The NHS in the UK has recently adopted a new Performance Assessment Framework (PAF), aiming to provide a broader view of performance within the NHS The PAF is not only a multi-stakeholder approach reflecting various stakeholders' interests across six dimensions, but is also used by the Government as a strategic management tool to ink national strategies with local operation activities. The Government claims that the PAF is a "balanced scorecard" approach This study discusses the concepts of the BSC underlying the NHS PAF.
Health sector restructuring has been in vogue, but no country has engaged in as much health sector restructuring as New Zealand where, in a decade, there have been four different public health sector structures. This article discusses New Zealand's four structures with an emphasis on relocating the critical functions of health care planning and purchasing, and on the development of the present district health board system. The four structures include: an area health board system (1989-1991) with planning and purchasing located at "home" in local areas and closely aligned with service provision; a competitive internal market system (1993-1996) which separated planning and purchasing from service provision; a centralised system with a "headquarters" controlling planning and purchasing (1997-1999) while maintaining the distance from provision; and the district health board system currently under development (1999-) which sees purchasing and planning sent home again to regions and linked closely with service provision. The present system entails the devolution of considerable responsibility to the local level, within a framework of strong central government control. Based on New Zealand's experience, the article notes that all but the market structure appear to have provided an adequate environment for effective health care planning and purchasing.
This paper presents the findings of a qualitative study, based on interviews with over 130 nurses and midwives in four London Trust hospitals on: the main factors influencing nurse satisfaction and retention; empirical support for the robustness of a conceptual framework or model "the nurse satisfaction, service quality and nurse retention chain"; and some managerial considerations for recruitment and retention. The three main factors influencing job satisfaction were patients, the inherent characteristics of nursing and the nursing team; the two main sources of job dissatisfaction were staff shortages and poor management and amongst nurse retention strategies improving working conditions was more important than increased pay. For recruitment, as well as retention, improving the image and reputation of nursing along with improvements in work-life balance were pre-requisites for meeting the challenging target of an additional 20,000 nurses on the wards by 2004.
This paper introduces the concept of the emotional climate of the workplace and explores how it both shapes and is shaped by the emotions experienced, expressed and redefined by nurses. It extracts emotional aspects of an organizational climate framework developed by Litwin and Stringer and examines these with respect to nurse's experiences. The primary research was carried out at a general hospital NHS Trust in the East Midlands of the UK using a grounded theory methodology. The research methods included semi-structured interviews and observation. The themes identified include many of those found by Litwin and Stringer, others which represent variations upon these, and a new set, which, when combined, identify the emotional climate of the organization. The findings have confirmed that the "experiment" of using a 33-year-old positivistic framework to investigate aspects of qualitative research has enabled a robust contribution to the conceptual area of emotional climate.
Describes part of a wider evaluation exercise undertaken to assess the impact of the introduction of a picture-archiving and communication system (PACS) on the adult intensive care unit (AICU) at the Royal Brompton NHS Trust in London. The objectives of this research were to evaluate the perceptions of PACS of the medical and ancillary staff working within AICU as well as to undertake a preliminary assessment of its impact on the workload of radiographers. Questionnaires, interviews and a process analysis were undertaken. The research findings indicate that the overall perception of staff towards the introduction of the PACS was positive. The impact of the system on the workload of radiographers was significant, reducing the time taken to obtain an image from 90 to 60 minutes. However, lessons to be learned for future PACS implementations include the need to ensure compatibility with existing IT systems, adequate IT support and initiatives to ensure that the benefits of PACS are communicated to the hospital at large.
After briefly describing self-managed integrated community teams, the authors explore potential and actual methods of evaluating their structures, processes and outcomes. Primary health care staff in three comparable sites were studied using non-participant observation, interviews, focus groups and questionnaires. After describing the fieldwork, the authors examine integrated team structures, which are characterised by a large number of barriers that integrated teams face. Processes surrounding different working practices are explored next. Ways of unifying health care professional practice in integrated teams are suggested using evidence from both the literature and fieldwork. Outcomes that emerged after one year of the new teams' lives are discussed in detail. The difficulty in establishing acceptable outcomes, especially the validity and reliability of outcome measures, is considered. Throughout, the positive and negative aspects of integrated teams emerging from the fieldwork are compared and contrasted with issues in the literature. Finally, recommendations are made to help strengthen integrated teams in the UK.
The NHS in England has developed a strong focus on clinical and managerial leadership. The article describes both emerging ideas on leadership models and approaches to developing leaders as a background to the description of two evaluation studies of leadership programmes for executive directors and the lessons learned for the future.
More GPs are needed, but there are concerns about retaining the existing workforce quite apart from recruiting new doctors. This survey of GP principals in the Northern deanery aged over 45, identified factors potentially encouraging them to take early retirement (before 60) or to work on beyond 60. Over a third of those with retirement plans intended to retire early. Perceived undesirable changes in the NHS and workload were the main factors influencing intentions to retire. Reducing hours and administrative duties, and improving managerial support were factors that may encourage later retirement. Financial incentives in the form of increased pensions were most attractive to those already planning later retirement. A total of 35 per cent scored above threshold for significant psychological distress, and the higher psychological distress the earlier GPs wanted to retire. Interventions encouraging later retirement should be targeted at reducing workload and administration. Interventions to reduce stress could also encourage later retirement.
In their conceptualization of the principal/agent relationship, Jensen and Meckling were not referring to a knowledge worker (KM) agent. Agency theory is extended to the context of a KW agent to identify a key role for IS/IT in facilitating the monitoring function. To test this, the dynamics of a critical principal-KW agent relationship in the health-care industry are investigated It is demonstrated that IS/IT goes beyond just alleviating the agency problem to enabling the KW agent to perform "self-monitoring". The results are significant for health care, agency relationships and the use of IS/IT with knowledge workers.
