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Cascón-Pereira R, Kirkpatrick I, Exworthy M. [The status of the medical profession: reinforced or challenged by the new public management?]. GACETA SANITARIA 2016; 31:273-275. [PMID: 27751642 DOI: 10.1016/j.gaceta.2016.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 11/29/2022]
Abstract
This article aims to assess if the status of the medical profession has been reinforced or weakened with the new public management. With this purpose, it collects the opinion of two international experts regarding situation in the United Kingdom, in order to apply some lessons to the Spanish case. Both agree that, far from losing status and power with the healthcare reform, the medical profession has protected its status and autonomy against other social agents such as managers, politicians and patients. However, the maintenance of the status quo has been at the expense of an intra-professional stratification that has caused status inequalities linked to social class within the medical profession.
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Affiliation(s)
- Rosalía Cascón-Pereira
- Departamento de Gestión de Empresas, Universidad Rovira i Virgili, Reus (Tarragona), España.
| | - Ian Kirkpatrick
- Warwick Business School, University of Warwick, Coventry, UK
| | - Mark Exworthy
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Kristensen SR, McDonald R, Sutton M. Should pay-for-performance schemes be locally designed? Evidence from the Commissioning for Quality and Innovation (CQUIN) Framework. J Health Serv Res Policy 2014; 18:38-49. [PMID: 24121835 DOI: 10.1177/1355819613490148] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES It is increasingly recognized that the design characteristics of pay-for-performance schemes are important in determining their impact. One important but under-studied design aspect is the extent to which pay-for-performance schemes reflect local priorities. The English Department of Health White Paper High Quality Care for All introduced a Commissioning for Quality and Innovation (CQUIN) Framework from April 2009, under which local commissioners and providers were required to negotiate and implement an annual pay-for-performance scheme. In 2010/2011, these schemes covered 1.5% (£ 1.0 bn) of NHS expenditure. Local design was intended to offer flexibility to local priorities and generate local enthusiasm, while retaining good design properties of focusing on outcomes and processes with a clear link to quality, using established indicators where possible, and covering three key domains of quality (safety; effectiveness; patient experience) and innovation. We assess the extent to which local design achieved these objectives. METHODS Quantitative analysis of 337 locally negotiated CQUIN schemes in 2010/2011, along with qualitative analysis of 373 meetings (comprising 800 hours of observation) and 230 formal interviews (audio-recorded and transcribed verbatim) with NHS staff in 12 case study sites. RESULTS The local development process was successful in identifying variation in local needs and priorities for quality improvement but the involvement of frontline clinical staff was insufficient to generate local enthusiasm around the schemes. The schemes did not in general live up to the requirements set by the Department of Health to ensure that local schemes addressed the original objectives for the CQUIN framework. CONCLUSIONS While there is clearly an important case for local strategic and clinical input into the design of pay-for-performance schemes, this should be kept separate from the technical design process, which involves defining indicators, agreeing thresholds, and setting prices. These tasks require expertise that is unlikely to exist in each locality. The CQUIN framework potentially offered an opportunity to learn how technical design influenced outcome but due to the high degree of local experimentation and little systematic collection of key variables, it is difficult to derive lessons from this unstructured experiment about the impact and importance of different technical design factors on the effectiveness of pay-for-performance. Balancing the policy goal of localism with the objective of improving patient outcomes leads us to conclude that a somewhat firmer national framework would be preferable to a fully locally designed framework.
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Affiliation(s)
- Søren Rud Kristensen
- Research Fellow, Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, UK
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Garcia C, Kelley CM, Dyck MJ. Nursing home recruitment: trials, tribulations, and successes. Appl Nurs Res 2013; 26:136-8. [PMID: 23522734 DOI: 10.1016/j.apnr.2013.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/02/2012] [Accepted: 01/21/2013] [Indexed: 11/17/2022]
Abstract
Many challenges are inherent when conducting research in the older adult population as well as in the nursing home environment. The safety and quality of care provided in nursing homes need further examination through research. The purpose of this paper is to discuss research issues and recruitment barriers experienced by a research team collecting data for a study assessing the education and learning needs of nursing home nurses in central Illinois and related resident outcomes. Research barriers identified in this study include organizational and administrative barriers in addition to staff barriers. The strategy that was most helpful in gaining access to nursing homes in central Illinois was face to face contact. Future nursing home researchers are encouraged to familiarize themselves with the nursing home environment, communicate with nursing home trade associations, and develop personal contacts with area nursing home administrators.
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Affiliation(s)
- Christina Garcia
- Saint Francis Medical Center College of Nursing, Peoria, IL, USA.
