Navigating silence and voice: South Asian women healthcare professionals in the UK NHS during COVID-19 and beyond - a qualitative study.

Implementing cultural change and aligning organizational cultures could enhance innovation, quality, safety, and job satisfaction. The authors conducted this mixed-methods study to assess academic physician-scientists' perceptions of the current and preferred future organizational culture at a university medical school and its partner health system. In October 2010, the authors surveyed academic physicians and scientists jointly employed by the University of Oxford and its local, major partner health system. The survey included the U.S. Veterans Affairs Administration's 14-item Competing Values Framework instrument and two extra items prompting respondents to identify their substantive employer and to provide any additional open-ended comments. Of 436 academic physicians and scientists, 170 (39%) responded. Of these, 69 (41%) provided open-ended comments. Dominant hierarchical culture, moderate rational and team cultures, and underdeveloped entrepreneurial culture characterized the health system culture profile. The university profile was more balanced, with strong rational and entrepreneurial cultures, and moderate-to-strong hierarchical and team cultures. The preferred future culture (within five years) would emphasize team and entrepreneurial cultures and-to a lesser degree-rational culture, and would deemphasize hierarchical culture. Whereas the university and the health system currently have distinct organizational cultures, academic physicians and scientists would prefer the same type of culture across the two organizations so that both could more successfully pursue the shared mission of academic medicine. Further research should explore strengthening the validity and reliability of the organizational culture instrument for academic medicine and building an evidence base of effective culture change strategies and interventions.

The NHS: what are the UK's political parties promising?

Will politicians be architects or destroyers of the NHS?

UK doctors' anger over NHS cash crisis

BackgroundUK equality law and National Health Service (NHS) policy requires racial equality in job appointments and career opportunities. However, recent national workforce race equality standard (WRES) data show that nearly all NHS organisations in the UK are failing to appoint ethnically diverse candidates with equivalent training and qualifications as their white counterparts. This is problematic because workforce diversity is associated with improved patient outcomes and other benefits for staff and organisations.AimTo better understand the reasons behind underrepresentation of ethnically diverse candidates in first NHS healthcare jobs post-qualification and to identify any structural or systemic barriers to employment for such groups.MethodsThe study was informed by critical theory and the authors’ interdisciplinary perspectives as educators and researchers in the healthcare professions. Data collected from semi-structured face-to-face interviews with 12 nurse and physiotherapy recruiting managers from two NHS trusts in London were analysed using a healthcare workforce equity and diversity conceptual lens we developed from the literature. Using this lens, we devised questions to examine six dimensions of equity and diversity in the interview data from recruiting managers.ResultsRecruiting managers said they valued the benefits of an ethnically diverse workforce for patients and their unit/organisation. However, their adherence to organisational policies for recruitment and selection, which emphasise objectivity and standardisation, acted as constraints to recognising ethnicity as an important issue in recruitment and workforce diversity. Some recruiting managers sense that there are barriers for ethnically diverse candidates but lacked information about workforce diversity, systems for monitoring recruitment, or ways to engage with staff or candidates to talk about these issues. Without this information there was no apparent problem or reason to try alternative approaches.ConclusionThese accounts from 12 recruiting managers give a ‘backstage’ view into the reasons behind ethnic inequalities in recruitment to first healthcare job in the UK NHS. Adherence to recruitment and selection policies, which aim to support equality through standardisation and anonymisation, appear to be limiting workforce diversity and creating barriers for ethnically diverse candidates to attain the jobs that they are trained and qualified for. The Healthcare Workforce Equity + Diversity Lens we have developed can help to ‘raise the curtain on the equality theatre’ and inform more inclusive approaches to recruitment such as contextualised recruitment or effective allyship between employers and universities.

Local Purchasing of Journals is Required in Addition to a Nationally Purchased Collection to Meet the Information Needs of NHS Staff

Responsibility for managing healthcare-associated infections: where does the buck stop?

Purpose – The paper seeks to report on an audit undertaken in 2010 to support implementation of the Independent Safeguarding Authority (ISA) processes by National Health Service (NHS) Trusts. The ISA was set up under the Safeguarding Vulnerable Groups Act (SVGA) 2006. Concern has been expressed that some NHS employers are not familiar with their new obligations to consider making referrals to the ISA.Design/methodology/approach – This audit was designed to provide an estimate of possible NHS referrals to the enhanced vetting and barring scheme run by the ISA in England and Wales; and to explore two NHS Trusts' potential decision‐making and referrals to the ISA following disciplinary action or adverse events. The two NHS Trusts that participated engaged in a detailed review of incidents and their relationship to harm as defined in the SVGA 2006.Findings – The simple number of how many incidents have been reported to the ISA by an NHS Trust will not equate to the same number of cases of individual patients ...

Purpose – The purpose of this article is to outline the way in which internal mediation has been rolled out to support the successful merger of three NHS (National Health Service) Trusts in London. Design/methodology/approach – Based on the success of internal mediation as a method of managing and minimizing conflict in the workplace at other NHS Trusts, Barts Health NHS Trust recognized the potential of internal mediation to monitor, manage and minimize conflict and associated disruption in the workplace. Recognizing the benefits of attracting a multidisciplinary team of mediators and securing the backing of line managers to support the approach has put in place a bid for the funding of training for 140 mediators across the new Trust's five sites. Findings – The introduction of internal mediation has contributed to a significant decrease in legal expenditure and the number of formal disciplinary cases, which has consequently reduced the time line managers and other employees have had to spend on this type of activity. The strategy has also had an influence – although yet to be calculated – on the environment and culture of the organization. The introduction of tools to respond quickly to conflict situations enables staff to address issues promptly, before they escalate, thereby keeping patient care at the top of everyone's agenda. Originality/value – The case study presents a clear best practice approach for large organizations or those going through a merger or acquisition that may be considering how to positively manage conflict and dispute resolution in the workplace. It presents cost saving results associated with the introduction of internal mediation and indicates associated organizational benefits, such as the engagement of line managers with the solution.

