In today's rapidly evolving health and care landscape, it is almost certain that healthcare managers will be asked to lead, or at least be involved in, making a change at some point in their career. Business change manager Callum M Brown explains why there is often a mismatch between frontline staff and managers’ perspectives on change, and ways that managers can reduce change resistance in their teams.
Natural language processing could help to tackle delayed diagnosis in dementia care, allowing more patients to access services during the ‘intervention window’, but implementation has been slow. Ellie Koseda explores barriers to adoption of this technology and other AI-based tools, including fragmented care pathways, limited interoperability and ongoing governance concerns.
Doctors commonly report poor work–life balance, sleep deprivation and inadequate rest and recuperation facilities at work. NHS doctors are typically required to fund and voluntarily manage their own common rooms, known as ‘doctors’ messes’. A three-phase project was undertaken to improve the management of a doctors’ mess at an NHS hospital in England. In phase one, five improvements were made to financial and procurement operations to increase annual cash flow by 85.5%. This allowed for a further 20 improvements to be made, in phase two, to the facilities and services in the mess. These included 24/7 provision of hot food, a coffee bar, sponsored lunches, social events, entertainment and personalised clothing. In phase three, the project was evaluated using a digital staff survey to measure satisfaction with the changes through both Likert-style and free-text questions. A follow-up survey was then conducted 1 year later to assess the sustainability of the changes made. In the first survey, 94.8% of staff scored the mess facilities with the highest satisfaction score of 5/5, with a mean score of 4.93/5.00. However, in the follow-up survey this had fallen to 2.04/5.00, with over one-third of respondents stating that none of the improvements had been maintained. This project demonstrates that meaningful changes can be made to doctors’ mess facilities to improve staff rest and wellbeing. However, it also highlights the need for continuity in management; ideally, doctors’ messes should be managed and funded by NHS leadership.
Patient safety and avoidable harm represent an ongoing struggle for the NHS. In this article, Bruce Sheppy argues that this is a result of politicised strategy in the healthcare system, whereby institutional layering, blame attribution and power dynamics have made harm a predictable systemic outcome.
With the healthcare workforce under growing pressure, this article highlights the need for intraprofessional collaboration in healthcare education. Drawing on learning from an innovative international project, the authors explain how this approach can benefit both learners and clinical colleagues.
In April 2024, legislation was introduced to ensure that inpatients and care residents in the UK can be visited by loved ones. To see how this was affecting practice, Charlotte Whittaker visited five NHS hospitals in England, describing the benefits of, and barriers to, flexible visiting in these settings.
Background/Aims Job satisfaction has been associated with improved doctor wellbeing and patient experience, and could help to address staff turnover challenges. This study aimed to measure job satisfaction among anaesthesiology non-consultant hospital doctors (NCHDs) in a tertiary referral hospital, and explore the impact of motivators and hygiene factors. Methods An exploratory cross-sectional mixed-methods design was used, underpinned by Herzberg's two-factor theory, which conceptualises motivators as intrinsic factors that generate job satisfaction, and hygiene factors as extrinsic factors that prevent dissatisfaction, but do not independently produce satisfaction. Questionnaires were distributed to NCHDs to measure intrinsic, extrinsic and overall satisfaction, motivators and hygiene factors. Quantitative data were analysed using descriptive statistics and multiple regression analyses to assess relationships between variables. Free-text responses were analysed thematically. Results Among the 26 respondents, overall job satisfaction was relatively high (mean=68.65/100). Male participants reported higher satisfaction levels than female participants. Contrary to Herzberg's theory, both hygiene factors and motivators significantly influenced satisfaction. Qualitative findings revealed positive perceptions of coworkers and the work itself, while reported challenges included under-staffing, high workload, lack of rest days and administrative issues. Conclusions There is a need for comprehensive approaches to improving job satisfaction among NCHDs, tackling extrinsic issues such as workplace conditions and teamwork, while also supporting individual wellbeing. Implications for practice Addressing hygiene (extrinsic) factors and fostering intrinsic motivators could enhance job satisfaction among healthcare professionals. Potential differences in job satisfaction based on gender warrant further study, and suggest the need for tailored strategies.
