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Article
Publication date: 18 August 2014

Piotr Ozieranski, Victoria Robins, Joel Minion, Janet Willars, John Wright, Simon Weaver, Graham P Martin and Mary Dixon Woods

Research on patient safety campaigns has mostly concentrated on large-scale multi-organisation efforts, yet locally led improvement is increasingly promoted. The purpose…

Abstract

Purpose

Research on patient safety campaigns has mostly concentrated on large-scale multi-organisation efforts, yet locally led improvement is increasingly promoted. The purpose of this paper is to characterise the design and implementation of an internal patient safety campaign at a large acute National Health Service hospital trust with a view to understanding how to optimise such campaigns.

Design/methodology/approach

The authors conducted a qualitative study of a campaign that sought to achieve 12 patient safety goals. The authors interviewed 19 managers and 45 frontline staff, supplemented by 56 hours of non-participant observation. Data analysis was based on the constant comparative method.

Findings

The campaign was motivated by senior managers’ commitment to patient safety improvement, a series of serious untoward incidents, and a history of campaign-style initiatives at the trust. While the campaign succeeded in generating enthusiasm and focus among managers and some frontline staff, it encountered three challenges. First, though many staff at the sharp end were aware of the campaign, their knowledge, and acceptance of its content, rationale, and relevance for distinct clinical areas were variable. Second, the mechanisms of change, albeit effective in creating focus, may have been too limited. Third, many saw the tempo of the campaign as too rapid. Overall, the campaign enjoyed some success in raising the profile of patient safety. However, its ability to promote change was mixed, and progress was difficult to evidence because of lack of reliable measurement.

Originality/value

The study shows that single-organisation campaigns may help in raising the profile of patient safety. The authors offer important lessons for the successful running of such campaigns.

Details

Journal of Health Organization and Management, vol. 28 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 2 November 2010

Justin Waring, Mary Dixon‐Woods and Karen Yeung

This paper aims to outline and comment on the changes to medical regulation in the UK that provide the background to a special issue of the Journal of Health Organization

Abstract

Purpose

This paper aims to outline and comment on the changes to medical regulation in the UK that provide the background to a special issue of the Journal of Health Organization and Management on regulating doctors.

Design/methodology/approach

This paper takes the form of a review.

Findings

Although the UK medical profession enjoyed a remarkably stable regulatory structure for most of the first 150 years of its existence, it has undergone a striking transformation in the last decade. Its regulatory form has mutated from one of state‐sanctioned collegial self‐regulation to one of state‐directed bureaucratic regulation. The erosion of medical self‐regulation can be attributed to: the pressures of market liberalisation and new public management reforms; changing ideologies and public attitudes towards expertise and risk; and high profile public failures involving doctors. The “new” UK medical regulation converts the General Medical Council into a modern regulator charged with implementing policy, and alters the mechanisms for controlling and directing the conduct and performance of doctors. It establishes a new set of relationships between the medical profession and the state (including its agencies), the public, and patients.

Originality/value

This paper adds to the literature by identifying the main features of the reforms affecting the medical profession and offering an analysis of why they have taken place.

Details

Journal of Health Organization and Management, vol. 24 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 18 May 2012

Emma‐Louise Aveling, Graham Martin, Natalie Armstrong, Jay Banerjee and Mary Dixon‐Woods

Approaches to quality improvement in healthcare based on clinical communities are founded in practitioner networks, peer influence and professional values. However…

Abstract

Purpose

Approaches to quality improvement in healthcare based on clinical communities are founded in practitioner networks, peer influence and professional values. However, evidence for the value of this approach, and how to make it effective, is spread across multiple disciplines. The purpose of this paper is to review and synthesise relevant literature to provide practical lessons on how to use community‐based approaches to improve quality.

Design/methodology/approach

Diverse literatures were identified, analysed and synthesised in a manner that accounted for the heterogeneity of methods, models and contexts they covered.

Findings

A number of overlapping but distinct community‐based approaches can be identified in the literature, each suitable for different problems. The evidence for the effectiveness of these is mixed, but there is some agreement on the challenges that those adopting such approaches need to address, and how these can be surmounted.

Practical implications

Key lessons include: the need for co‐ordination and leadership alongside the lateral influence of peers; advantages of starting with a clear programme theory of change; the need for training and resources; dealing with conflict and marginalisation; fostering a sense of community; appropriate use of data in prompting behavioural change; the need for balance between “hard” and “soft” strategies; and the role of context.

Originality/value

The paper brings together diverse literatures with important implications for community‐based approaches to quality improvement, drawing on these to offer practical lessons for those engaged in improving healthcare quality in practice.

Details

Journal of Health Organization and Management, vol. 26 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 2 November 2010

Mark Exworthy, Glenn Smith, Jonathan Gabe and Ian Rees Jones

In recent years, the clinical performance of named cardiac surgeons in England has been disclosed. This paper aims to explore the nature and impact of disclosure of…

Abstract

Purpose

In recent years, the clinical performance of named cardiac surgeons in England has been disclosed. This paper aims to explore the nature and impact of disclosure of clinical performance.

