The organizational implications of the role NHS Service Managers played in the quality process in the mid-1990s

AIM: It is the intention of this paper to highlight the problems associated with the organizational implications of the role NHS Service Managers (SMs) played in the quality process of the mid-1990s. BACKGROUND: To provide quality care all staff must be committed and involved, in this study it appeared that few SMs played a part in the process. METHODS: Semistructured taped interviews were conducted with 33 SMs and three Chief Executives in seven Trusts. As part of a study they were asked the role SMs played in quality in their clinical directorate. The data was transcribed and analysed in a content-analysis approach. FINDINGS: Quality of care was not the SMs' primary objective. The role played by SMs was dependent on their background, experience and the organization in which they worked. Most Trusts' quality-control strategy was not standardized, co-ordinated or integrated, nor was the audit process regulated. For most, quality was seen as synonymous with professions, managers from a non-professional background found the monitoring of the quality of performance inherently difficult. Only one Trust (the most successful) appeared to undertake organizational learning, influenced by the philosophy of the Chief Executive.     

Calman-Hine reassessed: a survey of cancer network development in England, 1999-2000

Rationale, aims and objectives The paper assesses preliminary national data on the development of cancer care networks in England. Methods In January 2000, a national postal survey was sent to lead clinicians at 36 cancer centres and associate centres. Respondents were asked to provide basic numerical data on the design of the network (i.e. its configuration), detailing how many units it encompassed, and whether the centre was a multiple or a single entity. Results The survey highlighted national variations in the size and configuration of networks. The survey also highlighted tentative signs of shifts in clinical practice. The results showed that consultants at cancer centres and units were engaging in two forms of collaboration across centre–unit boundaries. Type 1 involved routine multidisciplinary team (MDT) outreach from centres to units, incorporating joint planning between clinicians at cancer centres and cancer units. Type 2 collaboration involved joint planning but also promoted joint centre and unit training and continuing professional development (CPD) programmes. Conclusions In our estimation, both forms of collaboration represented early evidence of qualitative changes in medical working practices. Organizational changes within cancer services have moved swiftly since initial soundings were taken in 2000 and we update our initial commentary in the light of recent empirical data. The findings may be of wider significance to managers and health practitioners who are working towards the implementation of delivery network elsewhere in the UK National Health Service.     

Effects of Problem-Based Learning Curricula on Faculty Learning: New Lenses, New Questions

Literature on the impact of problem-based learning (PBL) in medical education has short-changed important questions about the effect of PBL curricula on faculty learning and on faculty knowledge of their subject matter. This paper opens up new questions about the impact of PBL in medical colleges and other health sciences by focusing attention on its effects on faculty learning, on collegial networks in medical colleges, and, consequently, on other scholarly work by faculty. A brief review of research on the effects of PBL on faculty and faculty development is followed by a synthesis of relevant research findings from research on teaching and faculty learning in other disciplines. A new conceptual framework, drawn from the educational paradigms, methods and empirical findings from those other areas of higher education research and research on secondary school teaching, is applied to designing, examining, and evaluating problem-based learning. Viewing faculty as learners prompts a new research agenda including questions such as: What do faculty members learn by participating in integrative, interdisciplinary problem-based learning courses? How? How is that learning related to or integrated with other aspects of their scholarly work?     

Further testing of the Mental Health Problems Perception Questionnaire

AIM OF THE STUDY: This paper reports a two-part study relating to the further psychometric development of the Mental Health Problems Perceptions Questionnaire. BACKGROUND: The instrument was developed and used originally in a study to investigate the role of district nurses in caring for people with mental health problems, who live in rural settings. It is underpinned by an explicit theoretical framework in which therapeutic commitment, role support and role competency are core concepts. DESIGN: A two-part study is described. Part One used a test-retest method to examine the stability of the instrument on repeated administration. Part Two examined the instrument's internal reliability and construct validity by calculation of Cronbach's alpha coefficients and exploratory factor analysis. RESULTS: Satisfactory internal reliability for a new instrument was demonstrated. Exploratory factor analysis supported the previously proposed theoretical framework. Significant correlations were demonstrated between the scales which constitute the instrument, thereby providing further evidence of construct validity. CONCLUSIONS: The Mental Health Problems Perceptions Questionnaire provides a potentially useful instrument in relation to future educational, clinical and managerial research.     

