NHS Managers Research Articles

Large-scale acute hospital bed and mattress implementations: insights and recommendations

Background/Aims Hospital-wide replacement of beds and mattresses, often referred to as an ‘implementation’, can be an efficient way of ensuring that these products are up to date. However, large-scale implementations can be daunting for healthcare managers, with a lack of guidance to support them through this process. This service evaluation aimed to provide practical suggestions to NHS managers who are planning a hospital-wide acute hospital bed and mattress implementation from peers who have completed similar projects. Methods Interviews were conducted with a purposive sample of seven NHS staff members, all of whom had held a leading role in managing and executing an implementation project with the provider Medstrom. Exploratory, qualitative, semi-structured interviews were conducted, with data analysed through content-driven narrative analysis, using NVivo software. Results Four themes relating to large-scale bed and mattress implementation were identified: drivers; specification process; financial process; and physical implementation and training. Communication and planning were considered crucial, as was selecting a provider that could offer support throughout the implementation. Participants had been able to successfully implement a large volume of products, but all felt that a resource allowing healthcare managers to draw on the experiences of others who had previously completed a large-scale implementation project would be beneficial. Conclusions Large-scale mattress implementations are achievable with the right input and support. Learning from the experiences and knowledge of peers who have previously been involved in implementations can be very useful for healthcare managers embarking on this kind of project.

The cost of cosmetic surgery tourism complications to the NHS: A retrospective analysis

IntroductionMedical tourism refers to the process of patients travelling outside of their native country to undergo elective surgical procedures and is a rapidly expanding healthcare phenomenon [1–3]. Whilst a multitude of established Private Healthcare Providers (PHPs) offer cosmetic surgical procedures within the United Kingdom (UK), a growing number of patients are opting to travel outside of the UK to undergo cosmetic surgery. AimTo assess the number of patients presenting to the Canniesburn Plastic Surgery Unit, with cosmetic surgery tourism complications, from outside of the UK, and the associated costs to NHS Scotland over a five-year period. MethodsA retrospective case review of a prospectively maintained trauma database, which records all acute referrals, was undertaken analysing patients referred from January 1st 2019 to December 31st 2023 inclusive. Results81 patients presented over five years with complications of cosmetic surgery tourism. The most common presenting complaints were wound dehiscence (49.4%) or wound infection (24.7%). The total cost to NHS Scotland was £755,559.68 with an average of £9327.90 per patient. ConclusionThis is the largest single centre cohort of cosmetic surgery tourism complications reported within the NHS to date; with rates on the rise, demand grows for increased patient information regarding healthcare tourism risks, a national consensus on the extent of NHS management and urgent international collaboration with policymakers is required to address this issue across borders.

Diversity amongst Decision Makers?: Workplace Inequality, Black Underrepresentation, and the Afterlife of Colonialism in NHS Governance

Whereas senior management within NHS England was once so monocultural that it was dubbed the ‘snowy white peaks of the NHS’, recent data suggests that things have begun to change. However, Black staff in particular are still underrepresented. Interviews with Black and White NHS managers from four London trusts found that though the acronyms ‘BME’/‘BAME’ lack subtlety, management considered quantitative data important. The #BlackLivesMatter movement impacted NHS staff as a potential catalyst for change, though momentum fizzled out. Barriers to diversity and promotion have been seen to include microaggressions and negative stereotyping of Black staff. This article interrogates such underrepresentation, and uses the concept of ‘the afterlife of colonialism’ to suggest that NHS management hierarchies follow colonially-introduced hierarchies of ethnicity and discrimination, creating structural issues that are difficult to address. Taking a feminist framework of analysis, I will argue that diversity race work, including that of #BlackLivesMatter, is anti-hierarchical at its core, suggesting that it is difficult to assimilate within the hierarchically minded world of management. I will conclude that for ethnic diversity amongst staff to be realised, all staff must be committed to supporting this agenda, regardless of their race.

