Human resources policies and continuity of care

Strengthening the role of the ward manager: a review of the literature

BACKGROUND

The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care.

AIM

To identify initiatives that have strengthened the ward manager role.

METHODS

A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies.

FINDINGS

Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role.

CONCLUSION

The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position.

IMPLICATIONS FOR NURSING MANAGEMENT

The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems.

Evidence-based policy: implications for nursing and policy involvement

Evidence-based policy making is espoused as a central feature of government in the United Kingdom. However, an expectation that this will improve the quality of policy produced and provide a path to increased involvement of nurses in the policy process is misplaced. The purpose of this article is to demonstrate that the emphasis on evidence-based policy is problematic and cannot be regarded as a "new model" of policy making. Also, it could deflect attention from more practical approaches to policy involvement on the part of nurses. Policy development activities, acquisition of skills in policy analysis, and other forms of involvement are needed if nurses are to move along the continuum from policy literacy, through policy acumen, to policy competence. This involves taking a critical stance on the notion of evidence-based policy.

Exploring project management as a practical solution to long-term care service

The main purpose of this study is to explore the project management methodology as a practical solution for the field of long-term care management. This research was conducted by gathering data from reviewed literature and written documents. The conclusion suggests that project management methodology is applicable for long-term care service implementation. Moreover, the project management methodology discussed in this article could be applied to other Medicare practices to prove its validity in the future.

Patients' perceptions and experiences of 'continuity of care' in diabetes

BACKGROUND

'Continuity of care' is an important aspect of quality. However, definitions are broad and existing models of continuity are not well grounded in empirical data.

OBJECTIVE

To identify patients' experiences and values with respect to continuity in diabetes care.

METHODS

In-depth semi-structured interviews with 25 type 2 diabetic patients from 14 general practices in two inner London boroughs. Interviews were transcribed and responses analysed thematically and grouped into dimensions of continuity of care.

RESULTS

Patients' accounts identified aspects of care they valued that were consistent with four dimensions of experienced continuity of care. These were receiving regular reviews with clinical testing and provision of advice over time (longitudinal continuity); having a relationship with a usual care provider who knew and understood them, was concerned and interested, and took time to listen and explain (relational continuity); flexibility of service provision in response to changing needs or situations (flexible continuity); and consistency and co-ordination between different members of staff, and between hospital and general practice or community settings (team and cross-boundary continuity). Problems of a lack of experienced continuity mainly occurred at transitions between sites of care, between providers, or with major changes in patients' needs.

CONCLUSIONS

The study develops a patient-based framework for assessing continuity of care in chronic disease management and identifies key transition points with problems of lack of continuity. It is important that service 'redesign' and developments in vertically integrated services for chronic disease management take account of impacts on patients' experience of continuity of care.

Exploring the human resource implications of clinical governance

In 1998, clinical governance was introduced in the National Health Service, UK (NHS) as a major policy initiative to improve the quality of clinical care. The implementation of clinical governance is crucially dependent on the skills, competencies and willingness of the NHS staff. In turn, clinical governance influences the way people work in health care organisations. Therefore, it is no surprise that the introduction of clinical governance has thrown-up new challenges for human resource management. However, what are these human resource management challenges under the clinical governance framework? The current literature on the subject provides no answer. This article attempts to fill this gap in the literature. A qualitative approach influenced by phenomenological case study approach has been adopted. A heterogeneous group of 33 persons identified through a purposive sampling procedure were interviewed using a semi-structured format. The results indicate that the staff members appreciate the crucial role of human resources management in the implementation of clinical governance. However, there is little evidence to suggest that senior management is paying attention to develop the human resources function around the clinical governance agenda. The seven major human resource implications of clinical governance that emerged from the data analysis are discussed. The author argues that a more proactive HR approach is needed to make clinical governance everyone's business in the NHS organisations.