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Article
Publication date: 1 February 1991

A.K. Szczepura

The future of pathology services in the NHS is currently underconsideration. Recent developments in diagnostic technologies and theirpossible impact on pathology testing in the…

Abstract

The future of pathology services in the NHS is currently under consideration. Recent developments in diagnostic technologies and their possible impact on pathology testing in the future are discussed. Trends and patterns of demand for all three main pathology specialties are analysed over the 12‐year period, 1974‐86. The inflation‐adjusted, revenue cost of pathology testing per hospital admission (excluding capital costs) is shown to have fallen in real terms over this period, although it is uncertain whether this would still be the case were capital costs to be included. In the hospital sector, reported increases in demand can be quite simply related to increasing hospital activity by using a linear regression model. However, the very large increases in demand observed in the primary care sector cannot be related reasonably to any routinely reported practice activity indicators. The implications of this highly volatile pattern of demand in general practice are discussed, especially in relation to recent technological advances designed to produce rapid, near‐patient, surgery‐based tests. Although analysis indicates no evidence for historical technology‐induced increases in demand for laboratory services following the introduction of laboratory automation in the 1970s, the possibility of technology‐induced demand in the primary health care sector following the widespread introduction of surgery‐based tests is discussed.

Details

Journal of Management in Medicine, vol. 5 no. 2
Type: Research Article
ISSN: 0268-9235

Keywords

Open Access
Article
Publication date: 2 March 2022

Islam Ibrahim, Magda Sultan, Omaima Gaber Yassine, Adel Zaki, Hossam Elamir and Wafaa Guirguis

Healthcare environments are highly complex and full of variation and inefficiency. However, variation and inefficiency can be measured and improved, providing better quality care…

3898

Abstract

Purpose

Healthcare environments are highly complex and full of variation and inefficiency. However, variation and inefficiency can be measured and improved, providing better quality care at a lower cost. This study aims to report the application of Lean Six Sigma (LSS) in a haematology laboratory in a university hospital in Egypt.

Design/methodology/approach

The authors used case study research. Applying the define, measure, analyse, improve and control phases of the DMAIC methodology together with lean tools, the problem was identified, the process mapped, the causes analysed and improvements implemented.

Findings

Results show that LSS can be successfully implemented in challenging public sector healthcare settings. Management commitment, generating and implementing ideas from frontline staff, using a variety of quality tools and previous LSS training were all key to success. This is evidence that the LSS methodology is adaptable to any process, people or place.

Originality/value

There are no publications on LSS implementation in health care in Egypt. This study demonstrates the successful use of LSS in a university hospital (public sector) in a developing country, sharing insight into the facilitators and barriers in a real context with others in the healthcare field.

Details

International Journal of Lean Six Sigma, vol. 13 no. 5
Type: Research Article
ISSN: 2040-4166

Keywords

Article
Publication date: 1 August 1997

Stephen Procter and Andrew D. Brown

Study of the integration of operations through the application of computer technologies has focused on the manufacturing sector. In looking at the difficulties found in operating…

1017

Abstract

Study of the integration of operations through the application of computer technologies has focused on the manufacturing sector. In looking at the difficulties found in operating these technologies, increasing emphasis is being placed on their organizational aspects. These have been examined in depth by Ebers and Lieb, who concentrate on the social processes in implementation and the effects of reducing organizational slack. Applies this framework to the integration of information systems in a UK hospital. Examines the effects of integration: the new system is circumvented and organizational slack is redistributed as well as removed. Shows the importance of the cultural differences underlying the social processes between those introducing and those using the system, as well as within each of these groups. The framework of analysis provided by Ebers and Lieb thus proves to be quite robust. Concludes that our concern should not be computer‐integrated manufacturing but computer‐integrated operations.

