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Article
Publication date: 1 February 1998

Zafar Iqbal, Michael Clarke and David J. Taylor

Aim: To assess the potential for improved clinical effectiveness through the use of research‐based evidence in obstetric care. Design: A questionnaire survey to obtain…

Abstract

Aim: To assess the potential for improved clinical effectiveness through the use of research‐based evidence in obstetric care. Design: A questionnaire survey to obtain evidence about (i) the usage of reviews of controlled perinatal trials, and (ii) the attitudes of professionals towards the reviews and their practice, relating to 27 areas of clinical care addressed by the reviews. Subjects and setting: All doctors and midwives working in two teaching hospital maternity units (Units X and Y). Main outcome measures: The use of the reviews. For each of the 27 areas of clinical care, (i) whether a majority of professionals were in agreement with research‐based evidence, and (ii) how perceived current practice compared with research‐based evidence. Results: For most areas of clinical care (21/27 in unit X, 20/27 in unit Y) a majority of professionals agreed with the research‐based evidence. However, for a large proportion of these areas (16/21 in unit X, 12/20 in unit Y), practice appeared to be inconsistent with research‐based evidence. Conclusion: There is a considerable opportunity to improve clinical effectiveness, as in many of the areas of care examined professionals agree with research‐based evidence, but clinical practice appears to be inconsistent. The approach used in this study could be used to help develop practices for promoting clinical effectiveness.

Details

Journal of Clinical Effectiveness, vol. 3 no. 2
Type: Research Article
ISSN: 1361-5874

Content available
Article
Publication date: 18 December 2020

Maureen Alice Flynn and Niamh M. Brennan

While clinical governance is assumed to be part of organisational structures and policies, implementation of clinical governance in practice (the praxis) can be markedly…

Abstract

Purpose

While clinical governance is assumed to be part of organisational structures and policies, implementation of clinical governance in practice (the praxis) can be markedly different. This paper draws on insights from hospital clinicians, managers and governors on how they interpret the term “clinical governance”. The influence of best-practice and roles and responsibilities on their interpretations is considered.

Design/methodology/approach

The research is based on 40 in-depth, semi-structured interviews with hospital clinicians, managers and governors from two large academic hospitals in Ireland. The analytical lens for the research is practice theory. Interview transcripts are analysed for practitioners' spoken keywords/terms to explore how practitioners interpret the term “clinical governance”. The practice of clinical governance is mapped to front line, management and governance roles and responsibilities.

Findings

The research finds that interpretation of clinical governance in praxis is quite different from best-practice definitions. Practitioner roles and responsibilities held influence practitioners' interpretation.

Originality/value

The research examines interpretations of clinical governance in praxis by clinicians, managers and governors and highlights the adverse consequence of the absence of clear mapping of roles and responsibilities to clinical, management and governance practice.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 14 October 2019

Sine Lehn-Christiansen and Mari Holen

The purpose of this paper is to explore how clinical nurse education and nursing students’ care practices are shaped by different logics of care.

Abstract

Purpose

The purpose of this paper is to explore how clinical nurse education and nursing students’ care practices are shaped by different logics of care.

Design/methodology/approach

Inspired by Mol’s work on care, the paper explores care practices connected to the clinical education of nurses. The empirical data were generated from longitudinal, multi-sited ethnographic fieldwork among nursing students in clinical practice combined with follow-up interviews with the students and their supervisors.

Findings

The paper illustrates how three logics of care shape clinical education: the logic of relational care, the logic of care education and the logic of care production. The paper demonstrates how the logics unfold and entangle in everyday clinical education. On the one hand, care of patients based on the relationship between patient and nurse is highly valued. On the other hand, this logic is not institutionalized in the same way as practices induced by the logic of care production and the logic of care education.

Originality/value

The paper may be of value to scholars and practitioners in clinical education, as well as to health educational policy makers. The findings focus on paradoxes produced by conflicting logics in practice, thus offering new reflections and alternative sensemaking of well-known problems connected to clinical education.

Details

Journal of Organizational Ethnography, vol. 8 no. 3
Type: Research Article
ISSN: 2046-6749

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Article
Publication date: 1 February 2006

Keng Boon Harold Tan

Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG…

Abstract

Purpose

Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among practitioners so far would aid the understanding of factors influencing CPG compliance. This study seeks to provide this.

Design/methodology/approach

A general review and discussion of CPGs in areas of their attributes, benefits and pitfalls were carried out. Articles concerning the assessment of CPG compliance were also reviewed to understand the kind of data collected for such assessments (qualitative vs quantitative), the methods used to collect data (objective versus subjective), and the assessment measures employed (process versus outcome).

