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Article
Publication date: 28 January 2019

Kieran Mervyn, Nii Amoo and Rebecca Malby

Public sectors have responded to grand societal challenges by establishing collaboratives – new inter-organizational partnerships to secure better quality health services…

Abstract

Purpose

Public sectors have responded to grand societal challenges by establishing collaboratives – new inter-organizational partnerships to secure better quality health services. In the UK, a proliferation of collaboration-based healthcare networks exists that could help to enhance the value of investments in quality improvement programs. The nature and organizational form of such improvements is still a subject of debate within the public-sector literature. Place-based collaboration has been proposed as a possible solution. In response, the purpose of this study is to present the results and findings of a place-based collaborative network, highlighting challenges and insights.

Design/methodology/approach

This study adopted a social constructionist epistemological approach, using a qualitative methodology. A single case study was used and data collected in three different stages over a two-year period.

Findings

The study finds that leadership, data-enabled learning through system-wide training and development, and the provision of an enabling environment that is facilitated by an academic partner, can go a long way in the managing of healthcare networks for improving quality.

Research limitations/implications

Regardless of the tensions and challenges with place-based networks, they could still be a solution in maximizing the public value required by government investments in the healthcare sector, as they offer a more innovative structure that can help to address complex issues beyond the remit of hierarchical structures. This study is limited by the use of a single case study.

Practical implications

Across countries health systems are moving away from markets to collaborative models for healthcare delivery and from individual services to population-based approaches. This study provides insights to inform leaders of collaborative health models in the design and delivery of these new collaborations.

Social implications

As demand rises (as a result of increasing complexity and demographics) in the western world, health systems are seeking to redefine the boundaries between health service provision and community self-reliance and resilience. This study provides insights into the new partnership between health institutions and communities, providing opportunities for more social- and solidarity-based healthcare models which place patients and the public at the heart of change.

Originality/value

The city place-based network is the first of such organizational form in healthcare collaboration in the UK.

Details

International Journal of Organizational Analysis, vol. 27 no. 4
Type: Research Article
ISSN: 1934-8835

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Abstract

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Journal of Public Mental Health, vol. 7 no. 2
Type: Research Article
ISSN: 1746-5729

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Article
Publication date: 26 January 2010

Jennifer Anderson, Kit Wa Chan, Cathy Walsh and Mervyn London

The purpose of this paper is to evaluate the clinical practice for management of opiate dependence in a general hospital in‐patient population based on agreed standards…

Abstract

Purpose

The purpose of this paper is to evaluate the clinical practice for management of opiate dependence in a general hospital in‐patient population based on agreed standards and changes of clinical practice after the introduction of a guideline.

Design/methodology/approach

A complete cycle of audit was carried out based on the agreed guideline, which was introduced after the first cycle. Data were obtained, using a standardized audit form, over two one‐year periods, by cross‐sectional analysis of case notes for patients identified as having been dispensed methadone whilst an in‐patient.

Findings

There were significant increases in: referral to the specialist service whilst an in‐patient (p=0.01); referral to the addiction services on discharge (p<0.001) and providing information about the addiction diagnosis to GP (p<0.001). However, there was no improvement in the documented history and examination related to aspects of addiction, some of which were consistently low. Of most concern were significant decreases in the history documented for opiate withdrawal symptoms and alcohol consumption.

Research limitations/implications

The method used may not reflect actual clinical practice, only captures opiate‐dependent patients prescribed methadone and does not establish the extent of awareness of the new guideline.

Practical implications

The paper identifies a variation in clinical practice of management of patients with opiate dependence in the general hospital. Though there were some significant improvements, further improvement and continual evaluation are needed.

Originality/value

The paper identifies the need to study how co‐morbid opiate dependence is managed in the acute hospital setting.

