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Keeping individuals safe from harm and exploitation is a clearly articulated goal within both the health and social care sectors. Two key concepts associated with achieving this common aim are safety and safeguarding. The purpose of this paper is to critically appraise the differences in safety terminology used in health and social care, including opportunities and challenges for greater integration of safety systems across health and social care in England.

This paper presents the authors’ viewpoint based on personal, professional and research experience.

In healthcare, safety is usually conceptualised as the management of error, with risk considered on a universal level. In social care, the safeguarding process balances choice and control with individualised approaches to keeping adults safe, but lacks the established reporting pathways to capture safety incidents. Efforts to safely integrate health and social care services are currently constrained by a lack of shared understanding of the concepts of safety and safeguarding without further consideration of how these approaches to keeping people safe can be better aligned. As such, there is a need for a single, unified discourse of patient safety that cuts across the patient safety and safeguarding concepts and their associated frameworks in health and social care settings.

A single unified concept of safety in health and social care could coincide with an integrated approach to the delivery of health and social care, improving the care of patients transitioning between services.

The purpose of this paper is to investigate how three communication interventions commonly used during discharge planning and care transitions enable inter-professional knowledge sharing and learning as a foundation for more integrated working. These interventions include information communication systems, dedicated discharge planning roles and group-based planning activities.

A two-year ethnographic study was carried out across two regional health and care systems in the English National Health Service, focussing on the discharge of stroke and hip fracture patients. Data collection involved in-depth observations and 213 semi-structured interviews.

Information systems (e.g. e-records) represent a relatively stable conduit for routine and standardised forms of syntactic information exchange that can “bridge” time–space knowledge boundaries. Specialist discharge roles (e.g. discharge coordinators) support personalised and dynamic forms of “semantic” knowledge sharing that can “broker” epistemic and cultural boundaries. Group-based activities (e.g. team meetings) provide a basis for more direct “pragmatic” knowledge translation that can support inter-professional “bonding” at the cultural and organisational level, but where inclusion factors complicate exchange.

The study offers analysis of how professional boundaries complicate discharge planning and care transition, and the potential for different communication interventions to support knowledge sharing and learning.

The paper builds upon existing research on inter-professional collaboration and patient safety by focussing on the problems of communication and coordination in the context of discharge planning and care transitions. It suggests that care systems should look to develop multiple complementary approaches to inter-professional communication that offer opportunities for dynamic knowledge sharing and learning.

The purpose of this paper is to report a scoping review of reviews which investigated HLDP evaluations to determine: how the conceptualisation of leadership development programmes (HLDPs), and despite growing calls for robust evaluations of their pedagogic design, delivery and effectiveness, there are concerns regarding the quality of data associated with their evaluation. This scoping review of reviews investigated the reporting of HLDP evaluations to determine: how the conceptualisation of leadership underpinning HLDPs influence their evaluation; how the pedagogical approaches within HLDPs influence their evaluation; and the evaluation designs and measures used to assess HLDPs.

The scoping review was conducted on reviews of HLDPs. Searches were performed on four databases and on the grey literature. Data were extracted and a narrative synthesis was developed.

Thirty-one papers were included in the scoping review of reviews. A great deal of heterogeneity in HLDPs was identified. Evaluations of HLDPs were affected by poor data quality, and there were limitations in the evidence about “what works”. Leadership was conceptualised in different ways across HLDPs, and consequently, there was a lack of consistency as to what is being evaluated and the methods used to assess HLDPs.

This review of reviews summarises the current evidence on the evaluation of HLDPs. Evaluations of HLDPs need to explicitly account for the complexity of health systems, how this complexity impacts on the development and articulation of leadership practice, and how the underlying conceptualisation of leadership and the associated theory of change articulate a set of assumptions about how HLDPs support leaders to affect change within complex systems.

The impact of population ageing is significant, multifaceted and characterised by frailty and multi-morbidity. The COVID-19 pandemic has accelerated care pathways and policies promoting self-management and home-based care. One under-researched area is how patients and family caregivers manage the complexity of end-of-life therapeutic medicine regimens. In this position paper the authors bring attention to the significant strain that patients and family caregivers experience when navigating and negotiating this aspect of palliative and end-of-life care.

Focussing on self-care and organisation of medicines in the United Kingdom (UK) context, the paper examines, builds on and extends the debate by considering the underlying policy assumptions and unintended consequences for individual patients and family care givers as they assume greater palliative and end-of-life roles and responsibilities.

Policy makers and healthcare professionals often lack awareness of the significant burden and emotional work associated with managing and administering often potent high-risk medicines (i.e. opioids) in the domiciliary setting. The recent “revolution” in professional roles associated with the COVID-19 pandemic, including remote consultations and expanding community-based care, means there are opportunities for commissioners to consider offering greater support. The prospect of enhancing the community pharmacist's medicine optimisation role to further support the wider multi-disciplinary team is considered.

The paper takes a person-focused perspective and adopts a holistic view of medicine management. The authors argue for urgent review, reform and investment to enable and support terminally ill patients and family caregivers to more effectively manage medicines in the domiciliary setting. There are clear implications for pharmacists and these are discussed in the context of public awareness, inter-professional collaboration, organisational drivers, funding and regulation and remote care delivery.

This paper aims to outline and comment on the changes to medical regulation in the UK that provide the background to a special issue of the Journal of Health Organization and Management on regulating doctors.

This paper takes the form of a review.