Inequality and exclusion are characteristic of the experience of UK South Asian communities. In health care, community needs are often not addressed by health and social welfare services. An increase in cultural competency is now part of identified policy. The aim of this paper is to examine the extent to which there is evidence of cultural competency amongst professionals concerning South Asian parents caring for a person with cerebral palsy. Semi-structured interviews were conducted with respondents from 19 service organisations. Results are presented on perceptions of service delivery and on the dynamics of service development: evidence is found that inadequate service delivery continues despite professional knowledge that it exists. Conditions necessary for the achievement of cultural competence are discussed. We suggest that service development to meet the needs of South Asian carers must form part of an overall strategy geared to change at different levels within and outside service organisations.
Enterprise resource planning (ERP) systems provide organizations with the opportunity to integrate individual, functionally-oriented information systems. Although much of the focus in the popular press has been placed on ERP systems in large for-profit organizations, small hospitals and clinics are candidates for ERP systems. Focusing information systems on critical success factors (CSFs) allows the organization to address a limited number of areas associated with performance. This limited number of factors can provide management with an insight into dimensions of information that must be addressed by a system. Focuses on CSFs for small health-care organizations. In addition, also considers factors critical to the implementation of health-care information systems. Presents two cases. The results indicate support for the continuing use of CSFs to help focus on the benefits of ERPs. Focusing on groups of tangible and intangible benefits can also assist the rural health-care organization in the use of ERPs.
Current policies and practices concerning speech and language therapy provision in schools are reviewed and issues which remain to be addressed are considered A general move to cross-sector approaches has resulted in a move to indirect therapy through assistants, and the effectiveness of this requires to be established. Funding streams for therapy differ across the UK, and despite extensive research and policy development remain somewhat unclear and vulnerable. The implications for policies on 'joined up thinking" are considered.
This study seeks to determine the relative importance of factors non-profit hospital administrators rely on in their decisions to join a non-profit multihospital organization (MO) and their assessments of an MO in satisfying these motives. A related objective of the study is to determine whether or not the administrators of different types of hospitals (i.e. general vs specialty, member of a national vs non-national MO and church-affiliated vs non-church affiliated) differ in their judgements. The analytical framework of the importance-performance technique is used in analyzing the data gathered from the top administrators of a nation-wide sample of hospitals in the USA. Results and implications of the study are discussed.
Modern NHS organisations are seen to be increasingly reliant, in terms of achieving improvements and service targets, on the efficient provision of information to enable clinical, administrative and managerial decision making. A key barrier to effective ICT introduction in NHS trust hospitals has been identified as the complex social, organisational and political issues endemic within the organisation, preventing true discourse amongst key stakeholders. This paper describes how the adaptation of critical social theoretical thinking may be used to develop an innovative approach to participative process and information flow modelling. This approach is used within a hospital trust to investigate its potential as a precursor to ICT procurement and development. Empirical results of the research are described with suggestions for a more informed approach to ICT introduction, leading to a re‐examination of issues concerning: historical context, emancipatory practice and the role of the systems analyst.
High turnover amongst middle managers in organisations can lead to strategic instability as well as operational issues. Since the advent of the NHS internal market flatter management structures have led to middle managers being given more responsibilities along with larger spans of control. This has exacerbated the consequences of the high turnover found amongst service managers. This study examines the relationship between the length of time service managers wish to stay with their organisation, their participation in decision making in directorates, the feedback they receive and their perception of feeling valued. It outlines the findings from a small study and discusses the implications for health trusts.
This paper reports a national study which investigated the involvement of infection control professionals in (and their views about) the formal processes of contracting for health care in the NHS internal market. Health care professionals needed to be involved contracting, if it was to be effective. The study found that many infection control professionals were not, in fact, involved in contracting, while the importance of both contracts and informal professional networks were recognised But respondents did not think that their professional networks entirely compensated for their lack of involvement in contracting. As formal agreements continue to be central to achieving quality of care in the post-internal market NHS, infection control professionals need to be involved in specification and implementation of these arrangements.
The orthopaedic trauma session is almost universally adopted as a means of coping with non-elective orthopaedic demand Here patients who can be stabilised are treated in a weekday planned theatre session. It allows for greater consultant involvement and a reduction in out-of-hours operating. The utilisation of trauma theatre time is typically low. However, there is an opportunity to make better use of this time by including some "deferrable elective patients" in the session. These are elective patients who have been offered earlier treatment in return for accepting the possibility of postponement, if the trauma demand on the day of the appointment is high Simulation of patient demand was used to explore the balance between maximising the utilisation of the theatre sessions, avoiding too many overruns and ensuring a reasonable quality of care in a typical hospital in the UK.
This commentary surveys the current arguments for and against modifying the work of doctors and nurses by placing the main viewpoints - substitution and diversification - within the policy background, particularly that of the UK. We discuss the forces for modification: cost effectiveness, professional development, quality improvement and pragmatic management and how each provides a stand-point for evaluation of the issues. Policy makers and managers in the health sector should be aware of the rather fragmented evidence base for doctor-nurse substitution and should consider skill mix changes only when they are clear about: purpose, evidence base, acceptable risks, accountability and quality assurance. Doctor-nurse substitution is not necessarily cost effective, nor is it unfailingly a gain in nurse professionalism or in quality of care. Of the management perspectives available - advocacy, skepticism or pragmatism - the current evidence and policy base favours pragmatism over evaluations of the rightness or wrongness of a general policy.
