Trust Board Research Articles

So you want to be a nurse?

T he UK Government’s initial response to the Francis Report, given in the House of Commons on 26 March by Mr Jeremy Hunt, Member of Parliament for South West Surrey and Secretary of State for Health in England, was brief. He did, I am very pleased to say, acknowledge that what went wrong at the Mid Staffs Trust was ‘Not typical and that the vast majority of doctors and nurses give excellent care day-in day-out’. Mr Hunt also noted that more time was needed to consider the report in full but that some response was required as a matter of urgency. A number of key areas for urgent action were identified and of course nursing loomed large among them. It is hard to disagree with much of the initial response, which focused on the need for compassionate care, zero harm, training for healthcare support workers, reducing frontline bureaucracy and a review of the complaints process. At last the Nursing and Midwifery Council (NMC) (and other professional regulators) were asked by Government to ‘tighten’ their procedures for dealing with cases of failure to adhere to professional standards. Some of you might share my view that ‘tightening’ does not come close to what needs to happen at the NMC and radical change to protect nurses as well as the public is long overdue. Sir Robert Francis said that the responsibility for what went wrong at Mid Staffs lies with the trust board. In response Mr Hunt says the Government will look at new legal sanctions at a corporate level for organisations that deliberately withhold information they are required to provide. It would have been helpful if he had assured us that board members would be required to have an understanding of the NHS before their appointment and some insight into what delivering safe compassionate care to millions of patients every day across primary community and secondary care actually means. It would also have been helpful to restate the need, as Sir Robert does (Recommendation 204) to have a nurse on the board of every healthcare organisation. Recommendation 187 from the Francis Report seems to have struck a particular chord with the Secretary of State and it appears already to be policy in the making. Recommendation 187 states:

Ward sisters must be supervisory, ministers tell NHS trust boards

The Care Quality Commission will be instructed to check whether ward sisters have fully supervisory status on hospitals wards in England.

Women directors on boards of Australian Real Estate Investment Trusts

PurposeThis is the first paper which aims to investigate factors that might influence the gender composition of boards of directors of Australian Real Estate Investment Trusts (A‐REITs).Design/methodology/approachThis study follows Mateos de Cabo, Gimeno and Nieto and the gender diversity literature and investigates the existence and number of women directors on the boards of directors of 37 A‐REITs from 2006 to 2011.FindingsThere is evidence that larger (by market capitalization) A‐REITs are more likely to employ a woman director and that A‐REITs with larger boards are more likely to employ a woman director and indeed more women directors. It also appears that A‐REITs whose head office is in Sydney are more likely to employ a woman director and also more women directors.Practical implicationsWomen seeking to be engaged as directors of A‐REITs are more likely to be employed by larger A‐REITs (by market capitalization), those with larger boards and those located in Sydney.Originality/valueThis paper adds to the existing literature on gender diversity by examining the factors that appear to influence the employment of women on A‐REIT Boards.

Clinical focus and public accountability in English NHS Trust Board meetings

Previous studies have suggested that greater focus on clinical matters in NHS commissioner and provider Trust Board meetings might improve the range, quality or cost of clinical care. This study reports the extent of clinical focus in Board meetings in three types of NHS Trust and considers the implications for public accountability. (1) Content analysis of published minutes of Board meetings from 105 randomly selected NHS Trusts in 2008/09. (2) Structured observation of 24 Board meetings in a qualitative sub-sample of eight of the above Trusts in 2008/09. The percentage of clinical items among the items discussed by NHS Trust Boards ranged from 0% to 51%, but did not differ by Trust type. Primary Care Trusts (PCTs) recorded more items than NHS Trusts and NHS Foundation Trusts because of PCTs' dual role as service providers and commissioners. There were significant differences between Trusts' board meetings in the numbers of clinical items concerning service design, clinical outcomes and activity levels. The availability and accessibility of supposedly publicly-available minutes from NHS Foundation Trust Board meetings was sometimes problematic. Observation of meetings revealed a number of dynamics not evident in the minutes. Board meetings were generally chair-led (conducted according to the chair's discretion); collegial; had similar levels and extent of discussion from the non-executive directors, with a focus on current policy initiatives. Boards differed in the extent of public questioning, how they exercised internal governance over the provision and quality of patient care, and the extent of pre-planning before the Board meeting. Published minutes were not always an accurate record of meetings. Findings illuminate important transparency issues which should be given careful consideration in the English NHS.