Details

International Journal of Operations & Production Management, vol. 17 no. 8
Type: Research Article
ISSN: 0144-3577

Keywords

Article
Publication date: 1 October 1997

Aminah Jatoi, Rosemary Jaromin, Debera Grzybek and Phuong L. Nguyen

Personnel costs comprise the largest clinical laboratory expense. Yet standards to judge the productivity of personnel have not been established. A survey of the authors’ own…

401

Abstract

Personnel costs comprise the largest clinical laboratory expense. Yet standards to judge the productivity of personnel have not been established. A survey of the authors’ own personnel was conducted to derive productivity standards in the Clinical Hematology Laboratory at the Massachusetts General Hospital, Boston, Massachusetts, USA. Technologists were asked how many white blood cell differentials they could perform in an eight‐hour shift. Differential productivity was tracked before and after the survey. Of the respondents, 100 per cent failed to meet their own expectations of productivity. Nine technologists were tracked both before and after the survey was mailed and manifested a significant increase in productivity. These results suggest that technologists are objective in their assessment of their own productivity, that their opinions might be a resource for establishing productivity standards within the laboratory, and that such surveys may serve as motivational tools to augment productivity.

Details

Health Manpower Management, vol. 23 no. 5
Type: Research Article
ISSN: 0955-2065

Keywords

Article
Publication date: 19 September 2016

Birgitte Enslev Jensen, Pauline Anne Found, Sharon J. Williams and Paul Walley

Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes. However, these tasks are not systematically managed and are often extended…

Abstract

Purpose

Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes. However, these tasks are not systematically managed and are often extended due to missing information or equipment or staff unavailability. This research aims to assess whether ward rounds can be structured more efficiently and effectively from the perspective of patients and staff.

Design/methodology/approach

This mixed-method approach examines the ward rounds conducted in three units within a haematology department of a major Danish hospital. Baseline measures were collected to capture the value of the ward round described by patients and staff. The information on patient and equipment flows associated with a typical ward round was mapped with recommendations for improvement.

Findings

Staff aspired to deliver a good-quality ward round, but what this meant was never articulated and there were no established standards. The duration of the ward round was unpredictable and could take 6 hours to complete. Improvements identified by the team allow the ward rounds to be completed by mid-day with much more certainty.

Research limitations/implications

This research provides an insight as to how ward rounds are conducted within a Danish haematology department.

Practical implications

The research has implications for those involved in ward rounds to reduce the time taken whilst maintaining quality and safety of patient care.

Social implications

This research has implications for patients and their families who wish to spend time with consultants.

Originality/value

Previous research has focused on the interactions between doctors and nurses. This research focuses on the operational process of the ward round and presents a structured approach to support multi-disciplinary teams with a focus on value from the patient’s perspective.

Details

International Journal of Quality and Service Sciences, vol. 8 no. 3
Type: Research Article
ISSN: 1756-669X

Keywords

Article
Publication date: 24 June 2019

Christos Begkos, Sue Llewellyn and Kieran Walshe

The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat…

1920

Abstract

Purpose

The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat strategizing as a practical coping mechanism which begins in response to a problem and unfolds over time into an episode. This approach enables the authors to explore strategizing pathways and the ways they can mobilise accounting to advance from practical coping to explicit strategic intent.

Design/methodology/approach

The authors conducted semi-structured interviews with Clinical Directors, Business Managers and Finance personnel at three NHS hospitals. Documents were also collected, such as business cases and financial reports. The authors employed theories on strategizing agency, episodes and practical coping to select examples of strategizing and indicate how strategizing is constructed and performed. The authors present the results of this qualitative analysis in three strategizing narratives.

Findings

The analysis highlights how Clinical Directors’ strategizing with accounting, in response to their financial problems, can take on contesting, conforming and circumventing modes. As the strategizing pathway unfolds, accounting acts as an obligatory passage point through which Clinical Directors pursue their strategic intent. Along each pathway the authors identify, first, where practical coping takes on a clear strategic intent and, second, whether this emergent strategy proves efficacious.

Originality/value

The authors contribute to the nascent body of accounting and strategizing studies through seeing strategizing with accounting, not as the formulation of explicit organisational strategy as “done” in board rooms and strategy meetings, but as an impromptu response to a critical financial problem within a localised organisational setting. In response to a problem, actors may realise their immanent strategizing through their engagement with accounting practices.

