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Health services continue to face economic and capacity challenges. Quality improvement (QI) methods that can improve clinical care processes are therefore needed. However, the successful use of current QI methods within hospital settings remains a challenge. There is considerable scope for improvement of elective clinical pathways, such as hip and knee replacement, and so the use and study of QI methods in such settings is warranted.

A model to manage variability was adapted for use as a QI method and deployed to improve a hip and knee replacement surgical pathway. A prospective observational study, with a mixed-methods sequential explanatory design (quantitative emphasised) that consisted of two distinct phases, was used to assess its effectiveness.

Following the use of the novel QI method and the subsequent changes to care processes, the length of hospital stay was reduced by 18%. However, the interventions to improve care process highlighted by the QI method were not fully implemented. The qualitative data revealed that staff thought the new QI method (the model to manage variability) was simple, effective, offered advantages over other QI methods and had highlighted the correct changes to make. However, they felt that contextual factors around leadership, staffing and organisational issues had prevented changes being implemented and a greater improvement being made.

The quality of QI reporting in surgery has previously been highlighted as poor and lacking in prospective and comprehensively reported mixed-methods evaluations. This study therefore not only describes and presents the results of using a novel QI method but also provides new insights in regard to important contextual factors that may influence the success of QI methods and efforts.

The publication of the United Kingdom National Health Service (NHS) Information for Health Strategy heralded a new strategic focus for the provision of information systems (IS) support across the NHS. Key changes concerned the placement of much greater emphasis on clinical information needs by route of the Electronic Patient Record (EPR) and the Electronic Health Record (EHR). The last decade has seen unprecedented changes within the NHS due to government policies, political ideology, health‐care reform and pace of technological progress. This paper argues that this rate and scale of change has outstripped the ability of health‐care organisations to respond effectively in order to implement the key goals set by strategic policy makers. An historical review is combined with an analysis of recent empirical survey data to determine the evolution and progress of the NHS IM&T strategy over a period of ten years. The review and analysis is enabled by adopting techniques and theory derived from research within the field of Information Systems, whereby Information Systems maturity models are used as an heuristic to measure levels of sophistication of IT adoption and use. These models demonstrate that NHS hospitals are fairly immature in terms of the adoption and usage of information systems and technology; struggling to provide adequate foundations for systems integration (data, work and culture). Conclusions reflect on the current progress and ambition of the strategy and comment on its potential outcome given existing NHS knowledge of IT, skills, capability and infrastructure.

The development of a new agricultural chemical product begins with the screening of a large number of compounds (perhaps several thousand) through several stages, each progressively more detailed and specific. Eventually, the field is narrowed down to one compound that comes up for a “go” or “no‐go” decision.

Discusses the NHS Executive′s information management and technology (IM&T) strategy and its relationship to the 1991 reforms. Examines the recommendation for large acute hospitals to adopt integrated hospital information support systems (HISS). Reports that a recent census of these hospitals, undertaken by the authors, suggests that the implementation of the strategy′s recommendations has been slow at the local level. Attempts to diagnose the factors that are impeding implementation, using the evidence provided by the census. Identifies four main problem areas: the lack of success of past IM&T initiatives undermines confidence in the current strategy; the strategy is poorly aligned with other policy initiatives; the legacy of discrete, proprietary information systems within hospitals makes the creation of an integrative information environment difficult to accomplish without massive investment in new systems; and there are implicit contradictions between the following: the absence of a comprehensive post‐implementation evaluation of the economic, technological and cultural feasibility of HISS at any of the three HISS pilot sites; the strategy′s advocacy of HISS as the way forward for large acute hospitals; the requirement for a comprehensive business case to support any substantial investment in IM&T. Concludes that a massive rethink of policy is required, with a much greater emphasis on research, development and independent evaluation.