Challenging NHS Corporate Mentality: Hospital-Management and Bureaucracy in London’s Pandemic

ABSTRACT Whilst NHS Health Service management is usually characterized by hierarchized bureaucracy and profit-driven competitiveness, the COVID-19 pandemic drastically disrupted these ways of working and allowed London-based non-clinical management to experience their roles otherwise. This paper is based on 35 interviews with senior non-clinical management at a London-based NHS Trust during ‘Alpha phase’ of Britain’s pandemic response (May-August 2020), an oft-overlooked group in the literature. I will draw upon Graeber’s theory of “total bureaucratization” to argue that though the increasing neo-liberalization of the health-services has hitherto contributed toward a corporate mentality, the pandemic gave managers a chance to experience more collaboration and freedom than usual, which ultimately led to more effective realization of decision-making and change. The pandemic has shown NHS managers that there are alternatives to neoliberal logics of competition and hierarchy, and that those alternatives actually result in happier and effectively, more capable staff.

The policy and politics of healthcare corporatisation: The case of the English NHS

RationaleFew accounts of healthcare corporatisation examine the effects of the 2008 financial crisis. New Politics of the Welfare State (NPWS) theories recognise the relevance of crises but give more attention to programmatic than systemic (structural) retrenchment, and little to healthcare corporatisation. ObjectiveTo examine what changes the 2008 financial crisis produced in the pattern of healthcare corporatisation, and the implications for NPWS theories. MethodsUsing administrative data from the English NHS during 1995–2019 we formulated a multi-dimensional index of corporatisation, tested its validity, and used it to analyse longitudinally how the financial crisis affected the balance between the responsibilization of management and re-commodification (introduction of market-like practices) in provider corporatisation. ResultsThe financial crisis influenced NHS corporatisation through the fiscal austerity with which governments responded. The re-commodification of NHS providers stalled but not the responsibilization of NHS managers. ConclusionsThe corporatisation of NHS providers faltered after the financial crisis. These findings corroborate parts of NPWS theory but also reveal scope for further elaborating its accounts of systemic retrenchment in health systems.

SUPPORT AND TREATMENT AFTER JOINT REPLACEMENT (STAR): TRANSLATING TRIAL FINDINGS INTO NHS PRACTICE

AbstractIntroductionTotal knee replacement (TKR) aims to reduce pain and functional limitations. Despite a good outcome for many, 15–20% patients report chronic pain three months after TKR.The STAR Care Pathway is a clinically important and cost effective treatment to improve pain outcomes over 1 year for people with chronic pain at 3 months after total knee replacement surgery. The care pathway is delivered by specially trained Extended Scope Practitioners (ESPs).There is a gap between research findings and translation into practice. This work shows how the STAR trial findings were implemented into NHS practice at a single centre and the further work required to enable national implementation.MethodologyTrial findings were presented to NHS managers with a business case for an implementation pilot. Trial documentation was adapted for use in usual care using the COM-B model for behaviour change and evidence-based approaches to increase the return of postal questionnaires. Trial sites were contacted to understand their capacity to implement the intervention locally.ResultsThe STAR care pathway was successfully implemented into NHS practice with a screening response rate of 83%. It is now permanently part of usual care at North Bristol NHS Trust. Trial centres indicated that lack of availability of STAR trained ESPs as a barrier to implementation. The trial manual and training session were adapted for online delivery in partnership with Health Education England.ConclusionThe STAR care pathway has been successfully embedded into NHS care. A toolkit and online clinician training package enables national implementation.

P112 Patient Experience of Remote Healthcare during the Pandemic in Rheumatoid Arthritis and Adult Juvenile Idiopathic Arthritis