Findings

A total of 57 CPG compliance assessment studies were reviewed. Almost two‐thirds employed objective methods. Of the subjective assessments, 47 per cent analysed solely quantitative data, 32 per cent analysed solely qualitative information and 21 per cent analysed both. More than four‐fifths of all studies used process measures to determine CPG compliance and only 5 per cent used solely outcome measures.

Practical implications

Depending on the methods used, assessments can help identify various factors influencing CPG compliance. Such factors may be related to the physician, guidelines, health system or patient. A good understanding of these factors and their role in influencing compliance behaviour will help health regulators and administrators plan better and more effective strategies to improve doctors' CPG compliance.

Originality/value

This review looks at the various aspects of CPGs to understand how these influence practitioners' compliance.

Details

International Journal of Health Care Quality Assurance, vol. 19 no. 2
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 December 2001

Waleed M. S. Al‐Shaqha and Mohamed Zairi

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the…

Abstract

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualised patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients’ hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today’s health‐care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health‐care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.

Details

International Journal of Health Care Quality Assurance, vol. 14 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 16 November 2015

Ninna Meier

– The purpose of this paper is to explore how leadership is practiced across four different hospital units.

Abstract

Purpose

The purpose of this paper is to explore how leadership is practiced across four different hospital units.

Design/methodology/approach

The study is a comparative case study of four hospital units, based on detailed observations of the everyday work practices, interactions and interviews with ten interdisciplinary clinical managers.

Findings

Comparing leadership as configurations of practices across four different clinical settings, the author shows how flexible and often shared leadership practices were embedded in and central to the core clinical work in all units studied here, especially in more unpredictable work settings. Practices of symbolic work and emotional support to staff were particularly important when patients were severely ill.

Research limitations/implications

Based on a study conducted with qualitative methods, these results cannot be expected to apply in all clinical settings. Future research is invited to extend the findings presented here by exploring leadership practices from a micro-level perspective in additional health care contexts: particularly the embedded and emergent nature of such practices.

Practical implications

This paper shows leadership practices to be primarily embedded in the clinical work and often shared across organizational or professional boundaries.

Originality/value

This paper demonstrated how leadership practices are embedded in the everyday work in hospital units. Moreover, the analysis shows how configurations of leadership practices varied in four different clinical settings, thus contributing with contextual accounts of leadership as practice, and suggested “configurations of practice” as a way to carve out similarities and differences in leadership practices across settings.

Details

Journal of Health Organization and Management, vol. 29 no. 7
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 June 2001

Matthew J. Walsh and Neil Small

The experience of implementing clinical governance in Bradford South and West Primary Care Group illustrates how an emphasis on cultural change rather than on target…

Abstract

The experience of implementing clinical governance in Bradford South and West Primary Care Group illustrates how an emphasis on cultural change rather than on target setting, scrutiny and enforcement is both more consistent with the primary care context and more likely to create lasting improvements. The emerging focus on governance is reviewed and its implementation in one PCG via baseline assessment, strategic planning and innovative practice is presented. Linking clinical governance with a reduction in medical autonomy, as some commentators have done, does not allow for the complexity of power and responsibility characteristic of primary care. Alternative analytic models that draw on organizational theory and on sociology are offered.

Details

British Journal of Clinical Governance, vol. 6 no. 2
Type: Research Article
ISSN: 1466-4100

Keywords

Content available
Article
Publication date: 10 July 2017

Chenzhang Bao and Indranil Bardhan

The purpose of this study is to evaluate the determinants of health outcomes of dialysis patients, while specifically focusing on the role of dialysis process measures and…

Abstract

Purpose

The purpose of this study is to evaluate the determinants of health outcomes of dialysis patients, while specifically focusing on the role of dialysis process measures and dialysis practice characteristics. The dialysis industry is facing a major transition from a volume-based health care system to a value-based cost-efficient care model, in the USA. Under the bundled Prospective Payment System, the treatment-based payment model is subject to meeting quality thresholds as defined by clinical process measures including dialysis adequacy and anemia management. Few studies have focused on studying these two processes and their association with the quality of patient health outcomes.

Design/methodology/approach

In this study, the authors focus on identifying the determinants of patient health outcomes among freestanding dialysis clinics, using a large cross-sectional data set of 4,571 dialysis clinics in the USA. The authors use econometric analyses to estimate the association between dialysis facility characteristics and practice patterns and their association with dialysis process measures and hospitalization risk.

Findings

The authors find that reusing dialyzers and increasing the number of dialysis stations is associated with higher levels of clinical quality. This research indicates that deploying more nurses on-site allows patients to avail adequate dialysis, while increasing the supply of physicians can hurt anemia control process. In addition, the authors report that offering peritoneal dialysis and late night shifts are not beneficial practices in terms of their impact on the hospitalization risk.

