Search results

1 – 10 of over 13000
Article
Publication date: 1 January 1992

A composite of the views of nine eminent doctors, managers andacademics on just what the business of the NHS is. Issues discussedinclude: resource limitations: “care and…

Abstract

A composite of the views of nine eminent doctors, managers and academics on just what the business of the NHS is. Issues discussed include: resource limitations: “care and repair” versus prevention and health promotion; balance between sectors, services and population groups; quality and efficiency.

Details

Journal of Management in Medicine, vol. 6 no. 1
Type: Research Article
ISSN: 0268-9235

Keywords

Article
Publication date: 13 July 2022

Rangani Handagala, Buddhike Sri Harsha Indrasena, Prakash Subedi, Mohammed Shihaam Nizam and Jill Aylott

The purpose of this paper is to report on the dynamics of “identity leadership” with a quality improvement project undertaken by an International Medical Graduate (IMG…

Abstract

Purpose

The purpose of this paper is to report on the dynamics of “identity leadership” with a quality improvement project undertaken by an International Medical Graduate (IMG) from Sri Lanka, on a two year Medical Training Initiative (MTI) placement in the National Health Service (NHS) [Academy of Medical Royal Colleges (AoMRC), 2017]. A combined MTI rotation with an integrated Fellowship in Quality Improvement (Subedi et al., 2019) provided the driver to implement the HEART score (HS) in an NHS Emergency Department (ED) in the UK. The project was undertaken across ED, Acute Medicine and Cardiology at the hospital, with stakeholders emphasizing different and conflicting priorities to improve the pathway for chest pain patients.

Design/methodology/approach

A social identity approach to leadership provided a framework to understand the insider/outsider approach to leadership which helped RH to negotiate and navigate the conflicting priorities from each departments’ perspective. A staff survey tool was undertaken to identify reasons for the lack of implementation of a clinical protocol for chest pain patients, specifically with reference to the use of the HS. A consensus was reached to develop and implement the pathway for multi-disciplinary use of the HS and a quality improvement methodology (with the use of plan do study act (PDSA) cycles) was used over a period of nine months.

Findings

The results demonstrated significant improvements in the reduction (60%) of waiting time by chronic chest pain patients in the ED. The use of the HS as a stratified risk assessment tool resulted in a more efficient and safe way to manage patients. There are specific leadership challenges faced by an MTI doctor when they arrive in the NHS, as the MTI doctor is considered an outsider to the NHS, with reduced influence. Drawing upon the Social Identity Theory of Leadership, NHS Trusts can introduce inclusion strategies to enable greater alignment in social identity with doctors from overseas.

Research limitations/implications

More than one third of doctors (40%) in the English NHS are IMGs and identify as black and minority ethnic (GMC, 2019a) a trend that sees no sign of abating as the NHS continues its international medical workforce recruitment strategy for its survival (NHS England, 2019; Beech et al., 2019). IMGs can provide significant value to improving the NHS using skills developed from their own health-care system. This paper recommends a need for reciprocal learning from low to medium income countries by UK doctors to encourage the development of an inclusive global medical social identity.

Originality/value

This quality improvement research combined with identity leadership provides new insights into how overseas doctors can successfully lead sustainable improvement across different departments within one hospital in the NHS.

Details

Leadership in Health Services, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1751-1879

Keywords

Book part
Publication date: 22 March 2021

Stuart Redding, Richard Hobbs, Catia Nicodemo, Luigi Siciliani and Raphael Wittenberg

Purpose: In this chapter, we examine the National Health Service (NHS) and Adult Social Care (ASC) in England, focussing on policies that have been introduced since 2000…

Abstract

Purpose: In this chapter, we examine the National Health Service (NHS) and Adult Social Care (ASC) in England, focussing on policies that have been introduced since 2000 and considering the challenges that providers face in their quest to provide a high standard and affordable health service in the near future.

Methodology/Approach: We discuss recent policy developments and published analysis covering innovations within major aspects of health care (primary, secondary and tertiary) and ASC, before considering future challenges faced by providers in England, highlighted by a 2017 UK Parliament Select Committee.

Findings: The NHS and ASC system have experienced tightening budgets and serious financial pressure, with historically low real-terms growth in health funding from central government and local authorities. Policymakers have tried to overcome these challenges with several policy innovations, but many still remain. With large-scale investment and reform, there is potential for the health and social care system to evolve into a modern service capable of dealing with the needs of an ageing population. However, if these challenges are not met, then it is set to continue struggling with a lack of appropriate facilities, an overstretched staff and a system not entirely appropriate for its patients.