Abstract Background/Aims COVID-19 challenged traditional care models and necessitated introduction of remote consultations. We wanted to understand the experiences of people with rheumatoid arthritis (RA)/adult juvenile idiopathic arthritis (AJIA) on accessing healthcare remotely, and how well people understood their condition and treatment. Methods This collaborative work between the National Rheumatoid Arthritis Society (NRAS) and clinicians in Oxford led to the development of an electronic questionnaire that was disseminated in July 2021 for four weeks through e-newsletters and all NRAS social media platforms. Those living in the UK with RA and AJIA aged 18 and over were eligible. Analyses of data were performed in Microsoft Excel and IBM SPSSv28. Results We analysed 316 responses. There was a middle-aged (ages 46 to 54, 54.1%, n = 171), Caucasian (97.5%, n = 306), female (92.4%, n = 292) preponderance. Most had RA (93%, n = 294) followed by another inflammatory arthritis (4.1%, n = 13) and AJIA (2.8%, n = 9). The majority had their condition for >10 years (43.4%, n = 137) but some were diagnosed <12 months ago (3.2%, n = 10). Two thirds of participants (66.5%, n = 210) did not know their DAS28 score. Of the remaining third, the most commonly reported measure was moderate disease activity (12%, n = 38). Those with higher self-reported DAS28 scores were using analgesia more regularly (p < 0.01) but we found no difference in NSAID, DMARD or steroid use. Age did not influence steroid usage (p = 0.35), but those who had their condition for longer used more steroids and regular analgesia. Only 33.9% (n = 107) of responders felt their condition had been managed adequately in the pandemic, with more reporting poor status (40.8%, n = 129) rather than good (16.8%, n = 53). Those living in the South of England reported statistically better disease control than those from the North, despite having more virtual assessments (p = 0.02). Travelling and fear of Covid appeared more important than consultation skills. Just over a fifth (20.3%, n = 64) felt greater focus should be given to patient concerns. Of the 9.1% of patients (n = 29) with a new diagnosis made during the pandemic, 24.1% (n = 7) unable to book a GP appointment easily. Patients experienced a median symptom time of 4-10 weeks before consulting GPs. Once assessed, 31% (n = 9) were referred immediately while the median time was 4-8 weeks. We found 58.6% (n = 17) of patients received their diagnosis within their initial rheumatology consultation and 76.5% (n = 13) of these started a DMARD immediately. Conclusion Despite a greater emphasis on patient education and PROMs influencing clinical decision-making, it is staggering that two-thirds did not know their DAS28 score. Analgesia and steroid use were common in patients with well-established disease which remains a concern. Accessing appointments was a significant barrier to patients and delays in care were experienced at every step in the NHS management pathways. Remote consultations need greater emphasis on patient concerns. Disclosure R.S. Andev: Member of speakers’ bureau; RSA received speaker funds from Novartis. A. Bosworth: None. C. Jacklin: None. S. Dubey: None.

Mid- to late-term follow-up of primary hip and knee arthroplasty: the UK SAFE evidence-based recommendations.

To review the evidence and reach consensus on recommendations for follow-up after total hip and knee arthroplasty. A programme of work was conducted, including: a systematic review of the clinical and cost-effectiveness literature; analysis of routine national datasets to identify pre-, peri-, and postoperative predictors of mid-to-late term revision; prospective data analyses from 560 patients to understand how patients present for revision surgery; qualitative interviews with NHS managers and orthopaedic surgeons; and health economic modelling. Finally, a consensus meeting considered all the work and agreed the final recommendations and research areas. The UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE) recommendations apply to post-primary hip and knee arthroplasty follow-up. The ten-year time point is based on a lack of robust evidence beyond ten years. The term 'complex cases' refers to individual patient and surgical factors that may increase the risk for arthroplasty failure. For Orthopaedic Data Evaluation Panel (ODEP) 10A* minimum implants, it is safe to disinvest in routine follow-up from one to ten years post-non-complex hip and knee arthroplasty provided there is rapid access to orthopaedic review. For ODEP 10A* minimum implants in complex cases, or non-ODEP 10A* minimum implants, periodic follow-up post-hip and knee arthroplasty may be required from one to ten years. At ten years post-hip and knee arthroplasty, clinical and radiological evaluation is recommended. After ten years post-hip and knee arthroplasty, frequency of further follow-up should be based on the ten-year assessment; ongoing rapid access to orthopaedic review is still required. Complex cases, implants not meeting the ODEP 10A* criteria, and follow-up after revision surgery are not covered by this recommendation.

Developing architecture of system management in the English NHS: evidence from a qualitative study of three Integrated Care Systems

ObjectiveIntegrated Care Systems (ICSs) mark a change in the English National Health Service to more collaborative interorganisational working. We explored how effective the ICS form of collaboration is in achieving...

Preventing cardiotoxicity in patients with breast cancer and lymphoma: protocol for a multicentre randomised controlled trial (PROACT)

IntroductionAnthracyclines are included in chemotherapy regimens to treat several different types of cancer and are extremely effective. However, it is recognised that a significant side effect is cardiotoxicity; anthracyclines can...

Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives

BackgroundDoctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors’ working conditions and, thus, their mental health.MethodsWe interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors’ working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations.ResultsJunior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork.ConclusionWe suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.

