UK Healthcare Organisations Research Articles

Unethical organ transplantation in China: preventing complicity in UK healthcare and related organisations

International criminal lawyer Eleanor Stephenson discusses forced organ harvesting in China and the risk of complicity in UK healthcare organisations and related bodies. Readers are signposted to guidance to help them reduce these risks and protect staff from being unknowingly involved in unethical transplantation practices.

Understanding organizational learning in a healthcare organization during sudden and disruptive change

PurposeComplex and sudden change that healthcare organizations often have to respond to, such as during the recent pandemic, can create major disruptions and a prolonged state of alert. Although the impact of such crises can be predominantly negative, rapid adjustments during this time can also yield positive change that can support organizational response to crisis, if managed well. Using insights from organizational learning and organizational change theory, the aim of this study was to understand organizational learning during sudden change. Specifically, the authors aimed to understand the experiences and types of gains and losses in the processes of complex and disruptive change in one large healthcare organization in the UK.Design/methodology/approachFocus group data were used from 23 focus group discussions with 575 participants representing all functions and departments in one Healthcare Trust.FindingsThe participants revealed the rich gains, losses, and lessons experienced in response to sudden change that can promote organizational learning. Perceived losses are more likely to drive a desire to refreeze “back to normal” and perceived gains more likely to lead to an emphasis on embedding gains and changing to better. Therefore, on balance, the substantial, in number and variety, gains and learnings point to a learning organization. This is an essential attribute for responding to disruptive change successfully and facilitating organizational recovery in a post-pandemic world.Practical implicationsThe findings highlight the importance of timely harnessing of the organizational learning emerging from crises and how this can inform a more resilient organization, as well as supporting sustainable organizational cross-learning.Originality/valueBy extending these insights on workers’ adaptation to sudden change, the findings can help to advance the science and practice of organizational learning and support organizational recovery, especially as they describe the new status in UK healthcare organizations.

Pharmacogenomics: Relevance and opportunities for clinical pharmacology

Pharmacogenomics: Relevance and opportunities for clinical pharmacology

The challenges and opportunities of mental health data sharing in the UK

The challenges and opportunities of mental health data sharing in the UK

Effectiveness of a group intervention to reduce the psychological distress of healthcare staff: a pre-post quasi-experimental evaluation

BackgroundWork stress and compassion fatigue are prevalent among healthcare staff and their negative effects on staff well-being and patient care are well-known. This paper reports on the implementation and evaluation of Schwartz Rounds® (Rounds) in UK healthcare organizations, predominantly part of the National Health Service (NHS). Rounds are one-hour, typically monthly, multidisciplinary forums during which clinical and nonclinical healthcare staff discuss the emotional and social demands of delivering patient care. The purpose of this research was to evaluate the effectiveness of Rounds attendance on the psychological distress, work engagement, compassion and self-reflection of healthcare staff.MethodsWe used a pre-post control design to assess the effect of Rounds attendance across 10 UK healthcare organizations. This design was most appropriate given the voluntary nature of Rounds and ensured the study had ecological validity. Self-reported data were collected from attenders and non-attenders at baseline and at eight-months follow-up. The outcomes were psychological distress, work engagement, compassion and self-reflection.ResultsDuring the 8 months’ study duration, regular attenders (N = 51) attended Rounds on average 4 times (2–8). Attenders showed a significantly greater decrease in psychological distress (as measured with the General Health Questionnaire (GHQ)) than non-attenders (N = 233; odds ratio of 0.197; 95% confidence interval (0.047–0.823)). However, Rounds attendance had no significant effect on work engagement, compassion and self-reflection.ConclusionsRounds attendance was linked to a 19% reduction in psychological distress adjusting for covariates. As an organization-wide intervention, Rounds thus constitute an effective, relatively low-cost intervention to assist staff in dealing with the demands of their work and to improve their well-being.

Retaining newly Registered Nurses in the profession.

