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1 – 10 of 115
Article
Publication date: 17 June 2011

David Wilkie, James Middleton, Alison Culverwell and Alisoun Milne

This article aims to describe the aims, role and impact of a specialist intermediate care service for people with dementia in Kent, entitled the Home Treatment Service (HTS). The…

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Abstract

Purpose

This article aims to describe the aims, role and impact of a specialist intermediate care service for people with dementia in Kent, entitled the Home Treatment Service (HTS). The authors reflect on two workshops about the service, delivered as part of the “Dementia Care: A Positive Future” conference held in May 2010.

Design/methodology/approach

The 45 participants in the workshops included service providers, professionals and family carers. The aims and nature of the service were outlined by members of the clinical team as: adopting a multi‐professional approach, emphasising the value of a shared assessment process and having a commitment to flexible and intensive working within a person centred framework.

Findings

Focusing on the HTS's work with care homes, presenters offered case illustrations to highlight its collaborative approach to working with service users, staff, managers and families to improve the quality of life for users presenting with “challenging behaviour” and preventing placement breakdown. Discussion with participants explored the obstacles and opportunities in working productively with care homes. The HTS's potential to reduce reliance on anti‐psychotic medication was specifically highlighted. In addition to improving user and carer quality of life, outcomes of HTS intervention include a reduction in and quicker discharge from, mental health hospitals and maintaining the person in their existing setting.

Originality/value

The importance of including all parties – the older person with dementia, relatives, care staff and professionals – in co‐creating “solutions” was identified as one the HTS's keys to success.

Details

Quality in Ageing and Older Adults, vol. 12 no. 2
Type: Research Article
ISSN: 1471-7794

Keywords

Article
Publication date: 5 June 2017

Manda Broekhuis, Marjolein van Offenbeek and Monique Eissens-van der Laan

The purpose of this paper is to explore how functional and appropriateness arguments influence the adoption of modularity principles during the design of a professional service…

1021

Abstract

Purpose

The purpose of this paper is to explore how functional and appropriateness arguments influence the adoption of modularity principles during the design of a professional service architecture.

Design/methodology/approach

Action design research was conducted to examine the design process of a modular service architecture for specialised elderly care by a multi-professional group. Data collection methods included, partly participatory, observations of the interactions between professionals during the design process, interviews and document analysis. Data analysis focussed on the emerging design choices and the arguments underlying them.

Findings

A wide range of both functional and appropriateness considerations were enlisted during the design process. The three core modularity principles were adapted to varying degrees. In terms of the design outcome, the interdependencies between the modularity principles necessitated two trade-offs in the modular design. A third trade-off occurred between modularity and the need for professional inference where services were characterised by uncertainty. Appropriateness was achieved through the professionals reframing and translating the abstract modularity concept to reconcile the concept’s functionality with their professional norms, values and established practices.

Originality/value

The study adds to service modularity theory by formulating three trade-offs that are required in translating the core modularity principles into a functional set of design choices for a multi-professional service environment. Moreover, the inherent intertwinedness of the core modularity principles in professional services requires an iterative design process. Finally, the authors saw that the ambiguity present in the service modularity concept can be used to develop a design that is deemed appropriate by professionals.

Details

International Journal of Operations & Production Management, vol. 37 no. 6
Type: Research Article
ISSN: 0144-3577

Keywords

Article
Publication date: 3 October 2008

Michael Aherne and José L. Pereira

The purpose of this paper is to use a descriptive case study to establish how collaboration, innovation and knowledge‐management strategies have scaled‐up learning and development…

3120

Abstract

Purpose

The purpose of this paper is to use a descriptive case study to establish how collaboration, innovation and knowledge‐management strategies have scaled‐up learning and development in rural, remote and other resource‐constrained Canadian delivery settings.

Design/methodology/approach

Intervention design was realized through a one‐time, collaborative, national capacity‐building project. A project portfolio of 72 sub‐projects, initiatives and strategic activities was used to improve access, enhance quality and create capacity for palliative and end‐of‐life care services. Evaluation was multifaceted, including participatory action research, variance analysis and impact analysis. This has been supplemented by post‐intervention critical reflection and integration of relevant literature.

Findings

The purposeful use of collaboration, innovation and knowledge‐management strategies have been successfully used to support a rapid scaling‐up of learning and development interventions. This has enabled enhanced and new pan‐Canadian health delivery capacity implemented at the local service delivery catchment‐level.

Research limitations/implications

The intervention is bounded by a Canada‐specific socio‐cultural/political context. Design variables and antecedent conditions may not be present and/or readily replicated in other nation‐state contexts. The findings suggest opportunities for future integrative and applied health services and policy research, including collaborative inquiry that weaves together concepts from adult learning, social science and industrial engineering.