Do general practitioners working in or alongside the emergency department improve clinical outcomes or experience? A mixed-methods study

ObjectivesTo examine the effect of general practitioners (GPs) working in or alongside the emergency department (GPED) on patient outcomes and experience, and the associated impacts of implementation on the workforce.DesignMixed-methods...

Whistleblowers are protecting patients, not NHS managers

Whistleblowers are protecting patients, not NHS managers

Pandemic priorities: the impact of the COVID 19 pandemic on ethical leadership in the healthcare profession

PurposeThe COVID 19 pandemic has brought into sharp focus the importance of leadership and the ethics of health-care leadership. The purpose of this study is to investigate the impact of COVID 19 on ethical leadership principles using a validated quantitative survey of NHS leaders to compare pre- and post-pandemic ethical leadership principles.Design/methodology/approachThis study involved a quantitative survey of NHS “leaders”. Inclusion criteria included consultants and registrars leading clinical teams, or NHS managers, senior nurses and matrons. The survey was designed as a modification of the Ethical Leadership Questionnaire proposed by Langlois et al. (2013). A modification was made to ask questions from the questionnaire pertaining to before the pandemic and presently. This allowed a comparison of responses and measures of ethical leadership qualities before and after the pandemic. Twenty-three questions were on attitudes pre-pandemic, and 23 were post-pandemic.FindingsA total of 79 responses were received. Responses were divided for analysis into those related to an ethics of care dimension, those related to ethics of justice and those related to the ethics of critique. This study has found significant changes in attitudes of health-care leaders with regards to the ethics of critique. Leaders were more likely post-pandemic to speak out against injustice and unfair practices. Leaders were also more concerned with matters of human dignity as well as understanding how some groups may be privileged. Other ethical principles showed no statistical difference.Originality/valueThis paper highlights the changes the COVID-19 pandemic has had on leaders’ attitudes to ethics.

Ethical dilemmas in sharing transformative experiences with patients in a clinical setting: A Reflective Account

Abstract I write this article as a postgraduate researcher undertaking a doctorate in Education, with an interest in research as a transformative process, and fascinated by the debate as to whether reality is objective or subjective. In reflecting on this, I recalled a significant incident that occurred when I was Professional Education Lead in an NHS hospital. I had been asked to work with a nurse, who had been disciplined as a consequence of talking about her Christian faith with a patient. The nurse was assuming that, in sharing experiences that were transformative for her, she might also transform the patient’s perception of her own illness and its meaning. As a Christian myself, I was caught in a situation where I could understand the conflicting perspectives of all key players, including the patient, her family, the nurse, and the NHS managers. I explore how I mediated my way through this situation, aiming to do justice to all perspectives, and the ethical dilemmas I faced when having to choose between personal and professional values. As a consequence of this incident, I have learned that, not only is transformation a deeply personal experience, but because it is either influenced by, or leads to, a specific world view, it supports the idea of reality being subjective rather than objective.

COVID-legal study: neurosurgeon experience in Britain during the first phase of the COVID-19 pandemic – medico-legal considerations

Introduction: The COVID-19 pandemic has resulted in a significant number of changes to elective and emergency neurosurgical practice. Materials and Methods: This paper reports the results of an online survey of Society of British Neurological Surgeons (SBNS) members undertaken between 10th and 24th of June 2020 regarding changes in consent practice in response to COVID-19, as well as the physical challenges experienced while operating under higher levels of personal protective equipment (PPE). Results: Despite the real and substantial risks associated with COVID-19, 23% of surgeons reported they were not made any changes to their usual consent process, and 54% of surgeons indicated that they made reference to COVID-19-associated risks in their written consent documentation. 93% of neurosurgeons reported physical difficulties operating using PPE; 62% reported visors/goggles fogging up, 55% experienced ‘overheating’, 62% reported fatigue, and 82% of surgeons reported difficulty communicating with the theatre staff. Conclusions: This survey highlights discrepancies in the consent practice between neurosurgeons which needs to be addressed at both local and national levels. The PPE being used in neurosurgical operations is not designed for use with specialist equipment (82% of respondents reported having to remove PPE to use the microscope) and the reported physical difficulties using PPE intraoperatively could significantly impact on both neurosurgeon performance and patient outcomes. This requires urgent attention by NHS procurement and management and should be urgently escalated to trust occupational health authorities as a workplace safety concern.