Research limitations/implications

While early studies of dialysis care mainly focused on the associations between practice patterns and patient outcomes, this research reveals the underlying mechanisms of these relationships by exploring the mediation effects of clinical dialysis processes on patient outcomes. The results indicate that dialysis process measures mediate the impact of the operational characteristics of dialysis centers on patient hospitalization rates.

Practical implications

This study offers several managerial insights for owners and operators of dialysis clinics with respect to the association between managerial and clinical practices that they deploy within dialysis clinics and their impact on clinical quality measures as well as hospitalization risk of patients. Managers can draw on this study to optimize staffing levels in their dialysis clinics, and implement innovative clinical practices.

Social implications

Considering the growth in healthcare expenditures in developing and developed countries, and specifically for costly diagnoses such as dialyses, this study offers several insights related to the inter-relationships between dialysis practice patterns and their clinical quality measures.

Originality/value

This study makes several major contributions. First, the authors address the extant gap in the literature on the relationships between dialysis facility and practice characteristics and clinical outcomes, while specifically highlighting the role of clinical process measures as antecedents of patient hospitalization ratio, a key metric used to measure performance of dialysis clinics. Second, this study sheds light on the underlying mechanisms that serve as enablers of the dialysis adequacy and anemia management. To the best of the authors’ knowledge, this is the first study to explore these relationships in the dialysis industry. The authors’ approach provides a new direction for future studies to explore the pathways that may impact clinical quality measures in the delivery of dialysis services.

Details

Journal of Centrum Cathedra, vol. 10 no. 1
Type: Research Article
ISSN: 1851-6599

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Article
Publication date: 15 June 2015

Nomie Eriksson and Sandor Ujvari

Clinical governance and leadership concepts can lead to more or less successful implementations of new clinical practice. The purpose of this paper is to examine how Fiery…

Abstract

Purpose

Clinical governance and leadership concepts can lead to more or less successful implementations of new clinical practice. The purpose of this paper is to examine how Fiery Spirits, as institutional entrepreneurs can, working in a team, implement sustained change in hospital clinical practice.

Design/methodology/approach

This paper describes two case studies, conducted at two Swedish hospitals over a period of two years, in which changes in clinical practice were implemented. In both cases, key-actors, termed Fiery Spirits, played critical roles in these changes. The authors use a qualitative approach and take an intra-organizational perspective with semi-structured in-depth interviews and document analysis.

Findings

The new clinical practices were successfully implemented with a considerable influence of the Fiery Spirits who played a pivotal role in the change efforts. The Fiery Spirits persuasively, based on their structural and normative legitimacy and the adoption of learning processes, advocated, and supported change.

Practical implications

Fiery Spirits, given flexibility and opportunity, can be powerful forces for change outside the trajectory of management-inspired and management-directed change. Team members, when inspired and encouraged by Fiery Spirits, are less resistant to change and more willing to test new clinical practices.

Originality/value

The paper complements literature on how the Fiery Spirit concept aligns with concepts of clinical governance and leadership and how change can be achieved. Additionally, the findings show the effects of legitimacy and learning processes on change in clinical practice.

Details

Journal of Health Organization and Management, vol. 29 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 October 2000

Elisabeth Davenport

The difficulties of basing healthcare on literary warrant have been explained in different ways: busy practitioners have no time to read extensively, physical access is…

Abstract

The difficulties of basing healthcare on literary warrant have been explained in different ways: busy practitioners have no time to read extensively, physical access is difficult, and adequate surrogates for texts like indexes, abstracts, systematic reviews are partial in their coverage. The author suggests that a deeper problem of domain conflict must be addressed. This paper reviews problems identified in previous research on evidence‐based nursing practice, which indicates that there are conflicts between medical and nursing domains. EBM (evidence‐based medicine, or “text”) poses challenges for nurses (proponents of “caritas”). An additional surrogate for the medical corpus, the clinical guideline, is discussed. When based on inclusive consultation, this may prove to be a hospitable epistemological bridge for groups whose domains are in conflict. Drawing on “social studies of science” literature, the author explores the provenance and status of the clinical guideline as a “translation artefact” or bridging mechanism, and presents a “snapshot” case study of the Scottish Intercollegiate Guidelines Network in 1998. She suggests that the clinical guideline is a powerful documentary genre, which links several strands of information science: information retrieval, literary warrant and the politics of classification.

Details

Journal of Documentation, vol. 56 no. 5
Type: Research Article
ISSN: 0022-0418

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