Background/Aims In 2021, the Welsh Nursing Care Record (WNCR) was introduced as the first digital nursing record system in Wales. This evaluative study aimed to explore the experiences of nurses of the implementation process and use of this electronic health record system. Methods This mixed-methods design involved six of the 10 hospital sites that had taken part in the implementation of the WNCR in one health board in Wales. All nurses working in wards where the WNCR had been implemented were invited to participate in a 32-item survey, comprising open and closed questions. Respondents were asked to volunteer to participate in semi-structured interviews to discuss their experiences in more depth. Quantitative data were analysed descriptively while qualitative data were analysed thematically. Results Of the 86 survey respondents, most had completed the training offered by the internal implementation team. Negative experiences with the WNCR were mostly related to IT and hardware issues, such as slow log in processes and lack of available devices. In both the surveys and interviews, improved quality of records was noted as a key benefit for the WNCR, while challenges included other areas of nursing care not being included in the digital system, and the issues related to running paper-based and digital systems in parallel. Conclusions Nurses’ experiences of the WNCR in its early stages were mixed, but most participants reported benefits, including improved care record quality. Training and support during implementation emerged as an important factor, while IT issues and the interface with other paper-based systems were key frustrations. Implications for practice When undertaking digital change, a training needs analysis should be considered in order to understand existing digital skills and support needs among staff. Communication and collaboration with clinicians and other stakeholders is also crucial throughout the process, from inception to launch, and through ongoing integration.
Late discharges in cardiology inpatient units contribute to patient flow inefficiencies and poor patient outcomes. The authors conducted an interventional quality improvement study in an Australian cardiology inpatient unit over the course of 1 year, aiming to reduce the frequency of late discharges, defined as those that occur after 12:00 pm. Baseline mean discharge times were calculated over 1 month to identify causes of delays, then new departmental policies were created and implemented to improve discharge times, using the plan-do-check-act framework. Discharge outcomes were reassessed at 1 and 6 months post intervention. Key reasons for delayed discharge included delayed ward rounds and paperwork, or the requirement of review from another faculty. Interventions included formalising ward round commencement times, optimising discharge planning and enabling junior staff to more readily enact discharges. At 1 month post intervention, there was a significant reduction in the median discharge time of 87 minutes (95% CI 11–134 minutes, P <0.01). This was sustained at 6 months, with an 80-minute reduction compared to baseline (95% CI 23–130 minutes, P <0.01). This indicates that targeted interventions can improve discharge efficiency in cardiology inpatient units, enhancing patient flow and operational performance. This framework could potentially inform similar initiatives in other settings.
This article constructs a theory of tactical command based on the lived experience of individuals in NHS tactical commander roles, including the concerns they had and how they sought to address them. Building on research into sudden-onset incidents in NHS hospitals, seven components of managers' response (navigating an unfamiliar landscape; lack of preparedness; absorbing accountability; effecting cultural change; seeking reassurance; constructing a single version of the ‘truth’; and challenging previous assumptions) are placed within the context of hospitals as complex adaptive systems responding to crisis. This centres around the concept of taking responsibility for the organisation, with a focus on patient, staff, hospital and public safety. This role requires tactical commanders to undertake boundary identification, interface management and consequence mitigation. Suggestions are made about how this theory and the associated insights into organisational complexity could contribute to training for tactical command and to understanding the effectiveness of hospital responses to a sudden-onset incident.
The gap between research and practice is a longstanding issue for the NHS, with knowledge mobilisation and ‘knowledge brokers’ stepping in to help bridge this divide. This article explores the potential benefits and risks of digital technologies, including artificial intelligence, in building collaborative, safe and evidence-based healthcare practice through knowledge mobilisation.