Details

Accounting, Auditing & Accountability Journal, vol. 32 no. 5
Type: Research Article
ISSN: 0951-3574

Keywords

Article
Publication date: 4 April 2016

Elham Abbas Aljaaly and Nahlaa Abduwahab Khalifa

Continuous integration of health screens to investigate and track variations in the students’ healthiness over time is essential. However, the sustainability of this practice…

Abstract

Purpose

Continuous integration of health screens to investigate and track variations in the students’ healthiness over time is essential. However, the sustainability of this practice remains challenging. The purpose of this paper is to identify the prevalence of anaemia based on haemoglobin (Hb) estimation among Saudi school girls in Jeddah city by examining capillary and venous blood.

Design/methodology/approach

The design is investigative, using primary data to define the prevalence of anaemia based on two techniques. Samples of venous (n=408) and capillary (n=797) blood from Saudi school girls in Jeddah city was collected and compared using: Reflotron Plus System method (capillary blood) and ABX MICROS 60-OT Automated Haematology Analyser for (venous blood).

Findings

When the capillary blood was used, the prevalence of anaemia was 40 per cent (n=319 out of 797). Using the venous blood, the prevalence was 29.4 per cent (n=120 out of 408). Comparison of Hb data for both tests showed a significant difference in Hb levels with levels between the 10g and 12 g/dl particularly and both measurements demonstrated good agreement (ICC=0.87, 95 per cent CI (0.845, 0.892)).

Research limitations/implications

The data were collected only in Jeddah city. Further studies should include a national sample that is representative of both gender from different backgrounds and geographical areas in the kingdom of Saudi Arabia.

Practical implications

The high prevalence of anaemia within the school girls’ population require decision makers to devise a set of maintainable projects to progress students’ general health, including health education and supplementation such as iron, particularly if anaemia is diagnosed to be nutrition-related. This particularly applied to the health centres at female schools that have anaemia screening programmes that going on in Saudi schools.

Originality/value

This study reveals a technique-based measures of anaemia prevalence that have public and practical health implications.

Details

World Journal of Science, Technology and Sustainable Development, vol. 13 no. 2
Type: Research Article
ISSN: 2042-5945

Keywords

Article
Publication date: 1 August 1994

A.R. Feeney and M. Zairi

Presents the results of a study which was undertaken to establish bestpractice in the management of a pathology department through bestpractice. The study was carried out in two…

1976

Abstract

Presents the results of a study which was undertaken to establish best practice in the management of a pathology department through best practice. The study was carried out in two stages: an in‐depth analysis of the pathology department through a SWOT analysis and in‐depth interviews with 25 key internal and external customers, and a survey of NHS laboratories both in the UK and Ireland by targeting a sample of consultant pathologists in 50 random locations – the purpose of this questionnaire was an attempt at establishing best practice in pathology quality management. The study revealed that in pathology there is currently a major dependency on quality control that reflects a compliance to set standards laid down by professional bodies. It also identified a poor understanding of customer needs and expectations, a mechanistic culture which is resistant to change, and a reluctance by pathology managers to delegate ownership for ongoing quality improvement or to take responsibility for quality improvement issues such as waste reduction and cost improvement. Concludes with a set of recommendations geared towards helping managers of pathology services to deal with issues such as cost of quality, listening to customers, empowering employees and getting the job done right the first time and every time.

Details

Benchmarking for Quality Management & Technology, vol. 1 no. 2
Type: Research Article
ISSN: 1351-3036

Keywords

Article
Publication date: 18 May 2015

Mariavittoria Cicellin, Mario Pezzillo Iacono, Alessia Berni and Vincenza Esposito

The purpose of this paper is to interpret employees’ resistance using the perspective of a Foucaultian/post-structuralist approach in critical management studies. The authors…

Abstract

Purpose

The purpose of this paper is to interpret employees’ resistance using the perspective of a Foucaultian/post-structuralist approach in critical management studies. The authors examine the relationship between management of diversity, based on employment contract, emotional construction of identity and processes of resistance. The authors explore the ways in which temporary agency nurses understand and experience their contract, respond to tensions regarding temporary employment, develop collective emotions and show processes of resistance.

Design/methodology/approach

The study adopted an interpretive and qualitative approach. The authors analysed empirical material collected in the Haematology Department of a hospital in Naples, Italy, to illustrate actual experiences in the workplace.

