Search results

The purpose of this paper is to classify and describe the purpose of ward rounds, who attends each round and their role, and participants’ perception of each other’s role during the respective ward rounds.

A literature review of face-to-face ward rounds in medical wards was conducted. Peer reviewed journals and government publications published between 2000 and 2014 were searched. Articles were classified according to the type of round described in the study. Purposes were identified using keywords in the description of why the round was carried out. Descriptions of tasks and interactions with team members defined participant roles.

Eight round classifications were identified. The most common were the generalised ward; multidisciplinary; and consultant rounds. Multidisciplinary rounds were the most collaborative round. Medical officers were the most likely discipline to attend any round. There was limited reference to allied health clinicians and patient involvement on rounds. Perceptions attendees held of each other reiterated the need to continue to investigate teamwork.

A collaborative approach to care planning can occur by ensuring clinicians and patients are aware of different ward round processes and their role in them.

Analysis fulfils a gap in the literature by identifying and analysing the different ward rounds being undertaken in acute medical wards. It identifies the complexities in the long established routine hospital processes of the ward round.

This paper begins by discussing two contrasting approaches to health care. The first approach is that of principlism, which emphasises four universal principles: respect for autonomy; beneficence; non‐maleficence; and justice. The second approach is the ethics of care that emphasise the importance of the relationship between the cared‐for and the one caring, rather than abstract principles. The problems with both of these approaches are highlighted, before arguing that an approach based on virtue ethics is more appropriate and better suited to health care ethics. Finally, by drawing on the conclusions of research undertaken with chronically ill people, the paper explores what this approach might mean for an approach that stresses dignity as a core value in health care ethics.

This viewpoint article discusses and analyses the need and benefits of a patient safety definition within the context of nursing.

This viewpoint article is supported by literature review, statutory documents and expert knowledge evidence. All these sources provided a unified narrative of the background, current aspects and future needs of patient safety.

The need for strengthening patient safety and the nurses' role within healthcare's actions towards patient safety are discussed. The predominant role of nurses due to the proportionate size and significant role along with the need for clarification of patient safety in nursing terms is recognised. Research evidence of nursing areas with safety issues and relevant nursing interventions are presented. Based on all findings, a research-based nursing specific patient safety definition is proposed. This definition includes three axes: what is patient harm, how this harm can be eliminated or reduced and which are the areas of nursing practice that are identified to provide opportunity for patient harm. These axes include nursing specifications of the patient safety definition.

It is the first time that a nurse specific patient safety definition is proposed. This definition strives to enhance nurse practitioners' understanding and engagement with patient safety by clarifying aspects of patient safety within everyday nursing practice.

Research on patient-centred professionalism in pharmacy is scarce compared with other health professions and in particular with pharmacists early in their careers. The purpose of this paper is to explore patient-centred professionalism in early career pharmacists and to describe reported behaviours.

This study explored patient-centred professional values and reported behaviours, taking a qualitative approach. In all, 53 early-career pharmacists, pharmacy tutors and pharmacy support staff, practising in community and hospital pharmacy in England took part; the concept of patient-centred professionalism was explored through focus group interviews and the critical incident technique was used to elicit real-life examples of professionalism in practice.

Triangulation of the data revealed three constructs of pharmacy patient-centred professionalism: being professionally competent, having ethical values and being a good communicator.

It is not known whether our participants’ perspectives reflect those of all pharmacists in the early stages of their careers. The data provide meaning for the concept of patient-centred professionalism. The work could be extended by developing a framework for wider application. Patient-centred professionalism in pharmacy needs further investigation from the patient perspective.

The findings have implications for pharmacy practice and education, particularly around increased interaction with patients.

The data contribute to a topic of importance to patients and in relation to UK health policy, which allocates more directly clinical roles to pharmacists, which go beyond the dispensing and supply of medicines.

The methods included a novel application of the critical incident technique, which generated empirical evidence on a previously under-researched topic.

