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The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services.

Data were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard’s framework.

Three overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders’ ability to focus on, and advance, the quality and safety agenda.

Typical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged.

There is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making.

The study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.

The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.

A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.

Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations

The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.

The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.

Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

This paper aims to explore the roles of psychologists in seclusion in adult mental health services in Ireland, their perspectives on seclusion and its use in recovery-oriented practice and related professional practice issues.

A qualitative hermeneutic phenomenological study was conducted from a social constructivist perspective. Semi-structured interviews with 17 psychologists were analysed using reflexive thematic analysis.

Twenty-four themes were identified, which were clustered into four overarching themes. Participants viewed themselves and psychology in Ireland more broadly as peripheral to seclusion. They believed that seclusion possessed no inherent therapeutic value but viewed it as an uncomfortable and multi-faceted reality. Participants regarded seclusion and recovery as largely inconsistent and difficult to reconcile, and they perceived systemic factors, which had a pervasive negative impact on seclusion and recovery in practice.

The findings highlight the perceived complexity of seclusion and its interface with recovery, and the need to conscientiously balance conflicting priorities that cannot be easily reconciled to ensure ethical practice. The findings suggest psychologists are well-suited to participate in local and national discussions on using seclusion in recovery-oriented practice.

This study offers a unique insight into psychologists’ perceptions of seclusion and considers the implications of these views. Participants’ nuanced views suggest that psychologists can make valuable contributions to local and national discussions on these topics.

The purpose of this paper is to review the establishment of Primary Health Network (PHN) in Australia and its utility in commissioning Primary Health Care (PHC) services.

This study is an analysis of management practice about the establishment and development of a PHN as a case study over the three-year period. The PHN is the Hunter New England and Central Coast PHN (HNECCPHN). The study is based on “insiders perspectives” drawing from documentation, reports and evaluations undertaken.

HNECCPHN demonstrates a unique inclusive organisation across a substantial diverse geographic area. It has taken an innovative and evidence-based approach to its creation, governance and operation. HNECCPHN addresses the health challenges of a substantial Aboriginal and/or Torres Strait Islander population. It contains significant and diverse urban, coastal and distinct rural, regional and remote populations. It can be described as a “virtual” organisation, using a distributed network of practice approach to engage clinicians, communities and providers. The authors describe progress and learning in the context of theories of complex organisations, innovation, networks of practice, knowledge translation and social innovation.

The study provides initial publication into the establishment phase of a PHN in Australia.

The study describes the implementation and progress in terms of relevant international practice and theoretical concepts. This paper demonstrates significant innovative practice in the short term.

The study describes significant engagement and the importance of that with and between communities, service providers and health professionals.

This is the first study of the results of the implementation of an important change in the funding and delivery of PHC in Australia.

This paper aims to evaluate the effectiveness of a stepped-care primary care psychology service through triangulating clinical outcome data, service user satisfaction ratings and feedback from referrers.

A mixed method approach including a repeated measures design (pre- and post-clinical data on standardised psychometrics) for clinical outcomes and an online and postal survey with quantitative and qualitative elements offered to all service users and referrers to the service.

In total, 125 service users completed a full intervention with the service with 56% treatment completers demonstrating a reliable reduction in the symptoms of low mood and 49.6% in anxiety. Of those within the clinical range for depression at assessment, 66.67% achieved clinical recovery following an intervention. Of those within the clinical range for an anxiety disorder at assessment, 62.03% achieved clinical recovery following an intervention. Service users reported high levels of satisfaction with the service specifying particular interpersonal qualities of the therapists and the individualisation of service provision as crucial positive factors. Referrers similarly reported high levels of overall satisfaction with the service, specifying that the speed of response to referral and length of intervention was of greatest importance to them.

Stepped-care psychological interventions reduce psychological distress in treatment completers with mild to moderate symptoms of anxiety and low mood. The overall interpersonal experience may be of greater importance to service users in their evaluation of a service than clinical outcomes. In their relationship to a Psychology service, referrers value speed of response and ongoing feedback. Building a robust, highly valued service may require the triangulation of evidence from all key stakeholders.

This paper provides a pragmatic template of how a rigorous evaluation of a primary care psychology service requires evidence from multiple stakeholders.

This article describes the Canadian Hospital Executive Simulation System (CHESS), which has been developed by two of the authors, Knotts and Parrish, in co‐operation with the Canadian College of Health Service Executives; the key features of CHESS are then outlined. The article also describes the use of CHESS in Executive Development Programmes conducted for healthcare executives by the Canadian College of Health Service Executives.

The themes that emerged from the qualitative data of a mixed methods study that explored the effects of leadership style on the job satisfaction of aged care workers.

The study is a mixed methods study with the qualitative approach informing the interpretative phenomenological analysis from the transcripts of semi-structured interviews.

Three themes related to the effects of leadership style on job satisfaction of aged care employees emerged from the IPA. These themes were, The Context of Aged Care, Employee Engagement and Voice and Leader Behaviour. Job burnout and organisational disengagement were prevalent in participants of the qualitative study.

The research deployed quantitative measurements to determine the differences between aged care leaders and their followers and used these to explore participants’ lived experiences and how they made sense of their personal and social worlds at work. In the quantitative study, there may be an overstatement of the strength of the relationship between variables among those motivated to participate in the study. The qualitative study requires the researcher to be thorough in describing the research context, and it may be that those who wish to transfer the results of this study to a different one are responsible for making the judgement on the suitability of the transferability of findings.

Decreasing job disengagement and burnout will positively impact reducing attrition and turnover and, thus, the availability of the aged care workforce. It will inform leadership development programs and training in aged care and other health and social care sectors.

The workforce is a primary consideration for aged care in Australia and globally. Reducing burnout and disengagement will reduce workforce attrition, thus, improving the care for some of the most vulnerable in the population.

This report is from original research with ethical clearance from a university human research ethics committee contributing to the knowledge of leadership practice in aged care in Australia.

This special “Anbar Abstracts” issue of the Journal of Management in Medicine is split into seven sections covering abstracts under the following headings: General Management; Personnel and Training; Quality in Health Care; Health Care Marketing; Financial Management; Information Technology; Leadership, management styles and decision making.

Clinical governance (CG) is an important foundation for a high-performing health care system, with many countries supporting its development. CG policy may be developed and implemented nationally, or devolved to a local level, with implications for the overall approach to implementation and policy uptake. However, it is not known whether one of these two approaches is more effective. The purpose of this paper is to probe this question. Its setting is Ireland and New Zealand, two broadly comparable countries with similar CG policies. Ireland’s was nationally led, while New Zealand’s was devolved to local districts. This leads to the question of whether these different approaches to implementation make a difference.

Data from surveys of health professionals in both countries were used to compare performance with CG development.

The study showed that Ireland’s approach produced a slightly better performance, raising questions about the merits of devolving responsibility for policy implementation to the local level.

The Irish and New Zealand surveys both had lower-than-desirable response rates, which is not uncommon for studies of health professionals such as this. The low response rates mean the findings may be subject to selection bias.

Despite the importance of the question of whether a national or local approach to policy implementation is more effective, few studies specifically focus on this, meaning that this study provides a new contribution to the topic.