Newly qualified nurses (NQNs) are one group at risk of early exit from the workforce. There is a need to reinforce the 'flaky bridge' (Health Education England [HEE] 2018) and ease 'transition shock' to facilitate NQN retention. (1) establish the current state of the art in the UK for nurse retention and transition from student to Registered Nurse; (2) provide UK healthcare organisations, higher education institutions and individual nurses with an evidence-based approach to plan for successful transition; (3) develop an evidence-based toolkit that enables NQNs and their employers to identify, implement and evaluate an individualised approach to transition. A rapid evidence assessment (REA) of NQN transition and retention was undertaken followed by 40 interviews with final year nursing students, NQNs, clinical leaders and academics and 113 written reflections from final year nursing students captured qualitative data on transition. A 'transition toolkit' was developed and used with one group of students (n=75) and data on retention and employment captured to determine impact on the number of nurses retained at the end of 12 months. A variety of formal and informal approaches that enhance and support transition were identified by the REA including having a formal orientation period; the initial placement; satisfaction with the unit and clinical supervision; empowerment; pre-registration employment; and low stress levels having had previous experience in the unit. Preceptorship was found to significantly increase NQNs competence, though no firm conclusions could be reached regarding the impact on retention. Qualitative data suggested that NQNs still experience transition shock and support during the transition period was important. Quantitative data indicated that most NQNs were employed full-time and working in local NHS hospitals. Most had undertaken employment during their programme and when qualified had not changed employer or role and did not plan to change. In the post-intervention group, most had engaged with the STaR project material and had accessed their place of first employment through the project. There were no statistically significant differences between cohorts, and no statistically significant relationships among the data. A supportive framework incorporating supernumerary status, preceptorship or equivalent, peer and organisational culture of support can help to ensure a smooth, seamless and comfortable transition. The link between NQN support and retention remains poorly evidenced.

Analysis of Pharmaceutical Industry Payments to UK Health Care Organizations in 2015

Drug company payments to health care organizations can create conflicts of interest. However, little is known about such financial relationships, especially outside the United States. To examine the concentration and patterns of drug company payments to health care organizations in the United Kingdom. This cross-sectional study examined nonresearch payments reported in the industry-run Disclosure UK database. Companies participating in Disclosure UK in 2015 and health care organizations receiving their payments were included in the analysis. The data were analyzed descriptively at the health care organization, payment, and donor levels, considering health care organization categories, payment categories, and companies from February 5 through May 28, 2017, with follow-up checks from June 1 through August 31, 2018. Analysis was conducted from July 10 through December 20, 2018. Share of funding and the Gini index (GI) to measure payment concentration (0 indicates perfect deconcentration [eg, all drug companies provide the same value of payments]; 1, perfect concentration [eg, 1 company provides the entire value of payments]) and median and interquartile range (IQR) to measure payment patterns. A total of 4028 health care organizations received 19 933 payments, worth US $72 110 156.6, from 100 companies. This study identified 11 categories of health care organizations, with 3-public-sector secondary and tertiary care providers, education and research providers, and professional organizations-accumulating 67.2% of funding. The health care organization categories had varying GIs (range, 0.65-0.92), medians (range, $750.3-$45 862.4), and IQRs (range, $389.1-$1843.9 to $3104.4-$199 868.2). Of 4 payment categories, the top category-donations and grants-captured 50.6% of funding. Joint working (collaborative projects with nonindustry partners) had a lower GI (0.64) than other payment categories (range, 0.79-0.84). The median and IQR were the lowest for contributions to costs of events ($366.8; IQR, $229.3-611.3) and highest for joint working ($14 903.7; IQR, $3185.0-34,748.4). The top 10 firms (58.6% of funding) had payments with varying medians (from $366.8 [IQR, $244.5-611.3] to $9781.3 [IQR, $1834.0-48 906.7]). Although organizations from across the health care system received funding, the payments were concentrated on a few large donors, payments, and recipients. Different payment and recipient categories had different patterns of payment values, suggesting that the industry has diversified its funding strategies across different parts of the health care system. These results suggest that Disclosure UK requires improved transparency, particularly by including built-in recipient categories, and that organizational conflicts of interest need more policy attention, including disclosure of payments independent of the industry.