Background/Aims Employee relations processes are established to ensure that conflicts are managed in a fair, equitable and consistent manner. This semi-quantitative and qualitative study aimed to explore the experiences of NHS staff members involved in formal employee relations processes in an ethnically diverse trust, to inform potential interventions to reduce or eliminate avoidable harm in these processes. Methods This service evaluation used a survey and semi-structured interviews to collect data from employees at one NHS trust. Participants included those who: had made formal complaints about colleagues; served as witnesses to a formal investigation; participated in a formal investigation as the case investigation officer or case commissioning officer (case manager), or chaired the panel of a formal disciplinary hearing. Data were collected using a semi-structured questionnaire, with free-text comment boxes attached to all questions. Semi-structured interviews were then conducted to explore this feedback further. Thematic analyses were conducted with interview data and survey free-text responses, while descriptive statistics were used to analyse quantitative data. Results A total of 33 staff members responded to the questionnaire, with 10 participating in the interviews. Seven themes emerged: lengthy processes and delays in timescales; lack of standardised processes and materials; lack of adequate administrative support; lack of timely and adequate communication; perceived lack of training; lack of support from human resources staff; and impact on staff members involved. Conclusions Findings from this study highlight the impact of employee investigations on individual NHS staff members. The results indicate potential changes that could be made to improve the experience of staff involved in these processes, to minimise or eliminate avoidable harm in future. Implications for practice Improving employee relations processes would likely require dedicated resources, better time management and provision of psychological support for all staff members involved, where needed. Timelines should be reviewed to define an acceptable and achievable time period for these processes. Changes should be co-designed by all stakeholders, using evidence-based frameworks.
Out-of-area mental health placements can be isolating and distressing for patients, impacting outcomes. In this article, Shirley O'Keeffe describes strategies implemented by NHS services working towards the UK government's goal of eliminating inappropriate out-of-area placements in adult mental health care.
Background/Aims Telephone calls are a key method of hospital communication, both with patients and other healthcare services. This study aimed to assess the time required for telephone calls to be routed through NHS switchboards to hospital wards in England. Ear, nose and throat (ENT) wards were selected as a focus, as this specialism is present in most acute NHS hospitals. Methods A total of 20 randomly selected NHS hospitals (10 university and 10 district general hospitals) in England were included. Telephone calls were made to the main switchboard of each hospital, then transferred through to the ENT ward. The process was timed from the moment the phone began to ring until the call was answered by the switchboard and subsequently by the ENT ward. Each call was capped at a maximum duration of 20 minutes. Call features were recorded, such as the presence of pre-recorded messages, options to enter an extension number and the use of an interactive voice response system. Results The average switchboard response time was 84.50±35.63 seconds in university hospitals and 108.00±37.95 seconds in district general hospitals. The average time for calls to be transferred from the switchboard to the ENT ward was 213.50±151.84 seconds in university hospitals and 206.50±55.88 seconds in district general hospitals. Three ENT wards did not answer calls routed through the switchboard within 20 minutes. Conclusions There are substantial delays in telephone call response times in NHS hospitals, which could have serious implications for communication and patient care. This highlights the importance of regular audits of NHS telecommunications. Implications for practice Increased staffing levels and the implementation of technological aids could help to increase the efficiency of hospital telephone systems and reduce response times. Automated messages should be regularly reviewed to ensure that they remain relevant and concise.
With the NHS Staff Survey consistently highlighting unacceptable levels of workplace bullying and harassment, there is a clear need for change. In this article, the authors argue for urgent intervention that proactively targets the systemic causes of this behaviour.
Background/aims The COVID-19 pandemic and its aftermath has arguably exacerbated challenges relating to healthcare staffing on an international scale. This study aimed to explore the human resources (HR) challenges experienced by HR managers in private hospitals in India and how these had evolved following the pandemic. Methods A qualitative study was conducted, with data collected via in-depth interviews with 26 HR managers and hospital administrators across 13 hospitals in India. Reflexive thematic analysis was used to analyse the data and generate global, organising and basic themes. Results The global theme of human resources challenges emerged from the data, with seven organising themes: migration-driven staff attrition; fostering commitment; discrepancies between staff qualifications and practical competencies; training for hospital culture; increased staffing costs; back-to-back recruitment; and perceived lack of empathy and trust. Within these groups were 19 basic themes. Conclusions HR managers in private hospitals face a variety of challenges, several of which have been exacerbated by the pandemic and its aftermath. Recruitment and retention of sufficiently skilled staff members were particular areas of concern, alongside training and culture. Implications for practice Addressing HR management challenges will likely require holistic, proactive and targeted approaches to improve training, reduce staff turnover and meaningfully shape organisational culture.
