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Book part
Publication date: 28 May 2019

Joanna Kho, Andreas Paul Spee and Nicole Gillespie

This chapter advances understanding of how professional expertise is enacted and created to accomplish routines in the context of technology-mediated work. Information and…

Abstract

This chapter advances understanding of how professional expertise is enacted and created to accomplish routines in the context of technology-mediated work. Information and communication technologies broaden the participation of professionals with various specialist skills and expertise to accomplish work together, which is particularly salient in health care. Broadening participation, however, creates jurisdictional conflict among professionals. Thus, a key challenge of interprofessional work is the need to mutually adapt established professional routines and overcome jurisdictional conflict to perform interdependent routine tasks. The authors examine how professionals adapt established routines by analyzing the new interactions and interdependent actions required to accomplish technology-mediated geriatric consultation routines. The findings of this study show that professionals create new patterns of actions that are shaped by relational forms of professional expertise, namely selective and blending expertise. The findings and theoretical insights contribute to the literature on routine dynamics by highlighting the importance of relational expertise, and showing how it can transform and destabilize otherwise established professional routines.

Details

Routine Dynamics in Action: Replication and Transformation
Type: Book
ISBN: 978-1-78756-585-2

Keywords

Article
Publication date: 19 September 2016

Fatou Farima Bagayogo, Annick Lepage, Jean-Louis Denis, Lise Lamothe, Liette Lapointe and Isabelle Vedel

The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address…

Abstract

Purpose

The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives.

Design/methodology/approach

This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and informal discussions.

Findings

This study documents how two inter-professional networks were developed through professional agency. The findings show that the means by which networks are developed influence the form of collaboration therein. One of the networks developed from day-to-day, immediately relevant, exchange, for patient care. The other one developed from more formal and infrequent research and training exchanges that were seen as less decisive in facilitating patient care. The latter resulted in a loosely knit network based on a small number of ad hoc referrals while the other resulted in a tightly knit network based on frequent referrals and advice seeking.

Practical implications

Developing inter-professional networks likely require a sustained phase of interpersonal contacts characterized by persuasion, knowledge sharing, skill demonstration and trust building from less powerful professional groups to obtain buy-in from more powerful professional groups. The nature of the collaboration in any resulting network depends largely on the nature of these initial contacts.

Originality/value

The literature on inter-professional healthcare networks focusses on mandated networks such as NHS managed care networks. There is a lack of research on inter-professional networks that emerged from the bottom up at the initiative of healthcare professionals in response to clinical imperatives. This study looks at some forms of collaboration that these “grass-root” initiatives engender and how they are consolidated.

Details

Journal of Health Organization and Management, vol. 30 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 April 2001

Christina Victor, Ian Hastie, Georgina Christodoulou and Peter Millard

Despite the new ‘needs driven’ criteria for public funded admission to nursing homes, there remains concern that older people are entering such care inappropriately. However…

Abstract

Despite the new ‘needs driven’ criteria for public funded admission to nursing homes, there remains concern that older people are entering such care inappropriately. However, neither previous research or policy makers have sub‐divided such inappropriate entries into their constituent groups: those who are inappropriate because they are too independent and those who are inappropriate because they are too dependent. The aims of this study were to determine the extent of inappropriate nursing home admission amongst older people in nursing homes in six areas of England and Wales between 1995‐96. This was done through a retrospective case‐note review using a structured data‐collection pro forma. Although the study found no evidence of extensive inappropriate placement, extrapolation of these data suggests that 6,750 of those admitted to nursing care could have coped in a more independent environment. The inappropriately admitted group were more likely to have lived alone, be female, elderly and not to have seen a geriatrician. It is concluded that the most effective way to prevent such admissions would be to ensure the involvement of specialist geriatricians in the multidisciplinary team involved in admission decisions.

Details

Quality in Ageing and Older Adults, vol. 2 no. 1
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 1 April 1995

Gillian Craig

Describes how closure of hospital long‐stay wards for the frailelderly and their replacement by care in the community has led to amismatch of skills and patients. Restrictive…

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Abstract

Describes how closure of hospital long‐stay wards for the frail elderly and their replacement by care in the community has led to a mismatch of skills and patients. Restrictive practices within the medical profession, and rigid adherence to the existing referral system from general practitioner to hospital consultant can operate against the interests of patients in the community. Some means must be found to bring skilled medical care to patients in residential and nursing homes. If this cannot be achieved within existing NHS structures, local authorities and the private sector should consider appointing their own consultants to liaise with NHS personnel as necessary.

Details

Journal of Management in Medicine, vol. 9 no. 2
Type: Research Article
ISSN: 0268-9235

Keywords

Open Access
Article
Publication date: 4 December 2023

Mariona Espaulella-Ferrer, Felix Jorge Morel-Corona, Mireia Zarco-Martinez, Alba Marty-Perez, Raquel Sola-Palacios, Maria Eugenia Campollo-Duquela, Maricelis Cruz-Grullon, Emma Puigoriol-Juvanteny, Marta Otero-Viñas and Joan Espaulella-Panicot

Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of…

Abstract

Purpose

Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.

Design/methodology/approach

A real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.

Findings

The integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.

Originality/value

This case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

Article
Publication date: 12 March 2018

Loretta M. Isaac, Elaine Buggy, Anita Sharma, Athena Karberis, Kim M. Maddock and Kathryn M. Weston

The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers’ expert…

Abstract

Purpose

The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers’ expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery.

Design/methodology/approach

A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses (“specials”), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken.