Findings

Fear turns out to be the discursive resource through which resistance is actually exerted. Through emotions, temporary nurses build a community of coping and enhance their collective identity. They use fear to develop solidarity and to mobilize collective resistance in the workplace. Although no traditional resistance behaviours are reported, they aim to undermine the reputation of top managers and challenge and re-write the prevailing discourses of the organization.

Originality/value

The paper contributes to the critical literature because the authors analysed a relationship that is rarely theoretically and empirically examined in literature, that between employment contract, collective identity-building dynamics and processes of resistance. We showed that the creation of a community of coping enabled minorities to voice their distance from and opposition to management.

Details

Journal of Health Organization and Management, vol. 29 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 20 May 2020

Rowena Catipay Buyan, Jill Aylott and Duncan Carratt

Over half of adults under the age of 65 years will be diagnosed with cancer at some point in their lives (Ahmad et al., 2015). Demand for services is outstripping the capacity in…

Abstract

Purpose

Over half of adults under the age of 65 years will be diagnosed with cancer at some point in their lives (Ahmad et al., 2015). Demand for services is outstripping the capacity in the NHS, as 77% of NHS Trusts are unable to start treatment within 62 days (Baker, 2019; NHS England, 2019). Side effects of treatment can be life threatening (Tsai et al., 2010) with many patients attending ED; however, these can be managed through a hospital’s Acute Oncology Service (AOS). This paper aims to explore a collaborative leadership approach to improve services for patients [Rubin et al., 2015; Department of Health (DOH), 2012].

Design/methodology/approach

A case study of an AOS in an NHS Trust was the focus for the development of a strategy of ‘Collaborative’ leadership, with the aim to increase the engagement of a wide network of clinical and non-clinical stakeholders in a review of the AOS. The case study identified the level of effectiveness of the service since its inception in 2012. Using a quality improvement methodology (Deming 2000; Health Foundation, 2011; Aylott, 2019) resulted in learning and increased collaboration between clinical and non-clinical staff.

Findings

Action learning processes revealed that AOS staff had been frustrated for some time about the dysfunction of the current process to manage the increased demand for the service. They reported their perceptions and frustrations with the current process of referral and patient discharge. Data revealed alerts from the Emergency Department (ED) to AOS resulted in 72% of patients inappropriately referred, with an over representation of patients who had a previous existing cancer condition. Clinical engagement with the data informatics manager (DC) revealed a need to improve data quality through improvements made to the database.

Research limitations/implications

Increasing demand for cancer services requires a continuous need for improvement to meet patient needs. Cancer waits for diagnostic tests are at their highest level since 2008, with 4% of patients waiting over 6 weeks to be tested compared to the tested target of 1% (Baker, 2019). This paper draws on data collected from 2017 to 2018, but a continuous review of data is required to measure the performance of the AOS against its service specification. Every AOS team across the NHS could benefit from a collaborative learning approach.

Practical implications

Clinical services need collaborative support from informatics to implement a Quality Improvement methodology such as the IHI Model for Improvement (IHI, 2003). Without collaboration the implementation of a quality improvement strategy for all NHS Trusts will not come to fruition (Kings Fund, 2016). Quality Improvement Strategies must be developed with a collaborative leadership implementation plan that includes patient collaboration strategies (Okpala, 2018), as this is the only way that services will be improved while also becoming cost effective (Okpala, 2018).

Social implications

In the UK, 20-25% of new cancer diagnoses are made following an initial presentation to the ED (Young et al., 2016). Cancer-related attendances at ED had a higher level of acuity, requiring longer management time and length of stay in ED. With cancer care contributing to 12% of all hospital admissions, an increase of 25% over the past two decades (Kuo et al., 2017) the AOS will need continued collaboration between clinical staff, informatic managers, patients and all stakeholder organisations to continuously improve its services to be “fit for purpose”.

Originality/value

This case study reports the innovative collaborative work between a Medical Oncologist, an NHS Trust Informatics manager and a QI academic facilitator. The Health Foundation and Kings Fund have identified the continued challenges presented to the NHS in the transformation of its services, with the Health Foundation (2011) reporting the need for more collaborative working between clinicians and non-clinicians to drive improvement. This model of collaboration creates a new way of working to drive improvement initiatives and sets out a rationale to develop this model further to involve patients. However, this will call for a new way of working for all.

Details

Leadership in Health Services, vol. 33 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

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