A qualitative study exploring how routinely collected Medication Safety Thermometer data have been used for quality improvement purposes using case studies from three UK hospitals

ObjectivesThe Medication Safety Thermometer (MedsST) is a medication safety data collection tool, which has been used by over 100 UK healthcare organisations to enable measurement of medication safety for improvement...

Hybrid managers, career narratives and identity work: A contextual analysis of UK healthcare organizations

While hybrid managers are increasingly important in contemporary organizations (especially in the public sector), we know little about why or how they become hybrid managers, or how this is shaped by the interplay of professional experience and organizational circumstances. In pursuit of a more variegated, contextualized and dynamic understanding of hybrid management, this article focuses on how individuals transition into managerial hybrids, emphasizing the dynamic and emergent nature of hybrid management identity. Studying managers in English healthcare, we employ the concept of identity work as expressed through career narratives to examine the influence of career trajectories and organizational experiences on emerging hybrid manager identity. The study identifies three broad managerial career narratives – aspirational, ambivalent and agnostic – and relates them to experiences of doctor and nurse hybrid managers in three healthcare settings. An interpretive analysis of these narratives reveals a more variegated, situated and dynamic interpretation of hybrid managerial identities than previously considered and underscores the importance of personal and organizational experiences in shaping emergent hybrid professional/managerial identity.

Hybrid Careers and Managerial Identity in UK Healthcare Organizations

In the context of institutional reform and organizational changes within the UK healthcare system, increasing attention has been directed to the changing nature of managerial work and the importanc...

Rules of attraction.

Nottingham University Hospitals NHS Trust is the latest in a small, select band of UK hospitals working to achieve Magnet hospital accreditation. Along with Oxford University Hospitals and the Heart of England NHS Foundation Trust in Birmingham, Nottingham is a key member of the new UK Magnet Alliance, which brings together UK healthcare organisations interested in pursuing Magnet recognition.

Multisource Feedback in Evaluating the Performance of Doctors

Internationally, there is increasing interest in monitoring and evaluating doctors' professional practice. Multisource feedback (MSF) offers one way of collecting information about doctors' performance. The authors investigated the psychometric properties of two questionnaires developed for this purpose and explored the biases that may exist within data collected via such instruments. A cross-sectional study was conducted in 11 UK health care organizations during 2008-2011. Patients (n = 30,333) and colleagues (n = 17,012) rated the professional performance of 1,065 practicing doctors, using the General Medical Council Patient Questionnaire (PQ) and Colleague Questionnaire (CQ). The psychometric properties of the questionnaires were assessed, and regression modeling was used to explore factors that influenced patient and colleague responses on the core questionnaire items. Although the questionnaires demonstrated satisfactory internal consistency, test-retest reliability, and convergent validity, patient and colleague ratings were highly skewed toward favorable impressions of doctor performance. At least 34 PQs and 15 CQs were required to achieve acceptable reliability (G > 0.70). Item ratings were influenced by characteristics of the patient and colleague respondents and the context in which their feedback was provided. The PQ and CQ are acceptable for the provision of formative feedback on a doctor's professional practice within an appraisal process. However, biases identified in the questionnaire data suggest that caution is required when interpreting and acting on this type of information. MSF derived from these questionnaires should not be used in isolation to inform decisions about a doctor's fitness to practice medicine.

