention to leave their hospital, nursing or the NHS, involving 124 nurses in four London hospitals. This paper presents nurses' perceptions and rankings of retention strategies and we compare these with the Plan's proposals. Lastly we propose an integrated approach to examining and dealing with the complex issue of nurse recruitment, retention and quality of patient care, based on a conceptual framework, the Nurse Satisfaction, Service Quality and Nurse Retention Chain, which highlights the scope of the challenges confronting the Plan, in both design and implementation of proposals designed to improve working conditions as a foundation for nurse recruitment and retention. Our principal findings are that just 57% of our interviewees may be viewed as 'core loyals' to the profession, 12% are serious in their intention to leave and the remainder may be sensitive to further deterioration in working conditions or a failure to meet expectations on pay. Such findings if realized clearly threaten the Plan's success.     

Healthy doctors, healthy communities

Promoting health and eliminating disease are goals of Healthy People 2010, a national initiative for all communities. Physician-directed interventions that advance these principles are most effective when directed by clinicians who regularly participate in such healthy behaviors themselves. This pilot study describes an 8-week intervention, "Well-being for You and Your Patients," for first-year medical students to experience health behavior change. In the 2-hour sessions, students set goals for changing health behavior in 6 dimensions of wellness; report their progress; and enjoy a 30-minute change-of-pace wellness activity. The authors recommend adapting the course for medical student alumni to facilitate health behavior change with small groups of adults, school-age children, teens, and elders in churches, schools, community health centers, and other community-based organizations. Through continuing medical education and Grand Rounds, residents and physicians in practice could also be trained to implement specific behavioral change strategies.     

A systems-in-transition paradigm for healthy communities.

WHO is generating a new approach to public health in many nations. In Canada the new public health has stimulated important innovations such as the Health Promotion Framework in Achieving Health For All and the Canadian Healthy Communities Project. There is a need, however, for a political theory of social organization and change to facilitate social and political analysis of communities. This article proposes a paradigm which organizes community using a structural-functional approach linked with process components addressing community change through development, stress and conflict. A new definition of a healthy community is proffered using the language of the model. The emerging political role of community health practitioners in the new public health is described.     

Modernisation. Fear of flying

Interviews with senior managers and clinicians involved in the national booking programme and cancer care collaborative found that scepticism, particularly among doctors, was a barrier to implementing change. Regular feedback and clear evidence of change emerged as key factors in persuading sceptics of the benefits of different ways of working. Getting sceptics on board can be a long process and time spent talking to them is not wasted. Consultants' support is key for endorsing change.     

The healthy communities movement and the coalition for healthier cities and communities

Part One of this article describes the principles and origins of the Healthy Communities movement. Part Two describes the Coalition for Healthier Cities and Communities, a national network of partnerships and organizations. The authors argue (a) that to sustain community initiatives, practitioners must move from projects that address symptoms of social problems to changing the underlying community cultures, incentives, and settings that give rise to these symptoms, and (b) that the Coalition's continued relevance depends on its ability to help leaders make that transition.     

Creating healthy communities,healthy homes,healthy people: initiating a research agenda on the built environment and public health

Mounting evidence suggests physical and mental health problems relate to the built environment, including human-modified places such as homes, schools, workplaces, parks, industrial areas, farms, roads and highways. The public health relevance of the built environment requires examination. Preliminary research demonstrates the health benefits of sustainable communities. However, the impact of mediating and moderating factors within the built environment on health must be explored further. Given the complexity of the built environment, understanding its influence on human health requires a community-based, multilevel, interdisciplinary research approach. The authors offer recommendations, based upon a recent conference sponsored by the National Institute of Environmental Health Sciences (NIEHS), for research and policy approaches, and suggest interagency research alliances for greater public health impact.     

Modernisation. The road to perfection

The Pursuing Perfection programme, piloted in four areas, lays down joint improvement strategies for directors of social services and NHS trusts. The programme dares to think what a perfect service would be like, and how it could be achieved. It uses the 'no needless...' formulation to eliminate risk.     

Checklist for healthy and sustainable communities

This paper describes a 10-point checklist for the planning and development of healthy and sustainable communities. The 10 domains in the checklist are essentially physical characteristics of places. Each domain has relevance to the health of people living in the place, and to the sustainability of the environment. The checklist is intended as a tool for those who plan, develop and manage urban environments. Such tools can be valuable for assessing the health and environmental impacts of decisions made by urban and transport planners, and businesses engaged in land development and infrastructure projects.