Practical implications

Scaling‐up for new capacity is ideally approached as a holistic, multi‐faceted process which considers the total assets within delivery systems, service catchments and communities as potentially being engaged and deployed.

Originality/value

The Pallium Integrated Capacity‐building Initiative offers model elements useful to others seeking theory‐informed practices to rapidly and effectively scale‐up learning and development efforts.

Details

Leadership in Health Services, vol. 21 no. 4
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 2 August 2013

Simon Turner, Angus Ramsay and Naomi Fulop

Using the example of medication safety, this paper aims to explore the impact of three managerial interventions (adverse incident reporting, ward‐level support by pharmacists, and…

Abstract

Purpose

Using the example of medication safety, this paper aims to explore the impact of three managerial interventions (adverse incident reporting, ward‐level support by pharmacists, and a medication safety subcommittee) on different professional communities situated in the English National Health Service (NHS).

Design/methodology/approach

Semi‐structured interviews were conducted with clinical and managerial staff from two English NHS acute trusts, supplemented with meeting observations and documentary analysis.

Findings

Attitudes toward managerial intervention differ by professional community (between doctors, nurses and pharmacists) according to their existing norms of safety and perceptions of formal governance processes.

Practical implications

The heterogeneity of social norms across different professional communities and medical specialties has implications for the design of organisational learning mechanisms in the field of patient safety.

Originality/value

The paper shows that theorisation of professional “resistance” to managerialism privileges the study of doctors' reactions to management with the consequent neglect of the perceptions of other professional communities.

Article
Publication date: 19 December 2019

Raffaella Gualandi, Cristina Masella and Daniela Tartaglini

Improving hospital patient flow has become a policy priority, to effectively balance the increasing demands of an unknown and variable volume of patients with limited available…

1515

Abstract

Purpose

Improving hospital patient flow has become a policy priority, to effectively balance the increasing demands of an unknown and variable volume of patients with limited available hospital resources. A systematic literature review was conducted in order to identify actions, actors involved and enablers in improving hospital patient flow. The paper aims to discuss this issue.

Design/methodology/approach

Searches were conducted in Scopus, Web of Science, MEDLINE and The Cochrane Library for quantitative and qualitative empirical primary studies with patients (adults) receiving inpatient acute hospital care. The study protocol was based on PRISMA-P guidance. A critical appraisal of included studies was performed by using the Quality Improvement Minimum Quality Criteria Set.

Findings

In total, 38 key papers were identified. A wide range of actions are reported, but most studies focus on one or a few departments instead of a whole hospital. Process efficiency is most often used as a performance indicator, clinical outcomes are poorly analyzed, and patients’ expectations and experience are rarely considered. Top-management commitment and front-line staff involvement are considered key factors for the success of implementations. Patient involvement in the process improvement is rarely mentioned.

Originality/value

Achieving improvements in hospital patient flow requires the design and implementation of complex, multifaceted and coordinated interventions. This study may be of value to healthcare managers, helping them to act effectively in their context, and to researchers of future studies including the different variables and the patient’s perspective.

Details

Business Process Management Journal, vol. 26 no. 6
Type: Research Article
ISSN: 1463-7154

Keywords

Article
Publication date: 4 January 2018

Gudbjörg Erlingsdottir, Anders Ersson, Jonas Borell and Christofer Rydenfält

The purpose of this paper is to describe five salient factors that emerge in two successful change processes in healthcare. Organizational changes in healthcare are often…

4896

Abstract

Purpose

The purpose of this paper is to describe five salient factors that emerge in two successful change processes in healthcare. Organizational changes in healthcare are often characterized by problems and solutions that have been formulated by higher levels of management. This top-down management approach has not been well received by the professional community. As a result, improvement processes are frequently abandoned, resulting in disrupted and dysfunctional organizations. This paper presents two successful change processes where managerial leadership was used to coach the change processes by distributing mandates and resources. After being managerially initiated, both processes were driven by local agency, decisions, planning and engagement.

Design/methodology/approach

The data in the paper derive from two qualitative case studies. Data were collected through in-depth interviews, observations and document studies. The cases are presented as process descriptions covering the different phases of the change processes. The focus in the studies is on the roles and interactions of the actors involved, the type of leadership and the distribution of agency.

Findings

Five factors emerged as paramount to the successful change processes in the two cases: local ownership of problems; a coached process where management initiates the change process and the problem recognition, and then lets the staff define the problems, formulate solutions and drive necessary changes; distributed leadership directed at enabling and supporting the staff’s intentions and long-term self-leadership; mutually formulated norms and values that serve as a unifying force for the staff; and generous time allocation and planning, which allows the process to take time, and creates room for reevaluation. The authors also noted that in both cases, reorganization into multi-professional teams lent stability and endurance to the completed changes.

Originality/value

The research shows how management can initiate and support successful change processes that are staff driven and characterized by local agency, decisions, planning and engagement. Empirical descriptions of successful change processes are rare, which is why the description of such processes in this research increases the value of the paper.