Details

Clinical Governance: An International Journal, vol. 15 no. 1
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 17 July 2009

Mervyn Conroy

Purpose – The purpose of this paper is to present the background and an evaluation of a new health and social care leadership programme. Design/methodology/approach – The…

Abstract

Purpose – The purpose of this paper is to present the background and an evaluation of a new health and social care leadership programme. Design/methodology/approach – The paper describes a three‐stage programme design methodology. First, participants were asked to narrate their stories of implementing change at a series of in‐depth interviews. Second, the dialogue was continued with these managers and others based around their stories of change to establish that their meanings of change and their support needs had been understood. Finally, their expressed needs and practical suggestions were analysed with the help of MacIntyre's virtue ethics schema. MacIntyre's schema was used for two reasons. First, because it is based on the notion of a narrative underpinning to social reality and to informing our moral standards, and second because strong resonance between the managers' narratives and the schema's underlying thesis of ethical conflict in modern institutions was found. Findings – The finding was that the programme exceeded expectations by influencing the participants' courage to lead change despite the complexity of their working environment. At the start of the programme many of the participants had reported feelings of powerlessness in face of central and local imperatives for reforms to their services. During the course of the six‐month programme their narratives changed from “mission impossible” to “mission possible”. Research limitations/implications – The main limitation is that this was a pilot study. However, the encouraging findings do support the view offered by Moore and Beadle that MacIntyre's thesis offers rich concepts for the furtherance of managerial and organisation studies and imply that a wider education programme based on this methodology and theorising would be worthwhile. Practical implications – The enthusiasm with which this pilot programme was received implies that public sector leadership education needs to pay more attention to narrative constructions of change, ethical conflict and engaging managers in concert with their constructed needs in the face of those conflicts. Originality/value – The study contributes a design methodology for health services leadership education informed by a narrative research methodology and a virtue ethics theoretical framework.

Details

Leadership in Health Services, vol. 22 no. 3
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 1 February 2002

Mariette Glover

Abstract

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The Journal of Adult Protection, vol. 4 no. 1
Type: Research Article
ISSN: 1466-8203

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Article
Publication date: 1 June 1957

ANDREW D. BOOTH

The present paper is intended to form an introduction to the ideas of machine translation; it is in no sense a complete account of the work which has been carried out at…

Abstract

The present paper is intended to form an introduction to the ideas of machine translation; it is in no sense a complete account of the work which has been carried out at Birkbeck College and elsewhere and which interested readers can study in more detail in a book which is in course of publication.

Details

Aslib Proceedings, vol. 9 no. 6
Type: Research Article
ISSN: 0001-253X

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Article
Publication date: 22 March 2011

Mervyn Conroy

The aim of this paper is to show how storytelling and MacIntyre's virtue ethics theoretical schema can inform a new approach to management development and coaching. It…

Abstract

Purpose

The aim of this paper is to show how storytelling and MacIntyre's virtue ethics theoretical schema can inform a new approach to management development and coaching. It also highlights the potentially collusive nature of a coaching relationship where there is an absence of broader research‐based input.

Design/methodology/approach

The approach has three stages: first, to sample what it means to lead reform implementation through managers' stories; second, to view those stories as passing on or coaching others in the virtues of the institution; third, to suggest an alternative approach to coaching which includes deepening managers' understanding about conflicting moral traditions, ideologies and discourses that often feature in their stories of change.

Findings

The capability to find a way through multiple and conflicting change initiatives appears to be enhanced when managers gain a deeper understanding of the antecedents of the different ideologies at play. It is argued that without the research input and stimulus to understand what is behind change policy, coaching could be submitting to disciplinary power (Foucault, 1980) where both coach and coachee are implicated in a collusive perpetuation of what Žižek calls a “narrative quilting of heterogeneous material into a unified ideological field”.

Originality/value

One suggested avenue for management development and coaching would be to build further on MacIntyre's notion that it is sometimes only through conflict that we learn what our ends and purposes are, with the question, “Of what [wider] conflicts is [my conflict] the scene?” (adapted from MacIntyre).