Details

The Sustainability of Health Care Systems in Europe
Type: Book
ISBN: 978-1-83909-499-6

Keywords

Book part
Publication date: 16 August 2014

Claire Marsh

This chapter presents an organizational learning approach to understanding the objectives and challenges of an National Health Service (NHS) Sustainable Development…

Abstract

Purpose

This chapter presents an organizational learning approach to understanding the objectives and challenges of an National Health Service (NHS) Sustainable Development agenda, which involves the integration of social, ecological and economic concerns into organizational functioning, for example the construction and management of buildings, design and delivery of services, and employment of staff.

Methodology

The approach is used to frame an empirical analysis of 11 Projects conducted by NHS organizations aiming to advance this agenda during a particularly active phase in the mid to late 2000s. The approach helps identify the assumptions of organizational purpose, strategy and practice inherent in proposals for Sustainable Development and expose the challenges these are likely to pose. This framing helps articulate a vision and identify the actor groups, and their guiding assumptions, which need to be engaged if progress is to be made.

Findings

The vision of Sustainable Development being promoted was predominantly one of an NHS contributing to the economic and social determinants of health through its procurement, service development and employment activities. Contributions to environmental determinants only took place where financial gains to the NHS organizations themselves made activities, such as investment in renewable energy, viable in the short-term. Within most Projects strategic tools able to predict and measure benefits had to be developed on-the-job and most received help from external agencies to do this work.

Social implications

Rather than expecting individual NHS organizations to progress this agenda alone, others involved in the shaping of collective assumptions of the NHS' purpose and strategies for growth must be engaged in what can be viewed as a social process of learning.

Details

Ecological Health: Society, Ecology and Health
Type: Book
ISBN: 978-1-78190-323-0

Keywords

Book part
Publication date: 28 November 2019

Debbie Porteous

The long-term plan for the National Health Service (NHS, 2019) identifies a blueprint to make the NHS fit for the future with a greater focus on prevention, improving…

Abstract

The long-term plan for the National Health Service (NHS, 2019) identifies a blueprint to make the NHS fit for the future with a greater focus on prevention, improving services for patients and the importance of integrating services to make them more effective and efficient. The challenge is in the delivery and who is responsible to implement changes. The key is to enable staff at local levels to have responsibility for ensuring that the health and social needs of their local population are met.

Established to oversee the implementation is the NHS Assembly with 50 individuals from across the health and care sector to advise NHS England and NHS Improvement on the implementation. This requires shared commitment and motivation to change; ensuring patient centred care is at the forefront of any changes to delivering care. At regional level, Sustainability and Transformation Partnerships and Integrated Care Systems are groups of local NHS organisations, local councils and other partners, who are working together in the region to develop and implement the NHS plan. There are many challenges ahead to ensure the plan delivers better regional health and social care, including the impending UK’s decision to leave the European Union. Brexit may present some opportunities but if freedom of movement and membership of the single market and customs union end as planned, NHS and social care face several significant threats in the region.

Details

The North East After Brexit: Impact and Policy
Type: Book
ISBN: 978-1-83909-009-7

Keywords

Book part
Publication date: 27 September 2021

Isabella Bertolini

A Memorandum of Understanding (MoU) was uncovered in January 2017 detailing the sharing of patient data from NHS Digital to the Home Office. It signified a deepening of…

Abstract

A Memorandum of Understanding (MoU) was uncovered in January 2017 detailing the sharing of patient data from NHS Digital to the Home Office. It signified a deepening of the hostile environment’s presence in the NHS, and was comprehensively rejected by medical professionals. In November 2018, following extensive action calling for its removal, the MoU was withdrawn. This chapter explores how three factors: the lack of legal basis, wide reaching effects, and ethical conflicts of the MoU led to the success of this action, and aims to apply these lessons to other areas of hostile environment policy. It will be established that ethics proved the most influential factor in inciting the opposition, however, all factors may have been integral to the overall success. It shall be demonstrated that, although the success of this action promises much with regards to charging policy, it may be of limited applicability to other areas of the hostile environment.