Organizational critical success factors influencing balanced scorecard systems in UK healthcare

AbstractThe balanced scorecard has increasingly become established as a practitioner management tool within UK healthcare organizations over the last two decades. This paper aims to outline the current organizational critical factors that have a propensity to influence the success of a balanced scorecard system within UK healthcare organizations, with focus on the system in England. The National Health Service (NHS) remains a uniquely complex sector, and is entering a period of further change. Ten critical success factors are identified, which are grouped into four over arching categories. The categories identified are: strategic purpose, design and process, contextual integration, and strategic human resource management. It is acknowledged that different approaches can be taken in terms of content and purpose for a balanced scorecard system, including systems focusing on performance measurement or strategic management. Notwithstanding such local interpretations, it is suggested that senior management mus...

Dialogues and dialetics: Limits to clinician–manager interaction in healthcare organizations

This paper examines clinician–manager interactions within healthcare organizations in the UK and contrasts the notions of dialetics and dialogues within such interactions. We draw particularly on Bakhtin’s work on dialogue to frame our focal research question, which considers the extent to which clinician–manager interactions are dialogic. Using data drawn from a thirty-two month study of five UK healthcare organizations we suggest that clinician-manager interactions are more dialectic than dialogic in their orientation. Further, we suggest that, despite the appearance of dialogical possibility between clinicians and non-clinicians, the tendency to dialectic positioning reinforces opposition between these groups and we conclude that local, rather than system-wide interventions, offer the best means of disrupting these dialectics and fostering productive dialogues.

Could GP commissioning enable collaboration throughout the NHS?

Could GP commissioning enable collaboration throughout the NHS?

Modernising Healthcare – is the NPfIT for Purpose?

This paper responds to the findings of the research by Currie and Guah on the introduction of the National Programme for Information Technology through an institutional theory perspective. It considers both the appropriateness and applicability of the method chosen in the light of what is already known about UK healthcare organisations and the complex and changing process that is involved in both the organisation and any research that takes place. This is further confounded by an unstable political environment both nationally and locally and a failure to understand the changing location, role and status of the medical record. Only when this is resolved will a transformational change occur, in line with the new patient-focused government agenda and the external world of technology that must engage with the emotional as well as the rational role that both technology and health play in people's lives.

Cardiopulmonary resuscitation standards for clinical practice and training in the UK

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post-resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.

Cardiopulmonary resuscitation standards for clinical practice and training in the UK

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.

Measuring progress in clinical governance: assessing the reliability and validity of the Clinical Governance Climate Questionnaire.

Despite a lack of conceptual clarity, the importance of cultural change to clinical governance is widely accepted. While generic measures of organizational performance, culture and climate are available, their relationship to clinical governance is unclear. Consequently, there is currently no valid and reliable measure of clinical governance climate. This study aimed to address the deficiency by reducing a pool of clinical governance climate indicators developed via previous qualitative research, describing a latent factor structure and assessing the internal consistency and external validity of the factor model. The resultant instrument, the Clinical Governance Climate Questionnaire (CGCQ), attained high internal consistency and external (discriminant and construct) validity in a study population of healthcare Trust staff. It consists of 60 items distributed across six sub-scales of clinical governance: planned and integrated quality improvement; proactive risk management; absence of unjust blame and punishment; working with colleagues; training and development; and organizational learning. The measure enables those charged with leading the clinical governance agenda in UK healthcare organizations to assess the progress of organizational development initiatives, highlighting areas requiring particular attention. They might also be of interest to those concerned about the negative unintended consequences of performance management.

Are different models of care pathways being developed?

Care pathways are becoming increasingly popular within UK healthcare organisations yet very little is known about the tool. Using the results from a survey of healthcare organisations, which are members of the National Pathways Association (NPA), the author suggests that different models of care pathways are being implemented. Four models or different types of care pathways are identified, with different features in each model. The models can be used prospectively by organisations to decide which particular features they may want to include. Alternatively, the models can be used as an assessment tool to identify the type of pathway being developed. This assessment can form the basis for any future evaluations of the effectiveness of the pathways which are developed.