Medical negligence: there are no winners

ObjectivesEarly MRI use varies in the management of acute wrist injuries in the UK, with only a minority of National Health Service (NHS) centres being able to offer this to...

Background There is increasing evidence demonstrating that lifestyle interventions of exercise and diet may represent a useful supportive therapy for men with prostate cancer, improving physiological and psychosocial outcomes. There has been limited investigation of the effects of such interventions in men with castrate resistant prostate cancer (CRPC), the terminal phase of the disease. It is not clear how exercise has been implemented in the prostate cancer care pathway and what a successfully implemented exercise programme might look like. Furthermore, the specific treatment and disease related barriers men with CRPC might face engaging in exercise is not documented, particularly when considering their advanced stage of disease. This work described in this thesis covers an exploration of the feasibility and acceptability of an exercise and dietary intervention to improve outcomes in men with CRPC. Methods A healthcare professional survey was conducted to assess the extent to which NHS trusts are meeting the NICE guidelines (CG175, 1.4.19) for exercise training for men with prostate cancer on androgen deprivation therapy (ADT). Semi-structured interviews of UK healthcare professionals, specialising in prostate cancer care and based in UK National Health service (NHS) trusts were conducted. These explored underlying reasons behind the variability in NHS trusts in delivering exercise training programmes and probed the views of the HCPs regarding exercise training, including the acceptability of concurrent use of an anabolic agent for men with CRPC. A feasibility randomised controlled trial (RCT) of an exercise and dietary intervention in CRPC patients was conducted (COMRADE). Men with CRPC recruited to the RCT were randomised on a 1:1 ratio to either the intervention or usual care for 16 weeks. Men allocated the intervention received up to 24 three sessions of supervised resistance exercise a week; supplemented with whey protein and creatine monohydrate; and given dietary advice. They were also asked to partake in at least one independent moderate intensity aerobic activity lasting at least 30 minutes a week. Following the RCT, post study participant focus groups addressed patients’ views on aspects of the study, particularly with regards to acceptability of trial procedures, barriers and facilitators to exercise training and the impact of living with CRPC. Results The healthcare professional survey demonstrated significant variability between NHS trusts in the UK in delivering the NICE guidelines and that a supervised exercise training programme is not currently embedded within "usual care" for prostate cancer. The healthcare professional interviews (n=12) demonstrated support for an individualised and adaptable exercise programme for men with CRPC which could improve fitness and mitigate some of the long term effects of their cancer/cancer therapy. Their opinions reflected that comorbidities and disease/treatment specific barriers to exercise must be taken into account to support better adherence. In the feasibility RCT, n=31 men were recruited from a total of n=3607 screened (recruitment rate=13.6%). There were eighteen in the intervention and thirteen randomised to the control group. The attrition rate was 16%, with n=4 dropping out of the intervention and n=1 death in the control. Adherence to the supervised and independent exercise sessions was 69% and 78% respectively. The adherence to the whey protein was 68% and creatine was 71%. There were 4 AEs associated with trial procedures, none of which were serious. Three primary themes were identified from the participant focus groups (n=3); these included 1) living with CRPC, 2) experience and opinions of the trial, 3) attitudes and experiences of exercise training and physical activity. The findings demonstrated that the study procedures were well received by 25 the participants, including the trial assessments and format of the intervention. Valuable insights were gained for implementing future exercise intervention studies - providing participant perspectives for the success of a lifestyle behaviour study such as COMRADE. Conclusions The findings suggest that it is feasible to randomise and retain men with CRPC to an exercise and diet intervention, however there was a high rate of attrition in the study, due to the complex nature of the disease in these men. Further work is required to address the barriers related to implementation of exercise in the prostate cancer pathway for men with CRPC.

National Health Service: not for sale

The UK National Health Service (NHS) is embarking on the largest investment programme in Information Technology (IT). The National Programme for IT (NPfIT) in the NHS is the biggest civil IT project in the world and seeks to revolutionise the way care is delivered, drive up quality and make more effective use of resources of the NHS. Despite these high expectations, the NHS has historically experienced some high profile IT failures and the sponsors of the programme admitted that there remain a number of critical barriers to the implementation of the programme. Clinicians’ reluctance to accept new IT systems at a local level is seen to be a major factor in this respect. Focusing on such barriers, this paper reports research that explored and explained why such reluctance occurs in the NHS. The main contribution of this research derives from the distinctive approach based on Kelly’s Personal Construct Theory (PCT) to understand the ‘reluctance’. The argument presented in the paper indicates that such reluctance should be viewed not as deliberate resistance imposed by clinicians, but as their inability of changing their established group personal constructs related to ISDD activities. Therefore, this paper argues that the means that could occur to reduce the ‘reluctance’ are creative rather than corrective or normative. The research took place in a NHS Trust and the paper pays considerable attention to technological, behavioural and clinical perspectives that emerged from the study. The research was conducted as a case study in a NHS trust and data was collected from two local NHS IT project. The main research participants in this study were: (a) IT professionals including IT project managers and senior IT managers; and (b) senior clinicians.

Achieving equitable management of allergic disorders and primary immunodeficiency in a Black, Asian and Minority Ethnic population