Medical bodies call on NHS trust boards to improve health of hospital staff

NHS board members must take proactive responsibility for the health and wellbeing of hospital staff, the Royal College of Physicians and Faculty of Occupational Medicine have said. The 2009 Boorman review of the health of NHS staff found a …

Supportive relationships.

Best practice guidance on building supportive relationships between foundation trust boards of directors and governors has been published by independent regulator Monitor.

Right to Request social enterprises: a welcome addition to third sector delivery of English healthcare?

The NHS in England introduced the Right to Request scheme in 2008, which enabled healthcare staff working in the public sector to carry over community health services into social enterprises. Staff wanting to do this had to apply to primary care trust boards, which were required to consider their requests and, if accepted, to guarantee contracts of between three and five years. This article reviews the Right to Request scheme and provides an overview of the organisations that have been launched to date. It then considers the implications of the scheme in relation to its implied objectives of improving patient care and empowering staff, as well as the impact on the health and social care system and on the third sector more widely

Doctor board members increase hospital performance

Including doctors on hospital trust boards increases the performance of the organisation, research by the University of Leeds has found. Those trusts in England with the highest proportion of doctors on their governing board had the highest Healthcare Commission (now Care …

Engaging junior paediatric trainees in patient safety improvement projects

Aims To engage junior paediatric trainees in patient safety projects. To demonstrate that patient safety is everyone9s responsibility, leading to safer paediatric care across the Wessex Deanery. Methods Since 2009 we have been developing a training programme in patient safety for all paediatric ST1 trainees in the Wessex Deanery. This has involved a compulsory training day which includes sessions on human factors, communication, leadership and lessons learnt from industry as well as relevant NPSA alerts. Under the supervision of a regional ‘Paediatric Patient Safety Champion’ the trainees undertake a project, using PDSA cycles where appropriate. The patient safety projects are all a result of discussions about safety issues within their individual departments. The programme culminates in a regional, cross speciality patient safety conference, attended by trainees and regional leaders in patient safety from trusts in the region. Results All paediatric ST1 trainees undertook patient safety projects in 2011. Across all specialities in 2011 there were 77 poster presentations and 15 oral presentations at the patient safety conference. The paediatric projects included ‘Inefficient referrals to medical staff for babies on the postnatal ward’, ‘Weekend care plans for long term patients on paediatric wards’, ‘Safe prescribing among junior doctors for neonates and children in primary and secondary care’, ‘The reorganisation of paediatric handover’ and ‘Creation of departmental Patient Safety Information Boards’. All projects have been very well received, for example one project was invited to present at trust board with a view to rolling out the project across the trust. Conclusion Patient safety training ensures trainees are aware of their role in this very important area. Our programme empowers junior paediatric trainees to identify patient safety issues in their day-to-day work and to produce high quality patient safety improvement projects. The patient safety training and projects have led to improvements in patient care in Wessex. In addition paediatric ST19s in the region are more aware of the importance and relevance of patient safety in everyday practice.

