Search results

Presents the results of a study which was undertaken to establish best practice in the management of a pathology department through best practice. The study was carried out in two stages: an in‐depth analysis of the pathology department through a SWOT analysis and in‐depth interviews with 25 key internal and external customers, and a survey of NHS laboratories both in the UK and Ireland by targeting a sample of consultant pathologists in 50 random locations – the purpose of this questionnaire was an attempt at establishing best practice in pathology quality management. The study revealed that in pathology there is currently a major dependency on quality control that reflects a compliance to set standards laid down by professional bodies. It also identified a poor understanding of customer needs and expectations, a mechanistic culture which is resistant to change, and a reluctance by pathology managers to delegate ownership for ongoing quality improvement or to take responsibility for quality improvement issues such as waste reduction and cost improvement. Concludes with a set of recommendations geared towards helping managers of pathology services to deal with issues such as cost of quality, listening to customers, empowering employees and getting the job done right the first time and every time.

Clinical Pathology Accreditation is a UK‐based scheme for the accreditation of pathology services. It was established 5 years ago and has now been adopted by over two thirds of UK laboratories. It offers a complete system for quality assurance and differs from standards such as EN 45001:1989 by focusing on the pre‐ and post‐analytical aspects of pathology, as well as the actual analysis. Tangible benefits for participants have included staffing and accommodation changes, together with a fresh focus for laboratory management and quality assurance activities. Problems with clinical pathology accreditation are inherently part of its reliance on peer review, but these are thought to be outweighed by the benefits. It seems that the scheme is capable of producing a real improvement in service.

The purpose of this paper is to adapt a causal modelling approach to investigate the organisational collaboration and information technology (IT) project management issues concerning the planning and adoption of inter‐organisational IT systems across NHS hospital pathology departments.

The researchers adopted an interpretive research approach utilising qualitative methods and in particular template analysis. Themes and categories were initially derived from a review of the literature based on critical success factors from enterprise resource planning (ERP) projects.

A causal loop modelling approach was adapted to define key linkages between success factors. This highlighted virtuous and vicious cycles associated with IT project management and team collaboration – influencing the adoption process of large‐scale integrated IT systems.

Single case studies can be problematic in terms of generalising from the research. The study had a limited number of interview participants due to the focus on strategic management. Future studies could extend the number of stakeholders involved and also focus on end‐users of services, such as clinicians in primary care.

The discussion and conclusions assess the appropriateness and utility of using a causal modelling approach, and an adapted causal loop model, to inform more effective approaches to IT planning, project management, team collaboration and adoption of integrated systems.

The findings indicate that a more enhanced understanding of project team collaboration involving technical, administrative and clinical stakeholders has the potential to inform more effective strategies for modernisation of hospital clinical services such as pathology.

This study investigates the anatomy of a high‐profile IT project under the umbrella of strategic modernisation of health services. Privileged access to key stakeholders has enabled the development of a causal model for IT project collaboration and management. This will form the basis for further development of more refined models to enhance project outcomes in the future.

Orthopaedics, rheumatology, pain management, specialist radiology and therapy services were brought under one umbrella to form Northwest Surrey integrated musculoskeletal (IMSK) services and introduced advance clinical practice, a multi-disciplinary team triage with a formalised straight to test (STT) process defined in 2018. Historically, prior to these services' integration, there were a primary and second care triage systems within individual specialities. The aim of this service evaluation is to assess the impact of a single IMSK multidisciplinary triage (MDT) system and the efficacy of STT from triage, which allows patients to be sent for diagnostics based on the cluster of symptoms and past medical history in order to achieve early identification of serious pathologies. This is a complex adaptive system with pathways spanning into the core areas of orthopaedics, rheumatology, therapies, pain management services, radiology and some less frequent specialities such as neurology, oncology, vascular and gynaecology. One of the objectives of this study was to identify how many referrals were triaged to consultants, Advance practice and therapies. In addition, the authors wanted to highlight the proportion of referrals that were sent straight to test from triage and the percentage of these that had sinister pathology identified. This information would then be compared against existing red flag literature to identify common themes. This study aims to discuss the aforementioned objectives.

Data were extracted retrospectively from a hospital database from January to December 2019 for all the adult musculoskeletal service referrals. The data collected were analysed on a Microsoft Excel sheet with information including date of triage, hospital number, ordering clinician, body part, type of diagnostic, indications for scanning, outcome for STT, serious pathology findings (named code 5 within our trust) and outcome of appointment.