Design/methodology/approach

The paper draws on literature from across the social sciences to assess the impact of disclosure, as a form of transparency, in improving clinical performance. Specifically, it employs the “programme theory” of disclosure.

Findings

The “programme theory” of disclosure involves identification, naming, public sanction and recipient response. Named individual (consultant) surgeons have been identified through disclosure but this masks the contribution of the clinical team, including junior surgeons. Mortality is the prime performance measure but given low mortality rates, there are problems interpreting this measure. The naming of surgeons has been achieved through disclosure on web sites, developed between the health‐care regulator and the surgical profession itself. However, participation remains voluntary. The intention of disclosure is that interested parties (especially patients) will shun poorly performing surgeons. However, these parties' willingness and ability to exercise this sanction appears limited. Surgeons' responses are emergent but about a quarter of surgeons are not participating currently. Fears that surgeons would avoid high‐risk patients seem to have been unrealised. While disclosure may have a small effect on individual reputations, the surgical profession as a whole has embraced disclosure.

Originality/value

While the aim of disclosure has been to create a transparent medical system and to improve clinical performance, disclosure may have the opposite effect, concealing some performance issues and possibly strengthening professional autonomy. Disclosure therefore represents greater transparency in health‐care but it is uncertain whether it will improve performance in the ways that the policy intends.

Details

Journal of Health Organization and Management, vol. 24 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 2 November 2010

Gerry McGivern and Michael Fischer

The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as…

Abstract

Purpose

The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals.

Design/methodology/approach

The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted.

Findings

Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel “guilty until proven innocent” within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing “spectacular transparency”, driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a “blame business” is driving this form of transparency, in which self‐interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame.

Research limitations/implications

A relatively small number of people were interviewed, so further research testing the findings would be useful.

Practical implications

Transparency has some perverse effects on doctors' practice.

Social implications

Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding.

Originality/value

Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice.

Details

Journal of Health Organization and Management, vol. 24 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 2 November 2010

Sue Kilminster, Miriam Zukas, Naomi Quinton and Trudie Roberts

The aims of this paper are to understand the links between work transitions and doctors' performance and to identify the implications for policy, regulation, practice and research.

Abstract

Purpose

The aims of this paper are to understand the links between work transitions and doctors' performance and to identify the implications for policy, regulation, practice and research.

Design/methodology/approach

The paper explains transitions in terms of the inseparability of learning, practice and performance and introduces the concept of the transition as a critically intensive learning period to draw attention to this phenomenon. It also identifies implications for practice, research and regulation

Findings

Drawing on empirical data in relation to prescribing and case management, the paper will show that, in contrast to current assumptions of, understanding about and practice in doctors' transitions, doctors can never be fully prepared in advance for aspects of their work.

Originality/value

Transitions are explained in terms of the inseparability of learning, practice and performance and we introduce the concept of the transition as a critically intensive learning period to draw attention to this phenomenon. Also identified are implications for practice, research and regulation.

Details

Journal of Health Organization and Management, vol. 24 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 2 November 2010

Sally Lloyd‐Bostock

This paper aims to clarify the potential to use data on doctors and fitness to practise (FTP) cases held by the UK General Medical Council (GMC) for wider regulatory…

Abstract

Purpose

This paper aims to clarify the potential to use data on doctors and fitness to practise (FTP) cases held by the UK General Medical Council (GMC) for wider regulatory purposes, such as identifying risk factors. The paper aims to concentrate on how data are shaped by the GMC's functions and organisational concerns, and by the configuration and use of their electronic database.

Design/methodology/approach

The GMC provided samples of their data, access to documentation surrounding the configuration and use of the database, and meetings with staff able to provide background on the database, GMC procedures, and the GMC as an organisation.

Findings

The FTP database is designed to process cases within complex legal rules, and to provide for accountability. The database and its use are adapted to these purposes. Attempts to use it for other purposes are likely to find it difficult to use, the scope and quality of data uneven and some codes unsuitable. The register data are very narrow in scope. While combining register and FTP data to identify risk factors is by itself of limited value, the database can contribute to closer study of risks to patient safety from poorly performing doctors.

Research limitations/implications

The research was exploratory. It provides initial insights and the basis for further research.

Practical implications

The data have potential policy use for the GMC, but it is essential to understand the limitations.

Originality/value

The paper examines previously unanalysed influences on the GMC's data. It also develops new angles on questions in the regulation literature about organisational risks and the creation of risk data.

Details

Journal of Health Organization and Management, vol. 24 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 20 March 2017

Peter J. Pronovost, Sally J. Weaver, Sean M. Berenholtz, Lisa H. Lubomski, Lisa L. Maragakis, Jill A. Marsteller, Julius Cuong Pham, Melinda D. Sawyer, David A. Thompson, Kristina Weeks and Michael A. Rosen

The purpose of this paper is to provide a practical framework that health care organizations could use to decrease preventable healthcare-acquired harms.