Details

Privatisation of Migration Control: Power without Accountability?
Type: Book
ISBN: 978-1-80117-663-7

Keywords

Book part
Publication date: 7 August 2019

Liisa Kurunmäki, Andrea Mennicken and Peter Miller

Much has been made of economizing. Yet, social scientists have paid little attention to the moment of economic failure, the moments that precede it, and the calculative…

Abstract

Much has been made of economizing. Yet, social scientists have paid little attention to the moment of economic failure, the moments that precede it, and the calculative infrastructures and related processes through which both failing and failure are made operable. This chapter examines the shift from the economizing of the market economy, which took place across much of the nineteenth century, to the economizing and marketizing of the social sphere, which is still ongoing. The authors consider a specific case of the economizing of failure, namely the repeated attempts over more than a decade to create a failure regime for National Health Service (NHS) hospitals. These attempts commenced with the Health and Social Care Act 2003, which drew explicitly on the Insolvency Act 1986. This promised a “failure regime” for NHS Foundation Trusts modeled on the corporate sector. Shortly after the financial crash, and in the middle of one of the biggest scandals to face NHS hospitals, these proposals were abandoned in favor of a regime based initially on the notion of “de-authorization.” The notion of de-authorization was then itself abandoned, in favor of the notion of “unsustainable provider,” most recently also called the Trust Special Administrators regime. The authors suggest that these repeated attempts to devise a failure regime for NHS hospitals have lessons that go beyond the domain of health care, and that they highlight important issues concerning the role that “exit” models and associated calculative infrastructures may play in the economizing and regulating of public services and the social sphere more broadly.

Abstract

Details

Health Policy, Power and Politics: Sociological Insights
Type: Book
ISBN: 978-1-83909-394-4

Article
Publication date: 18 March 2022

David Phillip Wood, Catherine A. Robinson, Rajan Nathan and Rebecca McPhillips

Despite repeated policy initiatives, progress in improving patient safety in the National Health Service (NHS) in England over the past two decades has been slow. The NHS

Abstract

Purpose

Despite repeated policy initiatives, progress in improving patient safety in the National Health Service (NHS) in England over the past two decades has been slow. The NHS Patient Safety Strategy (NHS England and NHS Improvement, 2019), which is being implemented currently, aims to address this problem. The purpose of this study is to identify learning from the implementation of past patient safety policies and thereby suggest means of supporting the NHS in delivering the current policy initiative successfully.

Design/methodology/approach

The authors identified key health policies in the domain of patient safety, published since 2000, by searching the United Kingdom (UK) government website. Discussion papers from the research literature concerning these policies were collated and reviewed. The authors then used a thematic analysis approach to identify themes discussed within these papers. These themes represent factors that support the effective delivery of patient safety policy initiatives.

Findings

Within the discussion papers the authors collated, concerning 11 patient safety policies implemented between 2000 and 2017, five inter-related core themes of capability, culture, systems, candour and leadership were identified. By evaluating these themes and identifying composite sub-themes, a conceptual framework is presented that can be used to support the delivery of patient safety policy initiatives to maximise their impact.

Originality/value

The conceptual framework the authors illustrate, arising from this new contribution to the body of knowledge, can be translated into a novel self-assessment for individual NHS trusts to understand organisational development areas in the domain of patient safety improvement.

Details

Journal of Health Organization and Management, vol. 36 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 18 October 2021

Jiju Antony, James Lancastle, Olivia McDermott, Shreeranga Bhat, Ratri Parida and Elizabeth A. Cudney

The purpose of this paper is to conduct an empirical study derived from the previous literature from the perspective of benefits, tools and techniques, continuous…

351

Abstract

Purpose

The purpose of this paper is to conduct an empirical study derived from the previous literature from the perspective of benefits, tools and techniques, continuous improvement (CI) and quality improvement (QI) methodologies and critical failure factors (CFFs) of Lean and Six Sigma (SS) in the national health service (NHS).

Design/methodology/approach

A literature review was carried out to identify previous findings, empirical data and critical variables concerning Lean and SS in healthcare for over ten years. Second, primary research in quantitative surveys and qualitative interviews was carried out with 110 participants who have experience using Lean and SS in the NHS.

Findings

Lean and SS have evolved into common practices within the NHS and now have an established list of tools and techniques frequently employed by staff. Lean and SS are considered robust CI methodologies capable of effectively delivering extensive benefits across many different categories. The NHS must overcome a sizable amount of highly important CFFs and divided organizational culture.

Originality/value

This paper has developed the most extensive empirical study ever produced on Lean and SS in the NHS and has expanded on previous works to create new and updated research. The findings produced in this paper will assist NHS medical directors and practitioners in obtaining up-to-date insight into Lean and SS status in the NHS. The paper will also guide the NHS to critically evaluate their current CI strategy to ensure long-term sustainability and deliver improved levels of service to patients.

Details

International Journal of Quality & Reliability Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0265-671X

Keywords

1 – 10 of over 13000