Findings

There was a significant reduction in number of falls and number of patients allocated “specials” over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers (n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent.

Originality/value

Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 2
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 4 February 2014

Edward Britton and William Nash

The hip fracture “best practice tariff” (BPT) came into effect in April 2010. It advocated two key improvements: surgery within 36hrs of arrival in the emergency department; and…

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Abstract

Purpose

The hip fracture “best practice tariff” (BPT) came into effect in April 2010. It advocated two key improvements: surgery within 36hrs of arrival in the emergency department; and multi-disciplinary care directed by ortho-geriatrician from admission to discharge. The aim of this paper is to look at the 36 hours to operation target and its implications for orthopaedic department trauma service staff in a busy district general hospital, and to evaluate the measures implemented to meet the target.

Design/methodology/approach

Trauma-list data, collected from a theatre management system, was compared with trauma patients placed on elective and emergency lists, before and after designated daily trauma lists were implemented.

Findings

After a designated daily trauma list was introduced, a significant rise (from 56 per cent to 85 per cent) became evident in the proportion of patients operated on within 36hrs, between November 2010 to February 2011, while hip fracture cases managed on the elective list fell from 24 per cent to 17 per cent.

Practical implications

Despite adding a half-day trauma list, the trauma service has insufficient capacity to achieve the new BPT for all hip fracture patients in the hospital. Therefore, there is a significant knock-on effect for managing patient overspill on elective services. Will the significant changes in service provision designed to achieve this BPT be cost effective?

Originality/value

This paper aims to answer how busy department staff address an issue that professionals in every English hospital are facing.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 24 March 2011

Antony Bayer

Geriatric medicine is the branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness in older people. Rather than being defined by…

Abstract

Geriatric medicine is the branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness in older people. Rather than being defined by some arbitrary cut‐off in chronological age, it recognises that most older people, especially the ‘young‐old’, are in good health for most of the time. They are likely to benefit from standard medical management by generalists. Geriatricians focus on the more challenging patients ‐ those older people who are physically and cognitively frail, many of whom will be among the growing numbers of the ‘old‐old’. This population is characterised by non‐specific presentation of illness, functional dependency and a need for a multidisciplinary approach to care and judicious use of drug therapy. Drawing on publications from the department of geriatric medicine in Cardiff, this article illustrates important aspects of clinical care of older people and highlight the need for better recognition and prevention, better assessment and diagnosis and better therapeutic tools to manage acute and chronic illness in old age.

Details

Quality in Ageing and Older Adults, vol. 12 no. 1
Type: Research Article
ISSN: 1471-7794

Keywords

Article
Publication date: 9 December 2011

Paul Clarkson, Jane Hughes, Michele Abendstern, Caroline Sutcliffe, Sue Tucker, Ian Philp and David Challis

The purpose of this paper is to raise issues around the involvement of clinicians relevant to current policies for integrated care by reviewing a previous policy to integrate…

Abstract

Purpose

The purpose of this paper is to raise issues around the involvement of clinicians relevant to current policies for integrated care by reviewing a previous policy to integrate assessments.

Design/methodology/approach

This paper is a review of data from a survey of specialist clinicians' involvement in the single assessment process for older people.

Findings

The paper finds that clinician involvement was limited, with assessments not changing to a discernable degree and little involvement of older people. Changes to assessment were predominantly related to paperwork. However, the use of standardised tools by clinicians did increase. The use of shared record systems with social services was significantly associated with involvement.

Practical implications

Clinicians have previously not been engaged in policies around integrated assessments. Factors that can help engagement include development of a shared vision, drawing on the traditions of particular groups of clinicians in informing integrated assessment policies, and appropriate IT systems to promote information sharing. Factors hindering engagement include national policy implementation, viewed as inimical to clinical practice and low involvement by service users/patients.

Originality/value

Reviewing such previously implemented polices around integration, particularly at the assessment stage, offers lessons to learn in terms of the factors that may help or hinder the achievement of integrated practice, particularly regarding current policies around clinical leadership.

Details

Journal of Integrated Care, vol. 19 no. 6
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 8 July 2019

George A. Heckman, Lauren Crutchlow, Veronique Boscart, Loretta Hillier, Bryan Franco, Linda Lee, Frank Molnar, Dallas Seitz and Paul Stolee

Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance…

Abstract

Purpose

Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance should be a foundational element of an integrated system of dementia care. The purpose of this paper is to understand physicians’ and specialists’ perspectives on such a system and identify barriers to its implementation.

Design/methodology/approach

The authors used interviews and a constructivist framework to understand the perspectives on a quality assurance framework for dementia care and barriers to its implementation from ten primary care and ten specialist physicians affiliated with PCCMCs.

Findings

Interviewees found that the framework reflects quality dementia care, though most could not relate quality assurance to clinical practice. Quality assurance was viewed as an imposition on practitioners rather than as a measure of system integration. Disparities in resources among providers were seen as barriers to quality care. Greater integration with specialists was seen as a potential quality improvement mechanism. Standardized electronic medical records were seen as important to support both quality assurance and clinical care.

Practical implications

This work identified several challenges to the implementation of a quality assurance framework to support an integrated system of dementia care. Clinicians require education to better understand quality assurance. Additional challenges include inadequate resources, a need for closer collaboration between specialists and PCCMCs, and a need for a standardized electronic medical record.

Originality/value

Greater health system integration is necessary to provide quality dementia care, and quality assurance could be considered a foundational element driving system integration.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 6
Type: Research Article
ISSN: 0952-6862

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