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Executive management in radical change—The case of the Karolinska University Hospital merger. SCANDINAVIAN JOURNAL OF MANAGEMENT 2011. [DOI: 10.1016/j.scaman.2010.08.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Buckwalter KC, Grey M, Bowers B, McCarthy AM, Gross D, Funk M, Beck C. Intervention research in highly unstable environments. Res Nurs Health 2009; 32:110-21. [PMID: 19035619 DOI: 10.1002/nur.20309] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article highlights issues and presents strategies for conducting intervention research in highly unstable environments such as schools, critical care units, and long-term care facilities. The authors draw on their own experiences to discuss the challenges that may be encountered in highly unstable settings. The concept of validity provides a framework for understanding the value of addressing the many methodological issues that can emerge in settings characterized by instability. We explain unstable environments by elaborating on knowable elements that contribute to instability. Strategies are provided for improving success of intervention research in unstable settings by carrying out an environmental assessment prior to beginning a study.
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Yano EM. The role of organizational research in implementing evidence-based practice: QUERI Series. Implement Sci 2008; 3:29. [PMID: 18510749 PMCID: PMC2481253 DOI: 10.1186/1748-5908-3-29] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Accepted: 05/29/2008] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Health care organizations exert significant influence on the manner in which clinicians practice and the processes and outcomes of care that patients experience. A greater understanding of the organizational milieu into which innovations will be introduced, as well as the organizational factors that are likely to foster or hinder the adoption and use of new technologies, care arrangements and quality improvement (QI) strategies are central to the effective implementation of research into practice. Unfortunately, much implementation research seems to not recognize or adequately address the influence and importance of organizations. Using examples from the U.S. Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI), we describe the role of organizational research in advancing the implementation of evidence-based practice into routine care settings. METHODS Using the six-step QUERI process as a foundation, we present an organizational research framework designed to improve and accelerate the implementation of evidence-based practice into routine care. Specific QUERI-related organizational research applications are reviewed, with discussion of the measures and methods used to apply them. We describe these applications in the context of a continuum of organizational research activities to be conducted before, during and after implementation. RESULTS Since QUERI's inception, various approaches to organizational research have been employed to foster progress through QUERI's six-step process. We report on how explicit integration of the evaluation of organizational factors into QUERI planning has informed the design of more effective care delivery system interventions and enabled their improved "fit" to individual VA facilities or practices. We examine the value and challenges in conducting organizational research, and briefly describe the contributions of organizational theory and environmental context to the research framework. CONCLUSION Understanding the organizational context of delivering evidence-based practice is a critical adjunct to efforts to systematically improve quality. Given the size and diversity of VA practices, coupled with unique organizational data sources, QUERI is well-positioned to make valuable contributions to the field of implementation science. More explicit accommodation of organizational inquiry into implementation research agendas has helped QUERI researchers to better frame and extend their work as they move toward regional and national spread activities.
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Affiliation(s)
- Elizabeth M Yano
- Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center of Excellence for the Study of Healthcare Provider Behaviour, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA.
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Abstract
The author discusses a service innovation that was intended to create “woman-centered” maternity care in U.K. health care. This innovation has now fallen into disuse. The author explores and offers a partial explanation for this failure. An unacknowledged contribution to the failure of this innovation was the power of myth. The author's perspective on this service innovation implies that a deeper grasp of the relevance of myth in creating meaning for service providers on the part of the innovators would be invaluable. For if service innovation is set up without taking into account the meaning given by employees to any changes, there will be a likelihood that implementation of the innovation will be impeded. The author recommends that narrative analysis of shared, interactively created discourses be used to gain insight into mooted changes. This approach, provided as a worked example in this article, is relevant to service managers and innovators in a range of professional settings.
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Abstract
The purpose of this article is to explore the social context and meanings of autonomy to physical therapy. Professional autonomy is a social contract based on public trust in an occupation to meet a significant social need and to preserve individual autonomy. Professional autonomy includes control over the decisions and procedures related to one's work (technical autonomy) and control over the economic resources necessary to complete one's work (socioeconomic autonomy). Professional autonomy is limited and weakened by the relationship of one profession to another (dominance), by the influence of other social institutions (rationalization and de-professionalization), and by the internal disposition of the profession itself (insularity). Professional autonomy for physical therapists is increasing as medical dominance has declined but is limited by the trends of rationalization and de-professionalization in health care. Physical therapists must recognize that professional autonomy represents a social contract based on public trust and service to meet the health needs of people who are experiencing disablement in order to maintain their individual autonomy.