扁平化管理带来的医院文化创新

从上海市东方医院的发展历程上分析了医院处于高速发展阶段,其高信息平台、高素质人才是进行扁平化管理的条件,并从其流程再造、能本主义、学习型队伍、管理跨度等方面展示了扁平化思想对医院文化建设的创新。同时,作者指出了在这种思想下企业文化建设尚有员工定位模糊、诚信践诺等一些待改革的难点需要继续研究。     

Performance improvement based on integrated quality management models: what evidence do we have? A systematic literature review.

PURPOSE: Health care organizations have to improve their performance for multiple stakeholders and organize integrated care. To facilitate this, various integrated quality management models can be used. This article reviews the literature on the Malcolm Baldrige Quality Award (MBQA) criteria, the European Foundation Quality Management (EFQM) Excellence model (Excellence award models) and the Chronic Care Model. The focus is on the empirical evidence for improved performance by the implementation of interventions based on these models. DATA SOURCES: A systematic literature review from 1995 to May 2006 in the Pubmed, Cochrane, and ABI- databases was conducted. STUDY SELECTION: After selection, 37 studies were included, 16 in the Excellence award model search and 21 in the Chronic Care Model search. DATA EXTRACTION AND RESULTS OF ANALYSIS: Data were retrieved about the main intervention elements, study design, evidence level, setting and context factors, data collection and analysis, principal results and performance dimensions. No Excellence Award model studies with controlled designs were found. For the Chronic Care Model, one systematic review, one meta analysis and six controlled studies were included. Seventeen studies (2 in Excellence award model, 15 in Chronic Care Model) reported one or more significant results. CONCLUSION: There is some evidence that implementing interventions based on the 'evidence-based developed' Chronic Care Model may improve process or outcome performances. The evidence for performance improvement by interventions based on the 'expert-based developed' MBQA criteria and the EFQM Excellence model is more limited. Only a few studies include balanced measures on multiple performance dimensions. Considering the need for integrated care and chronic care improvement, the further development of these models for guiding improvements in integrated care settings and their specific context factors is suggested.     

In-patient suicide in psychiatric hospitals

OBJECTIVE: In-patient suicides continue to be a matter of concern in hospital psychiatry. In-patients at risk for suicide need to be identified. METHOD: In-patient suicides in two psychiatric hospitals were assessed over a time-span of 8 years. Cases were detected by comparing police suicide data with the hospitals' admission and discharge records. Further information was then gathered from patients' records. RESULTS: During the period under investigation 44 in-patients committed suicide, the majority of them being diagnosed with affective disorders (45.4%) or schizophrenia (27.3%). The most commonly used method was 'jumping in front of a vehicle' (34.1%); 79.5% were treated in an open ward at the time of their suicide, 15.9% in a locked unit. The majority of open ward suicides happened outside the hospital; 39.4% of patients had left the ward without giving notice. CONCLUSION: Additional cautionary measures are warranted especially for patients in open wards.     

Evaluation of Consumer Participation Demonstration Projects in Five Australian Drug User Treatment Facilities: The Impact of Individual Versus Organizational Stability in Determining Project Progress

This project evaluated consumer participation projects in five drug user treatment services in metropolitan and regional areas in three Australian states. Qualitative interviews were conducted with staff and consumers at two time points between from 2010 (n = 108). At baseline staff and some consumers focused on the stability of consumers to undertake representative roles. At postimplementation, the focus was on the stability of the organization, as frequent staffing changes and lack of adequate handover affected the progress of the projects. These issues combined with the perceived “noncore” status of consumer participation resulted in none of the projects achieving all of their agreed goals.