A phenomenological inquiry into the lived experience of adults diagnosed with attention deficit hyperactivity disorder (ADHD) employed by the NHS

PurposeApproximately 3.5% of the workforce is diagnosed with attention deficit hyperactivity disorder (ADHD). With a greater risk of work-related stress and absences, work-based social interactions and environments are significant factors. The purpose of this study was to identify the professional challenges and benefits of living with ADHD in healthcare settings.Design/methodology/approachInterpretative phenomenological analysis was used to explore how employees with ADHD both experience and make sense of their employment and professional relationships. Participants self-identified from two NHS trusts and participated in semi-structured interviews.FindingsA total of seven interviews contributed to the final analysis. A total of four themes emerged: social environment (relationships), physical environment, behaviour and work tasks. Complex interactions were observed between individuals’ internal constructs and overall employment experience.Practical implicationsThe findings can be used to inform local NHS management frameworks for supporting workforce with ADHD.Originality/valueThis is a novel study that explores the psychodynamic and physical presentations of ADHD providing a unique perspective on the challenges and strengths of employees with ADHD.

Evidence to support delivery of effective health services: a responsive programme of rapid evidence synthesis

Background Two UK academic centres were commissioned to provide a responsive rapid evidence synthesis service. The service covered topics identified by the National Institute for Health Research Health Services & Delivery Research (NIHR HSDR) programme as priorities for the National Health Service or to inform research commissioning. Aims and objectives To describe and evaluate the review teams’ interactions with the evidence users the programme aimed to serve, primarily NHS clinicians, commissioners and managers. We particularly aim to highlight the barriers and facilitators to the impact that this type of programme may have on the uptake and use of research evidence by decision makers. Methods Narrative review of stakeholder interactions at different stages of the review process: prioritisation and defining scope; dealing with unexpected results; dissemination of findings; and measuring impact, illustrated by examples from the first three years of the service (2014–17). Conclusions Timely production of high-quality outputs was facilitated by: initial mapping and scoping of the available published evidence; early engagement with stakeholders to optimise their involvement within limited time and resources; and willingness to consider creative solutions and different ways of working to overcome problems encountered in specific projects.

Health policy and controlling Covid-19 in England: sociological insights

The global Covid-19 pandemic is posing considerable challenges for governments throughout the world and has and will have a significant influence on the shape of peoples social and economic life and wellbeing in the short and longer term. This opinion paper discusses the current health policy response adopted in England to control or manage the epidemic and identifies the key sociological and political influences which have shaped these policies. Drawing on the theoretical approach set out in his recent book, which emphasises the interplay of powerful structural and economic interest groups, the author will consider the influence of the key players. Government policy has tied itself to scientific and medical evidence and protecting the NHS so the key roles of the medical profession, public health scientific community and NHS management and their respective and relative powerful influences will be discussed. The government needs the support of the public if their policies are to be successful, so how have the government addressed maintaining public trust in this ‘crisis’ and how much trust do the public have in the government and what has influenced it? The strong emphasis on social distancing and social isolation in the national government policy response to Covid-19 has placed an increasing public reliance on the traditional and social media for sources of information so how the media has framed the policy will be considered. One policy aim is for an effective vaccine and the influence of the drug industry in its development is discussed. Finally, the role of the state will be discussed and what has shaped its social and economic policies.

Health policy and controlling Covid-19 in England: sociological insights

The global Covid-19 pandemic is posing considerable challenges for governments throughout the world and has and will have a significant influence on the shape of peoples social and economic life and wellbeing in the short and longer term. This opinion paper discusses the current health policy response adopted in England to control or manage the epidemic and identifies the key sociological and political influences which have shaped these policies. Drawing on the theoretical approach set out in his recent book, the author will consider the influence of the key players. Government policy has tied itself to scientific and medical evidence and protecting the NHS so the key roles of the medical profession, public health scientific community and NHS management and their respective and relative powerful influences will be discussed. The government needs the support of the public if their policies are to be successful, so how have the government addressed maintaining public trust in this ‘crisis’ and how much trust do the public have in the government and what has influenced it? The strong emphasis on social distancing and social isolation in the national government policy response to Covid-19 has placed an increasing public reliance on the traditional and social media for sources of information so how the media has framed the policy will be considered. One policy aim is for an effective vaccine and the influence of the drug industry in its development is discussed. Finally, the role of the state will be discussed and what has shaped its social and economic policies.