Although the UK medical profession enjoyed a remarkably stable regulatory structure for most of the first 150 years of its existence, it has undergone a striking transformation in the last decade. Its regulatory form has mutated from one of state‐sanctioned collegial self‐regulation to one of state‐directed bureaucratic regulation. The erosion of medical self‐regulation can be attributed to: the pressures of market liberalisation and new public management reforms; changing ideologies and public attitudes towards expertise and risk; and high profile public failures involving doctors. The “new” UK medical regulation converts the General Medical Council into a modern regulator charged with implementing policy, and alters the mechanisms for controlling and directing the conduct and performance of doctors. It establishes a new set of relationships between the medical profession and the state (including its agencies), the public, and patients.

This paper adds to the literature by identifying the main features of the reforms affecting the medical profession and offering an analysis of why they have taken place.

This paper seeks to identify the instances of informal knowledge sharing at the “backstage” of the clinical environment and to demonstrate their contribution to organisational learning and patient safety.

The approach takes the form of an ethnographic study in two Day Surgery Units in the UK National Health Service undertaken over three months in various clinical and non‐clinical settings. The observations recorded the instances of communication and knowledge sharing, as well as taking into account the wider socio‐cultural and organisational context.

The study identified situations of informal knowledge sharing. These were characterised by degrees of homogeneity/heterogeneity and patency/privacy. Focusing on three sites – staff lounge, storeroom, and theatre corridor, the paper elaborates the context and content of knowledge sharing, and the contributions to clinical practice, service function and learning.

Backstage knowledge sharing is premised on shared understanding, trust and mutuality and situational opportunity. This contrasts with more formal models of learning advocated in policy. Services managers might embrace, rather than replace, these relationships, whilst emphasising the need for knowledge to be shared more widely amongst peers and service leaders.

To date, little research in the area of patient safety has considered the contribution of informal learning at the “backstage”. This is an important, if taken‐for‐granted, part of everyday practice and makes a “hidden” contribution to organisational learning.

The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals.

The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted.

Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel “guilty until proven innocent” within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing “spectacular transparency”, driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a “blame business” is driving this form of transparency, in which self‐interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame.

A relatively small number of people were interviewed, so further research testing the findings would be useful.

Transparency has some perverse effects on doctors' practice.

Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding.

Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice.

This paper aims to clarify the potential to use data on doctors and fitness to practise (FTP) cases held by the UK General Medical Council (GMC) for wider regulatory purposes, such as identifying risk factors. The paper aims to concentrate on how data are shaped by the GMC's functions and organisational concerns, and by the configuration and use of their electronic database.

The GMC provided samples of their data, access to documentation surrounding the configuration and use of the database, and meetings with staff able to provide background on the database, GMC procedures, and the GMC as an organisation.

The FTP database is designed to process cases within complex legal rules, and to provide for accountability. The database and its use are adapted to these purposes. Attempts to use it for other purposes are likely to find it difficult to use, the scope and quality of data uneven and some codes unsuitable. The register data are very narrow in scope. While combining register and FTP data to identify risk factors is by itself of limited value, the database can contribute to closer study of risks to patient safety from poorly performing doctors.

The research was exploratory. It provides initial insights and the basis for further research.

The data have potential policy use for the GMC, but it is essential to understand the limitations.

The paper examines previously unanalysed influences on the GMC's data. It also develops new angles on questions in the regulation literature about organisational risks and the creation of risk data.

The aim of this paper is to examine the benefits of undertaking mixed methods social network analysis (SNA) to investigate patterns of interpersonal relationships in healthcare delivery. Although SNA has roots in anthropological and ethnographic research, recent emphasis has been on the mathematical properties of social networks utilising graph theory and statistical analysis. While such studies may present interesting data on the structure of ties, this paper argues that they sidestep other important elements of patterns of social relationships; their meaning and their implications for network members. The paper identifies how SNA survey can be employed alongside ethnographic data within a qualitative framework.

The paper reports on a study that investigated how knowledge sharing in social networks can contribute to patient safety in surgical care involving a social network survey, qualitative interviews and ethnographic observations.

Results describe how each research method illuminated different elements of professional practice networks. These focus on the additional elements of networks identified through qualitative methods. The discussion examines how qualitative and quantitative findings relate to each other and could be combined within an overall qualitative methodology.

The paper answers the call for a greater utilisation of network methods in healthcare studies; demonstrates the benefits of qualitative research on social networks; and presents data on the contribution of health professionals’ interpersonal relationships in the production of safe patient care.

In recent years, the clinical performance of named cardiac surgeons in England has been disclosed. This paper aims to explore the nature and impact of disclosure of clinical performance.

The paper draws on literature from across the social sciences to assess the impact of disclosure, as a form of transparency, in improving clinical performance. Specifically, it employs the “programme theory” of disclosure.

The “programme theory” of disclosure involves identification, naming, public sanction and recipient response. Named individual (consultant) surgeons have been identified through disclosure but this masks the contribution of the clinical team, including junior surgeons. Mortality is the prime performance measure but given low mortality rates, there are problems interpreting this measure. The naming of surgeons has been achieved through disclosure on web sites, developed between the health‐care regulator and the surgical profession itself. However, participation remains voluntary. The intention of disclosure is that interested parties (especially patients) will shun poorly performing surgeons. However, these parties' willingness and ability to exercise this sanction appears limited. Surgeons' responses are emergent but about a quarter of surgeons are not participating currently. Fears that surgeons would avoid high‐risk patients seem to have been unrealised. While disclosure may have a small effect on individual reputations, the surgical profession as a whole has embraced disclosure.

While the aim of disclosure has been to create a transparent medical system and to improve clinical performance, disclosure may have the opposite effect, concealing some performance issues and possibly strengthening professional autonomy. Disclosure therefore represents greater transparency in health‐care but it is uncertain whether it will improve performance in the ways that the policy intends.