Search results

This paper reviews the evidence base for vertical integration in health care. We describe its impact on organisational structures, on how services are provided, and on such outcomes as cost, clinical outcomes and patient experience. We also outline conditions that support successful integration.

Using the example of medication safety, this paper aims to explore the impact of three managerial interventions (adverse incident reporting, ward‐level support by pharmacists, and a medication safety subcommittee) on different professional communities situated in the English National Health Service (NHS).

Semi‐structured interviews were conducted with clinical and managerial staff from two English NHS acute trusts, supplemented with meeting observations and documentary analysis.

Attitudes toward managerial intervention differ by professional community (between doctors, nurses and pharmacists) according to their existing norms of safety and perceptions of formal governance processes.

The heterogeneity of social norms across different professional communities and medical specialties has implications for the design of organisational learning mechanisms in the field of patient safety.

The paper shows that theorisation of professional “resistance” to managerialism privileges the study of doctors' reactions to management with the consequent neglect of the perceptions of other professional communities.

The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS).

To analyse these multi-level dynamics, the authors blend Rogers’ diffusion of innovations theory (DoIT) with Webster’s sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts.

Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application – in particular speed, ease of use, reliability and flexibility and levels of readiness – were highly relevant but their influence was modulated through interaction with complex structural and relational issues.

Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of “co-construction” between designers and end-users.

The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.

In 1840 the ancient city of Brechin was the kind of community which was ceasing to be important. It was a market town of some 6000 people set in the fertile countryside of Angus in North East Scotland. During the Age of Improvement market towns had become wealthy by selling hitherto novel and expensive goods and services to the surrounding countrypeople who purchased them with the profits of capitalistic agriculture. Now the initiative was slipping away to cities like nearby Dundee and the emergent industrial centres of the central belt of Scotland. Nevertheless the town had a flax mill, a bleachfield, several linen works and two distilleries. There was also work for nine ministers, nine lawyers and nine doctors. The ministers and lawyers were particularly important: the former propounded rival arguments about church government, the latter formalised and interpreted the resulting conflicts. Their part in this cameo of library history calls for some explanation.

A conceptual framework for collaboratively based integrated health and social care (IHSC) integration is proposed to aid in understanding how to accomplish IHSC.

This model is based on extant literature of successfully IHSC initiatives.

The model aims to identify enabling integration factors that support collaborative integration efforts between healthcare and social services organizations. These factors include shared goals and vision, culture, leadership, team-based care, information sharing and communications, performance measurement and accountability agreements, and dedicated resources and financing. It also identifies factors that act as external influencers that can support or hinder integration efforts among collaborating organizations. These factors are geographic setting, funding models, governance structures, and public policies. These factors are intended to ensure that a realist lens is applied when trying to understand and explain IHSC.

This model is intended to provide a framework to support research, policy and implementation efforts.

The following admirable letter from MR. G. BOOTH‐HEMING, the Ex‐Mayor of the City of Westminster, has been published by the Daily Telegraph. The eminently sane views and the timely warnings it contains should give pause to the foolish advocates of false “economy” and the hysterical preachers of indiscriminate “retrenchment”:—

The laws directed against adulteration and fraudulent or unfair dealing have undoubtedly done much good wherever they have been enforced. Their application in this and in other countries has shown how widespread are these practices and how various are their forms, while the punishment of real offenders, in the by no means large proportion of cases where it has been possible to bring forward sufficient proof of guilt, has certainly not been displeasing to the general public, and must have afforded particular satisfaction to those members of the trading community who have appreciated the injury done to them by unfair or actually dishonest competition.

This chapter outlines the successful community engagement process used by the authors for the Kinship Online project in the context of Indigenous methodological, epistemological, and ethical considerations. It juxtaposes Indigenous and western ways of teaching and research, exploring in greater detail the differences between them. The following chapter builds on and extends Riley, Howard-Wagner, Mooney & Kutay (2013, in press) to delve deeply into the importance of embedding Aboriginal cultural knowledge in curriculum at the university level.

The chapter gives an account of an Office for Learning and Teaching (OLTC) grant to develop Indigenous Online Cultural Teaching and Sharing Resources (the Kinship Online Project). The project is built on an existing face-to-face interactive presentation based on Australian Aboriginal Kinship systems created by Lynette Riley, which is being re-developed as an online cultural education workshop.

A key consideration of the researchers has been Aboriginal community engagement in relation to the design and development of the project. The chapter delves deeply into the importance of embedding Aboriginal cultural knowledge into curriculum at the university level. In doing so, the chapter sets out an Aboriginal community engagement model compared with a western research model which the authors hope will be useful to other researchers who wish to engage in research with Aboriginal people and/or communities.