Predicting Student Outcome Measures Using the ASCA National Model Program Audit

This study explored the prediction of student outcome variables from the ASCA model level of program implementation. A total sampling of schools from two suburban school districts was conducted. Outcome variables were measures of math and reading achievement scores, attendance and graduation rates.At a time when accountability within the school counseling profession is at the forefront, school counselors are required to present evidence which validates the effectiveness of daily practices. The American School Counselor Association (ASCA) created a framework for implementing comprehensive developmental school counseling programs through specification of standards and competencies. But does degree of implementation of the ASCA National Model (2005) affect the ability of school counselors to meet student needs? This assertion is supported by correlative or indirect research which indicates the positive effects of fully implemented school counseling programs (Brigman & Campbell, 2003; Carrell & Carrell, 2006; Lapan, Gysbers, & Kayson, 2007; Lapan, Gysbers, & Petroski, 2001; Lapan, Gysbers, & Sun, 1997; McGannon, Carey, & Dimmitt, 2005; Nelson, Gardner, & Fox, 1998; Sink, 2005; Sink & Stroh, 2003; Whiston & Wachter, 2008).A focus on attaining the goals of a comprehensive program is essential to initiate systemic change and to establish the school counseling program as an integral part of the total educational process. School counselors develop and refine their roles in order to meet the diverse needs of students and the school community. Transitioning from the traditional guidance program, or no program at all, to a comprehensive, developmental school counseling program is a demanding task, but is attainable through collaboration among school counselors and stakeholders. A program audit is a fundamental step in this process as well as in evaluating where a counseling program currently is and establishing where the program aims to go in the future.ASCA (2005) presented a standardized framework for creating a comprehensive school counseling program that supports the academic, career and personal/social development of students throughout their academic careers. According to ASCA, a school counseling program is comprehensive, preventative and developmental in nature. This framework provides school counselors with an all-inclusive approach to program foundation, delivery, management and accountability. Similar to the Education Trust (2009) and College Board (2009), ASCA promotes a new vision for the school counseling profession which reflects accountability, advocacy, leadership, collaboration, and systemic change within schools, positioning professional school counselors as essential contributors to student success.The extant literature reveals much support for the positive benefits of school counseling programs for students. As a result of fully implemented school counseling programs, students enjoy higher grades (Lapan et al., 2001; Lapan et al., 1997), better school climate (Lapan et al., 1997), higher satisfaction with education (Lapan et al., 2001; Lapan et al., 1997), more relevant education (Lapan et al., 2001), higher ACT scores (Nelson et al., 1998), and greater access to more advanced math, science, technical and vocational courses (Nelson et al., 1998). Studies also have provided evidence of fewer classroom disruptions and improved peer behavior among students who participated in comprehensive school counseling programs (Brigman & Campbell, 2003; Lapan, 2001; Lapan et al., 2007; Lapan et al., 1997; Sink, 2005; Sink & Stroh, 2003).The program audit is an evaluation tool used to determine the extent to which components of a comprehensive program are implemented and helps to make decisions concerning future directions that a school counseling program will take. A program audit, or process evaluation assists school counselors in implementing the standards and components of a comprehensive school counseling program, in addition to identifying areas for improvement or enhancement (ASCA, 2005). …

Māori Issues

Māori Issues Margaret Mutu (bio) The year under review was one of shocking upheavals for Māori in more ways than one. In August and September 2010 we lost some key leaders. In September 2010, in February 2011, and in June 2011, Christchurch suffered a series of earthquakes that left many Māori families devastated and feeling abandoned as recovery aid passed them by. On the political scene, Prime Minister John Key finally got his wish when the Māori Party forced Hōne Harawira out, only to have Harawira win a by-election for his Taitokerau seat and return to Parliament as the leader of the new Mana Movement. But the most bewildering development was the Māori Party turning its back on its constituents and supporting the passage into law of the racist Marine and Coastal Area (Takutai Moana) Bill. [End Page 184] On 17 August 2010, two very different leaders from different parts of the country passed away. In Taranaki, Te Miringa Hohaia died unexpectedly at the age of fifty-eight. He was a scholar, artist, and activist who spent his adult life fighting the injustices perpetrated on his Taranaki people by the British. He was trained and deeply skilled in the traditions, customs, and history of his ancestral home, Parihaka, a place renowned for the atrocities that the British committed there over many years. In the 1970s he was involved in the eventually successful Treaty of Waitangi claims against the Crown to stop the pollution and despoliation of the seafood beds off the north Taranaki coast. In the 1990s he was one of the leaders of the complex and successful Taranaki Treaty claims. In 2000 he co-curated the hugely successful landmark exhibition Parihaka, The Art of Passive Resistance at Wellington's City Gallery, and in 2005 he created the Parihaka International Peace Festival, which has become an annual celebration of the heritage of Taranaki (Ashworth, Hond, and Hohaia 2010; Māori Party 2010a). An obituary noted, "In life he was akin to his tupuna [ancestors], becoming perhaps the most hated person in the province among Pakeha in the 1980s as he fought the injustice of the pittance paid by leaseholders farming confiscated Taranaki Maori reserve land. . . . Opponents vilified him, echoing the 19th century settler reaction to the non-violent campaign of Parihaka founders Tohu and Te Whiti" (Ashworth, Hond, and Hohaia 2010, 9). On the east coast, Te Kapunga (Koro) Matemoana Dewes passed away. He was staunchly Ngāti Porou, a scholar, a thinker, and the architect of the Māori Studies Department at Victoria University in Wellington. There he challenged the dry, dusty approach to university teaching and scholarship imported from Britain, writing the first MA thesis in the Māori language. However, he was passed over as the inaugural head of the department, so he left academia and returned home to his Ngāti Porou roots to farm and work for his people. It was many years before Victoria University recognized his contributions. In 2004 they awarded him an honorary doctorate in literature (Fox 2010). In September 2010, Sir Archie John Te Atawhai Taiaroa passed away. He was Te Atihaunui a Pāpārangi, Ngāti Tūwharetoa, and Ngāti Apa and chairman of the Whanganui River Māori Trust Board. He played a key role in one of the nation's longest running court cases—the Whanganui River claim. He took a number of leading roles tribally, nationally, and internationally. He was at the heart of the protracted Māori fisheries struggles and a leader of the Māori broadcasting litigation that spanned over twenty years and led to Māori radio and television. He traveled to the United Nations, the International Whaling Commission, and the Privy Council in London to defend the rights of Māori and indigenous people (Māori Party 2010b; Harawira 2010). On 8 September, the first earthquake hit Christchurch. It measured 7.1 on the Richter scale and, while there was extensive damage to buildings in the central business district in particular, there was no loss of human life. Hundreds of aftershocks followed, [End Page 185] and a magnitude 6.3 quake on 22 February...

Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice

AbstractBackground: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK‐wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy.Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients.Methods: at the macro‐level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced.Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients.Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK.

Quality accounts and quality monitoring by acute trust boards

The Department of Health’s main objective in mandating NHS acute sector providers in England to produce annual Quality Accounts from 2009–10 onwards was to increase the level of engagement of provider boards in quality improvement in their organisations. Quality Accounts are also intended to encourage boards to assess quality across the full range of services they offer. This study analysed the meeting minutes of boards of directors from a random sample of 15 NHS acute trusts to determine the prevalence of recurring board reports providing information on quality of care over the period 2008–2010. An increase in several types of quality-related reports was found. The board minutes of three trusts suggested that the requirement to produce Quality Accounts had led to modifications to the regular performance reports at board meetings. However, there was little evidence to suggest boards were monitoring the quality of specific services provided by their trusts at the main board meeting. Boards should consider giving more attention in their meetings to the clinical effectiveness of specific services and an appropriate response (e.g. by using clinical audits) rather than focusing so much on topics that are the subject of national targets such as hospital-acquired infections and waiting times.

Offline: “A singular lack of foresight”

On the evening of June 23, a meeting of senior staff took place in the Kennedy Lecture Theatre at the Institute of Child Health to discuss recent adverse publicity about Great Ormond Street Hospital (GOSH). The event was opened by Baroness Tessa Blackstone, chairman of the Trust Board. According to one person present, two issues were raised. First, the critical media coverage of GOSH, relating to the death of baby Peter Connelly in 2007. Second, the implications of concerns raised by GOSH staff about the hospital's management culture. The evening concluded with a standing ovation for GOSH's chief executive, Dr Jane Collins. To recap briefly. On June 18, we reported that Lynne Featherstone, a UK Member of Parliament and Minister in the current government, had drawn attention to serious concerns about the way GOSH handled events before and after the death of baby Peter. Dr Barbara Buckley and Prof Martin Elliott, co-medical directors of GOSH, have rejected these criticisms. But the central concern raised by some senior consultants at GOSH still remains: the international standing of the hospital has been—is being—let down by poor governance, inferior management, and a hostile culture. Response to Offline about Great Ormond Street HospitalWe are responding to your Offline column of June 18 (p 2068),1 in which you repeat allegations made by Lynne Featherstone, Member of Parliament, that Great Ormond Street Hospital (GOSH) withheld vital information from enquiries into the tragic death of Peter Connelly. Your article was highly speculative and ill-informed. Full-Text PDF

Does the level of evidence underpinning nice recommendations influence adoption into trust maternity guidelines?

IntroductionMaternity care providers are expected to follow National Institute for Health and Clinical Excellence (NICE) and other evidence-based guidelines.1AimsTo audit whether level of evidence influences adoption of NICE guidelines by...