Patient-centred care and patient involvement are increasingly central concepts in health policy in the UK and elsewhere. However, there is little consensus regarding their definition or how to achieve “patient-centred” care in everyday practice or how to involve patients in service redesign initiatives. The purpose of this paper is to explore these issues from the perspective of key stakeholders within National Health Service (NHS) hospitals in the UK.

Semi-structured interviews, covering a range of topics related to service redesign, were conducted with 77 key stakeholders across three NHS Trusts in the West Midlands. In total, 20 of these stakeholders were re-interviewed 18 months later. Data were managed and analysed using the Framework Method.

While patient-centred care and patient involvement were regularly cited as important to the stakeholders, a gap persisted between values and reported practice. This gap is explained through close examination of the ways in which the concepts were used by stakeholders, and identifying the way in which they were adapted to fit other organisational priorities. The value placed on positive subjective experience changed to concerns about objective measurement of the patients as they move through the system.

Increased awareness and reflection on the conceptual tensions between objective processes and subjective experiences could highlight reasons why patient-centred values fail to translate into improved practice.

The paper describes and explains a previously unarticulated tension in health organisations between values and practice in patient centred care and patient involvement in service redesign.

The purpose of this paper is to describe how Finnish experts perceive future (year 2030) hospital management and leadership.

A total of 33 experts participated in a three-round Argument Delphi process. Opposing views of management and leadership in 2030 were analyzed using inductive content analysis.

The experts’ perceptions were divided into two main categories: management and leadership orientation and future organization. Perceptions relating to management and leadership orientation were classified as relating to patient-centred, clinical dominance, professionally divided and management career options. Perceptions relating to future management and leadership organization were classified as representing shared, pair, team and the individual-centered leadership. The results highlighted the most distinctive issues raised by the participants.

This qualitative study was conducted in the context of Finnish healthcare according to the principles of the Argument Delphi Method. The panel consisted of high-level experts representing a diverse set of roles. However, as suggested in previous literature, these experts may not be the most astute in predicting the future development of hospital organizations.

The findings can be used to develop and renew management and leadership training and management practices in hospitals.

The findings can be exploited in discussions, planning and decision making regarding future management and leadership in hospitals.

Only a few studies have investigated perceptions of future management in hospitals. This study adopted the Argument Delphi Method to identify distinct perceptions on the future orientation and organization of management and leadership in hospitals.

The purpose of this paper is to examine how strategic, patient-centred communication plays a part in the discursive management of expectations posed to patients and healthcare organizations.

The paper provides an analysis of four documents collected as part of an ethnographic case study regarding “The Perspective of the Patient” – a Danish Hospital’s patient-centred communication programme. Mapping methods inspired by Grounded Theory are used to qualify the analysis.

The paper shows that strategic patient-centred communication addresses both a care-oriented approach to the patient and deploys market perceptions of patients. Market and care is seen as co-existing organizing modes that entail expectations to the patient. In the communication programme the patient is constructed in six information-seeking patient figures: affective patient; target group patient; citizen with rights; patient as a competent resource; user as active partner; and consumer. As a result, the patient-centred communication programme renders the patient as a flexible figure able to fit organizational demands of both care orientation and market concerns.

This study contributes to qualitative research in organizational health communication by combining two subfields – patient-centredness and health communication – in an empirical study of how market and care are intertwined in a patient-centred communication programme. The argument goes beyond the prevalent prescriptive approaches to patient-centredness and healthcare communication, instead providing a critical analytical perspective on strategic communication and patient-centredness and showing how expectations are posed to both patient and organization.

Developing ‘patient‐centred’ health services has become a goal in many countries but little work has been done to identify what research is needed to support the development of such services within mental health. The aim of this study was to consult all relevant stakeholder groups to establish research priorities for developing ‘patient‐centred’ mental health services in the UK. More than 1,000 stakeholders were consulted, including service users, carers and mental health professionals. The consultation identified 12 thematic areas requiring further research. These should be prioritised if services are to become more centred on the needs and aspirations of the people who use them.