A total of 47,039 referrals were received into the IMSK service. Of these referrals 19,967 were directly referred to therapies, with 27,072 referrals received into the IMSK service MDT process. Within triage, 718 patients were directed to STT to rule out serious pathology. A total of 28 patients (3.9%) had sinister pathology identified on their investigation. A total of 46% of patients were discharged from their first consultation following STT. Overall, 50% of the total number of referrals into the IMSK service was seen by advanced practitioners with 16% of patients directed to consultants with pre-consultation diagnostic work up.

This service evaluation highlights that STT allows early access to diagnostics, resulting in quicker access to identification of sinister pathology. A one stop MDT system has been shown to be effective in guiding the referral to the right place with increased referrals into allied health advance practice clinics and access to therapies directly. It has resulted in a reduction of unwarranted referrals to consultant care, duplication of investigations and identified patients on multiple pathways.

Using the framework of second‐order cybernetics, explores the institutional practices which lead to inadvertent pathologies of communication. As an example, a certain university regularly carries out large‐scale surveys of student attitudes towards its courses. Three interested parties are the researchers, senior management concerned with quality, and faculty members who produce the courses. All agree the surveys should be carried out, but there are no guarantees that the survey findings are appropriately interpreted and acted on. This kind of scenario is common in large institutions. Second‐order cybernetics offers a theoretical framework that can shed light on these communicative practices and help unpack them in a way that is “politically” neutral. It can also help foster reflective practice in the spirit of action research and “action learning”. Presents case histories of pathologies and gives an example of how pathologies of communication may prevent relevant research being undertaken.

This paper sets out to evaluate the potential of financial performance benchmarking as an expenditure control tool for a national pathology service comprising both public and private service providers.

Primary data were provided by direct consultation with a wide range of stakeholders, whose experience and perspectives were sought primarily through informal face‐to‐face interviews. The authors analyse these informant contributions alongside official reports and the published literature on dual public‐private health service provision.

Informants identified potential advantages and pitfalls in comparative pathology benchmarking for expenditure control. They also identified some significant negative implications for health service quality and suggested related compromises. Often misunderstood cost benchmarking issues are clarified in the paper.

Several areas of importance for further investigation are suggested.

The paper concludes that appropriate performance benchmarking can be applied to New Zealand pathology services as a useful service rationalisation tool and a realistic price‐signalling device, provided that certain safeguards on health service quality are in place.

General issues complicating financial performance benchmarking across sectors in a mixed economy for health service provision are identified for the guidance of researchers, decision‐makers and planners.

This paper describes how Finnish women and men pathologists account for their career choices. Finland has a gender‐balanced medical profession, but pathology has of all specialties the lowest proportion of women (28 per cent), except surgery. Nine men and nine women pathologists were interviewed in order to find out the reasons for having chosen a non‐patient specialty and if gender matters concerning performance and organisation of this occupation. In men’s accounts, the embedded character of gender rendered it invisible. The blindness of the male respondents to the related peer network and mentor system results in them supposing that their choice of specialty unfolds as though “by chance”. By contrast, the women whom we interviewed described their career choices as due to self‐selection. Women saw themselves as active agents, while men did not. A theoretical framework is presented for understanding women’s and men’s orientation to the gender division of labour and the gendered structures in medicine.

The aim of this paper is to assess highly toxic leaders and dysfunctional organizations as presented via management consulting and executive coaching assignments.

The paper employs an action research approach via two participant observer case studies incorporating the DSM IV‐TR: Diagnostic and Statistical Manual of Mental Disorders.

The paper finds that the nexus of dysfunctional organizational systems may be located in “pre‐existing” leadership pathologies.

First, additional research will be needed to confirm and extend the findings of individual pathologies in leaders to dysfunctional organizational systems; second, a closer look is necessary at the applicability of the DSM IV‐TR to pathologies at the organizational level; third, due to the action research, case study approach utilized, there is somewhat limited generalizability; fourth, there are limitations re: the applicability of DSM IV‐TR as an assessment tool for management researchers due to the necessity of training in clinical psychology.

The importance of distinguishing personality disorders in leaders from toxic behaviors falling within a range of “normal pathology,” and the ability to assess individual leadership pathology within organizational systems via the clinically trained usage of the DSM IV‐TR; providing clinical assessment tools for reducing the number of misdiagnoses of leadership pathology in the workplace; encouraging collaboration between management and psychology researchers and practitioners.

This paper fills a gap in the toxic organizations research by identifying personality disorders in leaders and providing an action research agenda for incorporating the DSM IV‐TR as a means of extending the repertoire of assessment tools;

The current political emphasis directing thinking in the British National Health Service towards an organisational climate in which competition is positively encouraged, is likely, sooner rather than later, to cause general managers to look more closely at their pathology services.

Speech pathology services have not been traditionally provided within school classroom settings. This chapter will describe the service-delivery options for provision of speech pathology services in classroom settings. A review of select research related to the efficacy of these services is included as applied examples for educators.