Cadaveric Hands-on Training for Surgical Specialties: Is This Back to the Future for Surgical Skills Development?

Delivery of surgical care is linked intricately to technical proficiency. Recent legislative changes in the United Kingdom have facilitated the introduction of new teaching methods. This article is a review of our experience with a cadaver laboratory housed within a tertiary referral hospital and assesses the impact of such for the future delivery of surgical care in the United Kingdom. We describe in this article the logistics of setting up and running a fresh frozen cadaver laboratory, the governance arrangements in place, the performance of the facility in the first 2 years, and the feedback from the participants. The center hosts approximately 60 courses per year across a range of surgical disciplines that have received excellent feedback. Support from the Trust Board, local charities, multidisciplinary faculty, and the industry underpinned by robust governance has resulted in a successful venture. Hands-on training is increasingly relevant in craft specialties. After the introduction of the European working time directive, there is clear evidence of reduction in time spent performing live surgical procedures by trainees. There has been an explosion in the introduction of new surgical technology and marked expansion in the instrumentation that accompanies such procedures. Greater scrutiny of surgical outcomes is now in the public domain. To embrace and maximize patient benefit successfully, it is mandatory that the surgeon of the future will require access to dedicated near patient surgical training in specific skills without jeopardizing patient care.

Clinical dashboards: do they actually work in practice? Three-year experience with the Maternity Dashboard

Clinical governance refers to a system or a framework through which National Health Service (NHS) organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish. Various ‘dashboards’ or ‘score cards’ are currently being promoted with an intention of improving patient care and outcomes. It is believed that a closer observation of selected parameters, on a regular basis, may facilitate timely action, thereby avoiding adverse incidents. It is, therefore, hoped that such ‘dashboards’ or ‘score cards’ may also help clinicians, managers, trust boards, commissioners and patients to identify areas of good clinical practice and also to recognize areas that require improvement.

Achieving high-quality care at the end of life in the acute hospital setting

With more than half (58%) of deaths in England taking place in hospitals, it is crucial that we continue to both improve the quality of end-of-life care (EoLC) in the acute sector and make the best use of available resources. The National End of Life Care Programme (NEoLCP) recently published a practical guide that will help nurses and doctors work with hospital managers and board members to achieve just that. The Route to Success in End of Life Care — Achieving Quality in Acute Hospitals (NEoLCP, 2010) follows the six steps in the EoLC pathway for acute hospitals ( Figures 1 and 2 ). For each step it sets out a series of questions and points that clinicians, senior managers and trust board members should consider when assessing how their own hospital cares for those nearing the end of life and their families. Figure 1. Delivering quality and productivity excerpt from The Route to Success in End of …

Implementing minimum notification criteria for organ donation in an acute hospital's critical care units

To increase the number of donated organs through an effective donor identification and referral scheme in a large acute hospital's critical care units. The barrier to successful organ transplantation is a serious shortage of donated organs. In January 2008, the Department of Health officially endorsed all 14 recommendations presented by the Organ Donation Taskforce. Recommendation 5 from the Taskforce is that minimum notification criteria for potential organ donation should be introduced on a UK-wide basis. A hospital policy entitled Required Referral was implemented into a large hospital trust consisting of four critical care units. Support from the trust board was sought and it was agreed that the policy would be implemented as a 'pilot policy' in the first instance, then a formal review after a 6-month period. A rolling education programme was instituted to incorporate 170 clinical staff to ensure the policy was activated with the following criteria: If the plan is to perform brain stem death tests on a patient or a clinical decision is made to withdraw treatment, the on-call donor transplant co-ordinator is contacted for an assessment of suitability. A significant increase in potential donor referrals and a 200% increase in donated organs has been achieved with the policy in place. A retrospective audit for the 6-month period prior to the policy launch had shown four referrals from the pilot sites. The following 12 months as the policy was implemented revealed an impressive 121 referrals to the transplant co-ordinator. This has resulted in nine successful multi-organ donors. The required referral scheme has clearly shown an impressive increase in donation activity within the trust. Donation has been embraced as a normal part of end of life care.

Trust boards must 'open up' to patients and practitioners.

NHS FOUNDATION trusts operate 'behind closed doors' and do not involve staff or patients in important decision making, a report has revealed.