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Affiliation(s)
- Robert W Sandstrom
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
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Rhodes M, Ashcroft R, Atun RA, Freeman GK, Jamrozik K. Teaching evidence-based medicine to undergraduate medical students: a course integrating ethics, audit, management and clinical epidemiology. MEDICAL TEACHER 2006; 28:313-7. [PMID: 16807168 DOI: 10.1080/01421590600624604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A six-week full time course for third-year undergraduate medical students at Imperial College uniquely links evidence-based medicine (EBM) with ethics and the management of change in health services. It is mounted jointly by the Medical and Business Schools and features an experiential approach. Small teams of students use a problem-based strategy to address practical issues identified from a range of clinical placements in primary and secondary care settings. The majority of these junior clinical students achieve important objectives for learning about teamwork, critical appraisal, applied ethics and health care organisations. Their work often influences the care received by patients in the host clinical units. We discuss the strengths of the course in relation to other accounts of programmes in EBM. We give examples of recurring experiences from successive cohorts and discuss assessment issues and how our multi-phasic evaluation informs evolution of the course and the potential for future developments.
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Sales A, Smith J, Curran G, Kochevar L. Models, strategies, and tools. Theory in implementing evidence-based findings into health care practice. J Gen Intern Med 2006; 21 Suppl 2:S43-9. [PMID: 16637960 PMCID: PMC2557135 DOI: 10.1111/j.1525-1497.2006.00362.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This paper presents a case for careful consideration of theory in planning to implement evidence-based practices into clinical care. As described, theory should be tightly linked to strategic planning through careful choice or creation of an implementation framework. Strategies should be linked to specific interventions and/or intervention components to be implemented, and the choice of tools should match the interventions and overall strategy, linking back to the original theory and framework. The thesis advanced is that in most studies where there is an attempt to implement planned change in clinical processes, theory is used loosely. An example of linking theory to intervention design is presented from a Mental Health Quality Enhancement Research Initiative effort to increase appropriate use of antipsychotic medication among patients with schizophrenia in the Veterans Health Administration.
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Affiliation(s)
- Anne Sales
- VA Puget Sound Health Care System and Department of Health Services, University of Washington, Seattle, WA 98108, USA.
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Kiefe CI, Sales A. A state-of-the-art conference on implementing evidence in health care. Reasons and recommendations. J Gen Intern Med 2006; 21 Suppl 2:S67-70. [PMID: 16637964 PMCID: PMC2557139 DOI: 10.1111/j.1525-1497.2006.00366.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Braithwaite J, Westbrook MT, Iedema RA. Giving Voice to Health Professionals' Attitudes About Their Clinical Service Structures in Theoretical Context. HEALTH CARE ANALYSIS 2005; 13:315-35. [PMID: 16435468 DOI: 10.1007/s10728-005-8128-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Within the context of structural theories this paper examines what health professionals say about their clinical service structures. We firstly trace various conceptual perspectives on clinical service structures, discussing multiple theoretical axes. These theories question whether clinical service structures represent either superficial or more profound changes in hospitals. We secondly explore which view is supported though a content analysis of the free text responses of 111 health professionals (44 doctors, 45 nurses and 22 allied health practitioners) about their clinical service structures in a questionnaire survey in two large hospitals that had implemented clinical service structures three years previously. Commentaries unfavourable toward clinical service structures were made by 47.7% of staff, favourable by 24.3%, mixed (both favourable and unfavourable) by 17.1% and non-evaluative statements were made by 10.8%. The most frequent criticisms were inefficient organisation of change (27%), poor management (24.3%), lack of cooperation between staff (15.9%) and failure to empower health practitioners (13.5%). All professions made more negative than positive evaluations of their clinical service structures but the ratio was highest for doctors and lowest for allied health. Ranking of nurses' and allied health staffs' specific evaluations were similar but both differed significantly from doctors'. Unfavourable or negative comments predominated, and change appears more superficial and less profound than advocates of structural contributions hope. Four types of belief systems about clinical service structures are apparent. Some study participants are disposed toward the status quo; others toward restructuring; yet others are team oriented; and a final group is tribally oriented. The implication of this paper for managers is that more work is needed if clinical service structures are to realise the promise of more multi-disciplinarity and less fragmentation across professional groups. For scholars, the implication is that marrying different theoretical frames with empirical data can serve to produce fresh perspectives and perhaps new insights.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Clinical Governance Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