National Health Service (NHS) Emergency Department (ED) attendances are at the second highest level ever recorded, (RCEM, 2021a) and as they soar, performance plummets, putting patient safety at risk (RCEM, 2021b). Managing patient flow in the ED is critical to reduce patient safety incidents and crowding, however, this needs effective leadership (Jensen and Crane, 2014). This paper aims to introduce an innovative form of managing patient flow in ED, which is a two hourly “Board Rounds”, providing a managed process to pull patients through the system meeting pre-determined time critical standards and preventing patient harm. Board Rounds combined with effective leadership can play a contributory role preventing crowding in the ED.

An evaluation of two hourly ED Board Rounds was undertaken using the hospitals’ ED Board Round Standard Operating Procedure to develop a series of short questions. As leadership is the responsibility of all clinicians (Darzi, 2008; Moscrop, 2012), a separate survey was undertaken for clinicians of all grades and managers to self-assess their own leadership styles using the Path-Goal Leadership Theory (House and Mitchell, 1974; Indvik, 1985; Northhouse, 2013). Findings were reported to the team to explore ideas for improvement not only to develop more effective leadership in the ED but also to raise awareness of how to optimise leadership in Board Rounds.

In total, 27 (n = 27) clinicians and managers reported support for a 2 hourly Board Round, for a period of 15 min, in both minor and major injuries departments in ED. A multi-disciplinary Board meeting, led by the lead nurse with support from the Emergency Physician in Charge, was preferred, locating it at the nurse’s station. A validated Path-Goal Leadership survey instrument was returned (n = 24). The findings reveal that leaders and managers are using a high level of the directive leadership style, where there is more potential to use the supportive, participative and achievement approaches to leadership.

This was a small sample, returned from a Hospital ED located in a semi-rural location, department requiring “improvement” from the Health Regulator. This research would benefit from being undertaken in a medium/large NHS ED department to identify if the findings report on a wider leadership culture in the NHS ED. The implications for this study are that improvement interventions such as a “Board Round” can be usefully evaluated alongside a review of leadership styles and approaches to understand the wider implications for continuous improvement and change in the ED.

NHS EDs are facing unprecedented challenges and require innovative evidence-based solutions combined with leadership at this time. The evidence base for improving patient flow is limited, however, this study provides some initial findings on the positive perception and experience of staff to Board Rounds. Board Rounds combined with leadership has the potential to contribute to the wider strategy to prevent crowding in ED. This paper is the first of its kind to evaluate perceptions of Board Rounds in the ED and to engage clinicians and managers in a self-assessment of their own leadership styles to reflect on optimum leadership styles for use in ED.

This paper seeks to take a patient‐centred perspective in exploring the treatment of multiple and chronic illnesses in inter‐organizational care practice in Finland.

The theoretical approach of the study is based on the sociology of translation and on cultural historical activity theory. The methodology of multi‐locale ethnography is used to research the translations in one patient's healthcare procedures in multiple care settings.

The care procedures emerge as unintegrated for the patient in the study. The patient has to take responsibility for his overall care since the medical professionals involved have only limited knowledge of other providers' care procedures. Despite their efforts to collaborate, professionals are lost in translation across healthcare boundaries.

Single cases are problematic for advancing generalizations on a research topic. The case of this study presents an example of the translations in the care procedures for a patient with multiple and chronic illnesses.

Unintegrated care organization poses a difficult challenge to patient‐centred care if the ideals of consumerism are followed in the health care system. A patient, with limited medical knowledge, may not be able to master an overall pattern of chronic illness care in a sustainable way. Better management and coordination of specialized knowledge are required for patients with chronic illnesses.

In contrast with the many studies that report on patients' experiences of illness, the paper provides new insights into the patient experience of health care organization.