Abstract

Purpose

The purpose of this paper is to provide a practical framework that health care organizations could use to decrease preventable healthcare-acquired harms.

Design/methodology/approach

An existing theory of how hospitals succeeded in reducing rates of central line-associated bloodstream infections was refined, drawing from the literature and experiences in facilitating improvement efforts in thousands of hospitals in and outside the USA.

Findings

The following common interventions were implemented by hospitals able to reduce and sustain low infection rates. Hospital and intensive care unit (ICU) leaders demonstrated and vocalized their commitment to the goal of zero preventable harm. Also, leaders created an enabling infrastructure in the way of a coordinating team to support the improvement work to prevent infections. The team of hospital quality improvement and infection prevention staff provided project management, analytics, improvement science support, and expertise on evidence-based infection prevention practices. A third intervention assembled Comprehensive Unit-based Safety Program teams in ICUs to foster local ownership of the improvement work. The coordinating team also linked unit-based safety teams in and across hospital organizations to form clinical communities to share information and disseminate effective solutions.

Practical implications

This framework is a feasible approach to drive local efforts to reduce bloodstream infections and other preventable healthcare-acquired harms.

Originality/value

Implementing this framework could decrease the significant morbidity, mortality, and costs associated with preventable harms.

Details

Journal of Health Organization and Management, vol. 31 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 7 January 2021

Husayn Marani, Jenna M. Evans, Karen S. Palmer, Adalsteinn Brown, Danielle Martin and Noah M. Ivers

This paper examines how “quality” was framed in the design and implementation of a policy to reform hospital funding and associated care delivery. The aims of the study…

Abstract

Purpose

This paper examines how “quality” was framed in the design and implementation of a policy to reform hospital funding and associated care delivery. The aims of the study were: (1) To describe how government policy-makers who designed the policy and managers and clinicians who implemented the policy framed the concept of “quality” and (2) To explore how frames of quality and the framing process may have influenced policy implementation.

Design/methodology/approach

The authors conducted a secondary analysis of data from a qualitative case study involving semi-structured interviews with 45 purposefully selected key informants involved in the design and implementation of the quality-based procedures policy in Ontario, Canada. The authors used framing theory to inform coding and analysis.

Findings

The authors found that policy designers perpetuated a broader frame of quality than implementers who held more narrow frames of quality. Frame divergence was further characterized by how informants framed the relationship between clinical and financial domains of quality. Several environmental and organizational factors influenced how quality was framed by implementers.

Originality/value

As health systems around the world increasingly implement new models of governance and financing to strengthen quality of care, there is a need to consider how “quality” is framed in the context of these policies and with what effect. This is the first framing analysis of “quality” in health policy.

Details

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

Keywords

Content available
Article
Publication date: 11 April 2016

Denise L. Anthony and Timothy Stablein

The purpose of this paper is to explore different health care professionals’ discourse about privacy – its definition and importance in health care, and its role in their…

Abstract

Purpose

The purpose of this paper is to explore different health care professionals’ discourse about privacy – its definition and importance in health care, and its role in their day-to-day work. Professionals’ discourse about privacy reveals how new technologies and laws challenge existing practices of information control within and between professional groups in health care, with implications not only for patient privacy, but also for the role of information control in professions more generally.

Design/methodology/approach

The authors conducted in-depth, semi-structured interviews with n=83 doctors, nurses, and health information professionals in two academic medical centers and one veteran’s administration hospital/clinic in the Northeastern USA. Interview responses were qualitatively coded for themes and patterns across groups were identified.

Findings

The health care providers and the authors studied actively sought to uphold the protection (and control) of patient information through professional ethics and practices, as well as through the use of technologies and compliance with legal regulations. They used discourses of professionalism, as well as of law and technology, to sometimes accept and sometimes resist changes to practice required in the changing technological and legal context of health care. The authors found differences across professional groups; for some, protection of patient information is part of core professional ethics, while for others it is simply part of their occupational work, aligned with organizational interests.

Research limitations/implications

This qualitative study of physicians, nurses, and health information professionals revealed some differences in views and practices for protecting patient information in the changing technological and legal context of health care that suggest some professional groups (doctors) may be more likely to resist such changes and others (health information professionals) will actively adopt them.

Practical implications

New technologies and regulations are changing how information is used in health care delivery, challenging professional practices for the control of patient information that may change the value or meaning of medical records for different professional groups.

Originality/value

Qualitative findings suggest that professional groups in health care vary in the extent of information control they have, as well in how they view such control. Some groups may be more likely to (be able to) resist changes in the professional control of information that stem from new technologies or regulatory policies. Some professionals recognize that new IT systems and regulations challenge existing social control of information in health care, with the potential to undermine (or possibly bolster) professional self-control for some but not necessarily all occupational groups.

Details

Journal of Health Organization and Management, vol. 30 no. 2
Type: Research Article
ISSN: 1477-7266

Keywords

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