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Braithwaite J, Westbrook M. Rethinking clinical organisational structures: an attitude survey of doctors, nurses and allied health staff in clinical directorates. J Health Serv Res Policy 2005; 10:10-7. [PMID: 15667699 DOI: 10.1177/135581960501000105] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine assumptions made by proponents and critics of clinical directorate (CD) structures in hospitals. Proponents argue that CDs are supported by the health professionals who constitute them and confer organisational and clinical benefits compared with traditional structural configurations. Critics deny these benefits and suggest CDs can compromise clinicians by incorporating them into management, to their cost. We investigated the attitudes of health professionals working in CDs to gather and consider evidence for these claims. METHODS A questionnaire survey of 227 health professionals (78 doctors, 89 nurses and 60 allied health) in two large hospitals in Australia that had implemented CDs three years previously. RESULTS Respondents were more negative than positive about CDs. Significant attitudinal differences were found between professions. Doctors were the most negative and held their attitudes with the greatest certainty and intensity. Allied health staff were the most positive but their attitudes tended to lack strength or certainty. Nurses' attitudes were polarised and intense but more positive than were doctors'. Increased organisational politics was cited by 58% of respondents as CDs' most frequent effect, followed by improved accountability (48%) and dumping hard decisions on staff (39%). Only 26% thought patient care had improved. CONCLUSIONS Clinical directorates were designed to promote team approaches and to improve patient care delivery, but the results call for a rethink of what can be expected from structural reforms in organisations.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Clinical Governance Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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Fulop N, Protopsaltis G, King A, Allen P, Hutchings A, Normand C. Changing organisations: a study of the context and processes of mergers of health care providers in England. Soc Sci Med 2005; 60:119-30. [PMID: 15482872 DOI: 10.1016/j.socscimed.2004.04.017] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper presents findings from a study of the context and processes of provider mergers in the NHS in England. Mergers are an example of organisational restructuring, a key lever for change in the UK health care sector and elsewhere, although it is only one strategy for organisational change. The framework for the study is key themes from the organisational change literature: the complexity of the effects of change; the importance of context; and the role of organisational culture. The drivers for health care mergers and the evidence for these are analysed. Using documentary analysis and in-depth qualitative interviews with internal and external stakeholders, the first part of the paper reports on stated and unstated drivers in nine mergers. This provides the context for four in-depth case studies of the process of merger in the second and third years post-merger. Our study shows that the contexts of mergers, including drivers of change, are important. Merger is a process without clear boundaries, and this study shows problems persisting into the third year post-merger. Loss of management control and focus led to delays in service developments. Difficulties in the merger process included perceived differences in organisational culture and perceptions of 'takeover' which limited sharing of 'good practice' across newly merged organisations. Merger policy was based on simplistic assumptions about processes of organisational change that do not take into account the dynamic relationship between the organisation and its context and between the organisation and individuals within it. Understanding the process of merger better should lead to a more cautious approach to the likely gains, provide understanding of the problems that are likely in the period of change, and anticipate and avoid harmful consequences.
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Affiliation(s)
- Naomi Fulop
- Health Services Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Mann KV, Ruedy J, Millar N, Andreou P. Achievement of non-cognitive goals of undergraduate medical education: perceptions of medical students, residents, faculty and other health professionals. MEDICAL EDUCATION 2005; 39:40-8. [PMID: 15612899 DOI: 10.1111/j.1365-2929.2004.02031.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Professionalism is increasingly emphasised in medical education. Non-cognitive goals, including values, attitudes and skills, remain challenging to define and measure. The purpose of this study was to better understand these goals and their achievement in the MD programme. METHODS Graduating medical students, faculty preceptors, residents and other health professionals (OHPs) completed a systematically developed mailed survey, rating achievement of 25 attribute statements. Following analyses of means and standard deviations, factor analysis of responses was conducted. Responses were compared across respondent groups. RESULTS The overall response rate was 50.1% (191/396), comprising 57.5% of the students, 54.1% of the faculty members, 30.9% of the residents and 50% of the OHPs. Five items received mean ratings over 4/5; none were below 3/5. Five factors explained 65% of variance. They were: 'Teamwork and interprofessional skills'; 'Duty and responsibility'; 'Communication and interpersonal skills'; 'Professionalism and values', and 'Trustworthiness and ethical behaviour'. The groups differed significantly on 2 factors: Teamwork and interprofessional skills (P < or = 0.0001) and Communication and interpersonal skills (P < or = 0.001). CONCLUSIONS Important curriculum goals received high mean ratings. Ratings differed significantly across groups, suggesting differing perceptions of the extent to which goals were met. More study is needed to understand the basis of these perceptions.
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Affiliation(s)
- Karen V Mann
- Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4H7, Canada.