Details

Journal of Management Development, vol. 30 no. 3
Type: Research Article
ISSN: 0262-1711

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Article
Publication date: 1 June 2009

Maria Bhatti and Ishaq Bhatti

This paper is an attempt to present legal issues of Islamic corporate governance (ICG) in the presence of global financial crises. It presents ICG model and discusses its…

Abstract

This paper is an attempt to present legal issues of Islamic corporate governance (ICG) in the presence of global financial crises. It presents ICG model and discusses its viability in today’s corporate structure. The model is based on institution of Hisbah which demands book keeping, disclosure, transparency based on Shariah principles of Islamic Finance Ethics.

Details

Journal of Economic and Administrative Sciences, vol. 25 no. 1
Type: Research Article
ISSN: 1026-4116

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Article
Publication date: 19 September 2018

Rebecca Malby, Kieran Mervyn and Terry J. Boyle

The purpose of this paper is to review the impact of the clinical leadership programme, in enabling the Darzi fellows to lead change projects in health and care services…

Abstract

Purpose

The purpose of this paper is to review the impact of the clinical leadership programme, in enabling the Darzi fellows to lead change projects in health and care services, and to secure quality healthcare in the NHS beyond the lifetime of the programme.

Design/methodology/approach

A longitudinal empirical investigation of clinical leaders (n=80) over an eight-year period was framed through an activity theory (AT)-driven research methodology using a mixed-methods approach.

Findings

AT illuminated how change was sustained in the NHS in London through the Darzi Clinical Leadership Fellowship. By any reasonable measurement, this programme excels, with learning and positive behavioural change sustained after the Fellowship across the NHS. Further recognition is needed of the continuing development needs of fellows as they take on more responsible leadership roles in their careers.

Research limitations/implications

Darzi fellows are a hard-to-reach group. The sample represents a response rate of 34 per cent. In total, 77 per cent of respondents emanated from cohorts 5 to 8 programmes.

Practical implications

The investment in a clinical leadership programme focused on systems leadership for quality generates value for the NHS.

Social implications

Countless interventions flowed through London’s healthcare community and beyond as a result of the Fellowship. This research exposed how Darzi fellows continue to lead innovation for alternative healthcare outcomes. Many proactive fellows employ a suite of learned skills and capabilities to lead systemic change.

Originality/value

This research is the first known longitudinal clinical leadership development study undertaken. The Darzi programme has created a unique clinical network of mutually supportive, team-centric systems thinkers and doers, with an evidence-based approach to systems change. Many fellows are catalysing sustainable change in the healthcare environment.

Details

Journal of Health Organization and Management, vol. 32 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 7 March 2019

Terry J. Boyle and Kieran Mervyn

Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning…

Abstract

Purpose

Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes have been based on a taught curriculum, but the purpose of this paper is to demonstrate more modern approaches through procedures and tools.

Design/methodology/approach

This study evolved from grounded and activity theory foundations (using semi-structured interviews with ten senior healthcare executives and qualitative analysis) which describe obstructions to progress. The study began with the premise that quality and affordable health care are dependent upon collaborative innovation. The growth of new leaders goes from skills to procedures and tools, and from training to development.

Findings

This paper makes “frugal innovation” recommendations which while not costly in a financial sense, do have practical and social implications relating to the Triple Aim. The research also revealed largely externally driven health care systems under duress suffering from leadership shortages.

Research limitations/implications

The study centred primarily on one Canadian community health care services’ organisation. Since healthcare provision is place-based (contextual), the findings may not be universally applicable, maybe not even to an adjacent community.

Practical implications

The paper dismisses outdated views of the synonymity of leadership and management, while encouraging clinicians to assume leadership roles.

Originality/value

This paper demonstrates how health care leadership can be developed and sustained.

Details

Journal of Health Organization and Management, vol. 33 no. 2
Type: Research Article
ISSN: 1477-7266

Keywords

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