Modern NHS organisations are seen to be increasingly reliant, in terms of achieving improvements and service targets, on the efficient provision of information to enable clinical, administrative and managerial decision making. A key barrier to effective ICT introduction in NHS trust hospitals has been identified as the complex social, organisational and political issues endemic within the organisation, preventing true discourse amongst key stakeholders. This paper describes how the adaptation of critical social theoretical thinking may be used to develop an innovative approach to participative process and information flow modelling. This approach is used within a hospital trust to investigate its potential as a precursor to ICT procurement and development. Empirical results of the research are described with suggestions for a more informed approach to ICT introduction, leading to a re‐examination of issues concerning: historical context, emancipatory practice and the role of the systems analyst.

This paper aims to contribute to the understanding of the factors that influence small to medium‐sized enterprise (SME) performance and particularly, growth.

This paper utilises an original data set of 360 SMEs employing 5‐249 people to run logit regression models of employment growth, turnover growth and profitability. The models include characteristics of the businesses, the owner‐managers and their strategies.

The results suggest that size and age of enterprise dominate performance and are more important than strategy and the entrepreneurial characteristics of the owner. Having a business plan was also found to be important.

The results contribute to the development of theoretical and knowledge bases, as well as offering results that will be of interest to research and policy communities. The results are limited to a single survey, using cross‐sectional data.

The findings have a bearing on business growth strategy for policy makers. The results suggest that policy measures that promote the take‐up of business plans and are targeted at younger, larger‐sized businesses may have the greatest impact in terms of helping to facilitate business growth.

A novel feature of the models is the incorporation of entrepreneurial traits and whether there were any collaborative joint venture arrangements.

The English National Health Service has undergone unprecedented political, economic and technological change. This has resulted in a requirement for radical improvements in operational efficiency and effectiveness. An effective IT infrastructure supporting key operational processes and management reporting is now seen as essential. This paper outlines the findings from empirical research in a North East hospital Trust. The authors collaborated on a requirements analysis project to investigate and model business processes and information flows using an automated IDEF0 software tool. A participatory action research framework was used, informed by principles derived from critical social theory, to describe the complexity of the situation and provide improved communication amongst stakeholders. The paper concludes by reflecting on the need for more “ideal” speech situations in order to deal with complex operations management problems where political, power and social issues can obstruct effective implementation of new computer‐integrated operations.

The Balanced Scorecard (BSC) emphasizes on the of information system to track a limited number of balanced metrics (measures and indicators) that are closely aligned with organization's goals. This study investigates how system integration in different forms is related to the success of using the BSC for performance measurement. The use of a BSC in performance evaluation is considered in five contexts: determining cost, measuring efficiency, ensuring quality and customer satisfaction measure, promoting continuous innovation and monitoring contract negotiation. The findings indicate that system integration defined in the study positively relates to the success of using the BSC in all five decision perspectives. The findings conclude that hospitals need a streamlined, information integration across the continuum of care to better assess the operation results, in both organizational and technical perspectives.

Adolescent health service provision is an area of growing concern in the UK, where a number of studies have indicated that young people in their teenage years find accessing formal health services difficult. The Bodyzone Project in Oxfordshire is an innovative programme aimed at bringing health services into schools to ensure greater accessibility. This paper reports on the first phase of a programme of evaluation of the Bodyzone Project, involving a cross‐sectional study. Methods used were both qualitative and quantitative to explore student knowledge, attitudes and behaviours with regards to health issues, health services and the Bodyzone service. The results of the study indicate that Bodyzone is a valued service for those who use it and by schools where it is based. However, there is also a clear indication of unmet health promotion and service need amongst students of those schools, which the current configuration of Bodyzone is not able to address fully.

The purpose of this paper is to investigate the evolution of school nursing in the USA in the early decades of the twentieth century, highlighting the linkages between schools and public health and the challenges nurses faced.

This historical essay examines the discussions about school nursing and school nurses’ descriptions of their work.

In the Progressive period, though the responsibilities of school nurse were never clearly defined, nurses quickly became accepted, respected members of the school, with few objecting to their practices. Nonetheless, nurses consistently faced financial complications that limited, and continue to limit, their effectiveness in schools and communities.

Few histories of school health have documented the critical role nurses have played and their important, although contested, position today. This paper points to the obstacles restricting the development of dynamic school nurse programs today.