Background/Aims Continuing professional development (CPD) is an evidence-based requirement for professionals working in healthcare systems across the world. In the last 10 years, several lower- and middle-income countries, including Jordan, have introduced CPD systems for licence renewal. This study aimed to assess healthcare professionals’ knowledge, attitudes and practices regarding CPD, as well as perceived barriers to CPD activity completion and recommendations for improvement. Methods An online survey study was conducted with healthcare professionals from across sectors (government, private, educational, military and non-profit) in Jordan. A self-administered survey was used to collect data between December 2024 and March 2025. Knowledge and practices were measured using ‘yes/no’ questionnaires, while attitudes and barriers were measured using a 5-point Likert scale. An open-ended question was included for recommendations for improvement. Data were analysed using descriptive statistics, with one-way ANOVA used to assess differences between employment sectors. Results A total of 1002 healthcare professionals completed the survey. The mean knowledge score was 92% and the mean attitude score was 3.90 out of 5.00, indicating generally positive attitudes towards CPD. The most common CPD activity was attending local seminars (85.0%), while publishing articles was the least practised activity (44.9%). Some significant differences were found between employment sectors in terms of attitudes and perceived barriers. The two greatest barriers reported by participants were a lack of quality learning activities availability and family responsibilities. All barriers were rated ‘moderate’. Conclusions Healthcare staff demonstrated high levels of knowledge, fairly favourable attitudes and active engagement in CPD, but barriers to completing these activities exist. These findings can provide key insights for leaders and policy makers to improve the effectiveness of, and access to, CPD in Jordan and beyond. Implications for practice Development of a wider range of accessible CPD activities, including online delivery, with a digital platform to help healthcare professionals track and manage their hours, could help to increase engagement and improve perceptions of CPD. Financial costs to healthcare professionals also need to be considered.
This article aims to advance a hybrid model for integrating traditional healers into South Africa's private health insurance system, framing inclusion as both an ethical obligation and a strategic reform. Anchored in the National Health Insurance Act 13 of 2023 and informed by international precedents from Ghana and Vietnam, the model proposes regulatory councils, capitation-based reimbursement pilots, digital claims platforms and structured cross-training between traditional and biomedical practitioners. This analysis draws on cultural competency, epistemic justice and health systems strengthening frameworks, positioning traditional healers as de facto primary care providers who can alleviate strain on the public sector while addressing entrenched racial and geographic inequities in healthcare access. Although upfront costs for infrastructure and harmonisation may be significant, potential long-term returns in efficiency, care quality and community trust provide a compelling justification. This model contributes to wider debates on culturally inclusive universal health coverage by offering actionable strategies for aligning traditional healing practices with private-sector financing in pluralistic healthcare systems.
Waqas Akhtar argues that leadership and governance reform in the royal colleges and other professional bodies is urgently needed, with a strong emphasis on accountability and transparency, to ensure that medical professionals have a voice.
This article outlines a process improvement project conducted in an NHS trust to enhance the learner experience and outcomes of the functional skills qualification programme. This programme is a mandatory prerequisite for higher clinical apprenticeships at the authors’ organisation, and thus can pose a barrier to the career progression of the healthcare support workforce, which is integral to the NHS workforce plan. The project involved collecting both formal and informal feedback on training needs, learner experience and course outcomes in relation to the existing functional skills qualification programme. This article discusses the key themes identified from this work, placing them within the context of current literature and national policies. Ways in which uptake and outcomes have been improved are also outlined, alongside approaches to enhance stakeholder experience and increase career progression opportunities for the support workforce through the implementation of a structured approach to functional skills qualification support.