Details

Journal of Health Organization and Management, vol. 32 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 27 March 2020

Mary Baginsky, Jo Moriarty, Jill Manthorpe and HHJ Carol Atkinson

The purpose of this paper is to describe and discuss both the early implementation of a US mental health intervention for young children in the context of its introduction to a…

Abstract

Purpose

The purpose of this paper is to describe and discuss both the early implementation of a US mental health intervention for young children in the context of its introduction to a pilot site in a London borough and the progress made in establishing a randomised controlled trial (RCT).

Design/methodology/approach

This paper describes an evaluation of a new intervention and the learning that followed in terms of its implementation and future evaluation. Qualitative data were collected from a range of stakeholders and practitioners through interviews and small group discussions. These interviews focussed on both of these issues, with particular reference to the proposal to conduct an RCT.

Findings

The findings of this evaluation add to the evidence on how best to support new initiatives that have been introduced from other settings and countries to embed in a receiving site and the optimal timing and feasibility of conducting an RCT. At the end of the feasibility study, which took place within the year of the service being introduced and which was only open to clients for six months of this year the conclusion was that an RCT at that point was neither possible nor desirable. Over the following years, the commitment of the judiciary to examine if there was a way to make an RCT study in respect of this intervention meant that a template was established that may well have broader application.

Research limitations/implications

At a time when there is an increasing demand for evidence on effective interventions this paper makes a valuable contribution to the development of RCTs in general and specifically in the family court arena. It also recommends that attention must also be paid to the time, which is needed to implement and establish interventions and then to test them.

Practical implications

This paper highlights the need to establish realistic timescales not only around the implementation of initiatives but also for their evaluation.

Originality/value

This study breaks new ground in considering implementation challenges in the court and children’s services’ context. It brings to the fore the important role of the judiciary in approving new processes.

Details

Journal of Children's Services, vol. 15 no. 2
Type: Research Article
ISSN: 1746-6660

Keywords

Article
Publication date: 14 December 2010

Karen Miller, Vikki Baker and Sandra Oluonye

This paper describes two different services within the UK, both of which aim to better address the needs of offenders with personality disorder. Both services have been developed…

Abstract

This paper describes two different services within the UK, both of which aim to better address the needs of offenders with personality disorder. Both services have been developed in the light of recent policy and practice guidance, which recognises the need to develop new ways of working with this hard‐to‐reach population.The importance of developing boundaries and optimistic therapeutic relationships in order to foster motivation and engagement is emphasised. It is within these that assessment and interventions to address risk, mental health and social integration issues can be undertaken. In addition, the need for different agencies to work together in partnership to better address these needs is also emphasised.Resettle is a stand‐alone service in the pilot stage whilst the probation link‐work role is a resource within an established community personality disorder service.

Details

Mental Health Review Journal, vol. 15 no. 4
Type: Research Article
ISSN: 1361-9322

Keywords

Article
Publication date: 7 October 2014

Marco António Ferreira Rodrigues Nogueira dos Santos, Hans Tygesen, Henrik Eriksson and Johan Herlitz

Despite their efficacy, some recommended therapies are underused. The purpose of this paper is to describe clinical decision support system (CDSS) development and its impact on…

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Abstract

Purpose

Despite their efficacy, some recommended therapies are underused. The purpose of this paper is to describe clinical decision support system (CDSS) development and its impact on clinical guideline adherence.

Design/methodology/approach

A new CDSS was developed and introduced in a cardiac intensive care unit (CICU) in 2003, which provided physicians with patient-tailored reminders and permitted data export from electronic patient records into a national quality registry. To evaluate CDSS effects in the CICU, process indicators were compared to a control group using registry data. All CICUs were in the same region and only patients with acute coronary syndrome were included.

Findings

CDSS introduction was associated with increases in guideline adherence, which ranged from 16 to 35 per cent, depending on the therapy. Statistically significant associations between guideline adherence and CDSS use remained over the five-year period after its introduction. During the same period, no relapses occurred in the intervention CICU.

Practical implications

Guideline adherence and healthcare quality can be enhanced using CDSS. This study suggests that practitioners should turn to CDSS to improve healthcare quality.

Originality/value

This paper describes and evaluates an intervention that successfully increased guideline adherence, which improved healthcare quality when the intervention CICU was compared to the control group.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 8
Type: Research Article
ISSN: 0952-6862

Keywords

Book part
Publication date: 24 October 2019

Susan P. McGrath, Irina Perreard, Joshua Ramos, Krystal M. McGovern, Todd MacKenzie and George Blike

Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been…

Abstract

Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information.

This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.

Details

Structural Approaches to Address Issues in Patient Safety
Type: Book
ISBN: 978-1-83867-085-6

Keywords

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