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Cereste M, Doherty NF, Travers CJ. An investigation into the level and impact of merger activity amongst hospitals in the UK's National Health Service. J Health Organ Manag 2003; 17:6-24. [PMID: 12800277 DOI: 10.1108/14777260310469283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since 1990 the National Health Service (NHS) has undergone a sustained period of change. This change has been necessary to prepare the NHS for the task of meeting a demand for services that continues to rise more rapidly than the availability of resources. Anecdotal evidence suggests that one of the most popular ways for trusts to improve their ability to meet demand is through mergers with other trusts. However, little rigorous research has been conducted to assess the extent or effectiveness of this strategy. A research project was, therefore, initiated to better understand the extent and impact of merger activity within the NHS. A questionnaire was developed and distributed to the chief executive, finance director, medical director and human resources director in all the 460 trusts that are currently members of the NHS confederation. In total the survey generated 459 responses out of a possible total of 1,840; an encouraging response rate of 25 per cent. The results of this research provide significant new evidence that "merger mania" has taken hold within the NHS. While 46 per cent of all responding trusts indicated that they had already merged, are actively involved in a merger, proposing to merge or are talking to prospective partners, a further 18.7 per cent of all trusts are forming strategic alliances rather than opting for a full merger. The dominant justification for merging are the beliefs that it will facilitate the reconfiguration of services and ultimately improve patient care. The paper concludes with a discussion of the significance of these results, before making recommendations with regard to their implications for future merger activity within the NHS.
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Affiliation(s)
- Marco Cereste
- Business School, Loughborough University, Loughborough, UK
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Kingma M. Economic incentive in community nursing: attraction, rejection or indifference? HUMAN RESOURCES FOR HEALTH 2003; 1:2. [PMID: 12904253 PMCID: PMC166116 DOI: 10.1186/1478-4491-1-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2003] [Accepted: 04/14/2003] [Indexed: 05/18/2023]
Abstract
BACKGROUND: It is hard to imagine any period in time when economic issues were more visible in health sector decision-making. The search for measures that maximize available resources has never been greater than within the present decade. A staff payroll represents 60%-70% of budgeted health service funds. The cost-effective use of human resources is thus an objective of paramount importance.Using incentives and disincentives to direct individuals' energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas. CONCLUSION: Understanding the value system of community nurses and how they respond to economic incentives/disincentives facilitates the development of reward systems more likely to be relevant and strategic. If nurse rewards are to become more effective organizational tools, the data suggest that future initiatives should:bullet; Improve nurses' salary/income relativities (e.g. comparable pay/rates);bullet; Provide just compensation for job-related expenses (e.g. petrol, clothing);bullet; Introduce promotional opportunities within the clinical area, rewarding skill and competence development;bullet; Make available a range of financed rewards.- Direct (e.g. subsidized education, additional leave, insurance benefits);- Indirect (e.g. better working conditions, access to professional support network, greater participation in decision-making bodies).
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Affiliation(s)
- Mireille Kingma
- Nursing and Health Policy, International Council of Nurses, Geneva, Switzerland.
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Affiliation(s)
- Kieran Walshe
- Manchester Centre for Healthcare Management, University of Manchester, Devonshire House, University Precinct Centre, Oxford Road, Manchester M13 9PL, UK.
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Affiliation(s)
- Kieran Walshe
- Manchester Centre for Healthcare Management, University of Manchester, Devonshire House, University Precinct Centre, Oxford Road, Manchester M13 9PL, UK.
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Peck E, Hills B. Provider arrangements for mental health services in 'The New NHS'. HEALTH & SOCIAL CARE IN THE COMMUNITY 2000; 8:325-335. [PMID: 11560703 DOI: 10.1046/j.1365-2524.2000.00257.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Mental health services in England, in common with many other European countries, have been the subject of sustained government attention during the 1990s. Since the election of the Labour administration in Britain in May 1997, mental health services have been discussed in most Department of Health documents on health and social care policy, and mental health services in England have a new national strategy. At the same time, the local provision of mental health services within NHS Trusts has been undergoing organisational change. This paper sets out the policy context and evidence base for the reorganisation of provider arrangements for mental health services. In addition, the results of a documentary analysis of unpublished reviews of provider arrangements in 10 localities are presented. The review identified three major themes: firstly, the reconfiguration of NHS Trusts is based around Specialist Mental Health Trusts and Community and Mental Health Trusts; secondly, the joint provision of services and/or the integration of services between health and social services is starting to appear and; thirdly, the delegation of responsibility to localities based on Primary Care Group/Social Services boundaries is being discussed. The paper discerns a number of trends and points to the need for further research, in particular into the relationship between organisational arrangements and effective service delivery.
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Affiliation(s)
- Edward Peck
- Institute for Applied Health and Social Policy, King's College London andCentre for Mental Health Services Development, Institute for Applied Health and Social Policy, King's College London
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