bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing the scope and impact of root cause analysis recommendations
Authors: Iedema Rick , Jorm Christine , Braithwaite Jeffrey 
Published: October 2008

PurposeIncreased public awareness of clinical failure and rising levels of litigation are spurring health policy makers in industrialized countries to mandate that clinicians report and investigate clinical errors and near misses. This paper seeks to understand the value of root cause analysis (RCA) recommendations for practice improvement purposes. The paper presents an analysis of interviews with nine senior health managers who were asked about their views on RCA as practice improvement method.Design/methodology/approachInterview data were collected as part of a multi‐method evaluation consultancy project investigating a local Health Safety Improvement Program. The interview data were discourse analysed and arranged into over‐arching themes.FindingsThe analysis reveals rather negative views of the improvement potential of RCA: RCA is subject to too many constraints to be able to produce valuable recommendations; RCA recommendations: are perceived to be of “variable quality”; generate considerable extra work for senior management to do with vetting RCA recommendations; are experienced as contributing in only a limited way to organizational and practice improvement.Research limitations/implicationsThis study focuses on nine interviewees only and presents an analysis of single (not multiple) interviews. However, these nine interviewees fulfil crucial roles in implementing clinical practice improvement initiatives in their respective geographic areas.Practical implicationsThe findings suggest that RCA requires much time and negotiation, and that the recommendations produced may not live up to the philosophy of clinical practice improvement's expectations. It may be necessary to reorient the expectations of the power of RCA, or accept that RCA produces communication about clinical processes that would otherwise not have taken place, and whose effects may not be registering for some time to come.Originality/valueBesides drawing out the implications for RCA as investigative practice, the analysis argues that interviewees' responses harbour indications to suggest that these officials are finding themselves engaged in increasing levels of communicative and emotional labour, in having to manage and compensate for the ambiguities, incommensurabilities and conflicting goals inscribed into “post‐bureaucratic” initiatives such as RCA.
The impact of engaging leadership on performance, attitudes to work and wellbeing at work
Authors: Alimo‐Metcalfe Beverly , Alban‐Metcalfe John , Bradley Margaret , Mariathasan Jeevi , Samele Chiara 
Published: October 2008

PurposeThe purpose of this paper is to examine the relationship between quality of leadership and attitudes to work and a sense of wellbeing at work, and organizational performance.Design/methodology/approachThis is a longitudinal empirical investigation, using quantitative methods.FindingsThe findings were fourfold: the leadership instrument used was demonstrated to have convergent, discriminant and predictive validity; differential relationships were found between three aspects of quality of leadership and attitudes to work and a sense of wellbeing at work; one leadership quality – “engaging with others” – was shown to be a significant predictor of organizational performance; leadership quality as assessed by competencies or “capabilities” did not predict performance.Originality/valueThe paper presents evidence of: the validity of a new leadership instrument; the differential relationship between leadership quality and staff attitudes to work and their sense of wellbeing at work; and a predictive relationship between leadership quality and organizational performance.
Transformational, transactional and laissez‐faire leadership among physician executives
Authors: Xirasagar Sudha 
Published: October 2008

PurposeThe purpose of this paper is to examine the empirical validity of transformational, transactional and laissez‐faire leadership and their sub‐scales among physician managers.Design/methodology/approachA nation‐wide, anonymous mail survey was carried out in the United States, requesting community health center executive directors to provide ratings of their medical director's leadership behaviors (34 items) and effectiveness (nine items), using the Multifactor Leadership Questionnaire 5X‐Short, on a five‐point Likert scale. The survey response rate was 40.9 percent, for a total 269 responses. Exploratory factor analysis was done, using principal factor extraction, followed by promax rotation).FindingsThe data yielded a three‐factor structure, generally aligned with Bass and Avolio's constructs of transformational, transactional and laissez‐faire leadership. Data do not support the factorial independence of their subscales (idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation under transformational leadership; contingent reward, management‐by‐exception active, and management‐by‐exception passive under transactional leadership). Two contingent reward items loaded on transformational leadership, and all items of management‐by‐exception passive loaded on laissez‐faire.Research limitations/implicationsA key limitation is that supervisors were surveyed for ratings of the medical directors' leadership style. Although past research in other fields has shown that supervisor ratings are strongly correlated with subordinate ratings, further research is needed to validate the findings by surveying physician and other clinical subordinates. Such research will also help to develop appropriate content of leadership training for clinical leaders.Originality/valueThis study represents an important step towards establishing the empirical evidence for the full range of leadership constructs among physician leaders.
Navy Nurse Corps manpower management model
Authors: Kinstler Daniel P. , Johnson Raymond W. , Richter Anke , Kocher Kathryn 
Published: October 2008

PurposeThe Navy Nurse Corps is part of a team of professionals that provides high quality, economical health care to approximately 700,000 active duty Navy and Marine Corps members, as well as 2.6 million retired and family members. Navy Nurse Corps manpower management efficiency is critical to providing this care. This paper aims to focus on manpower planning in the Navy Nurse Corps.Design/methodology/approachThe Nurse Corps manages personnel primarily through the recruitment process, drawing on multiple hiring sources. Promotion rates at the lowest two ranks are mandated, but not at the higher ranks. Retention rates vary across pay grades. Using these promotion and attrition rates, a Markov model was constructed to model the personnel flow of junior nurse corps officers.FindingsHiring sources were shown to have a statistically significant effect on promotion and retention rates. However, these effects were not found to be practically significant in the Markov model. Only small improvements in rank imbalances are possible given current recruiting guidelines. Allowing greater flexibility in recruiting practices, fewer recruits would generate a 25 percent reduction in rank imbalances, but result in understaffing. Recruiting different ranks at entry would generate a 65 percent reduction in rank imbalances without understaffing issues.Practical implicationsPolicies adjusting promotion and retention rates are more powerful in controlling personnel flows than adjusting hiring sources. These policies are the only means for addressing the fundamental sources of rank imbalances in the Navy Nurse Corps arising from current manpower guidelines.Originality/valueThe paper shows that modeling to improve manpower management may enable the Navy Nurse Corps to more efficiently fulfill its mandate for high‐quality healthcare.
Health care competition, strategic mission, and patient satisfaction: research model and propositions
Authors: Rivers Patrick A. , Glover Saundra H. 
Published: October 2008

PurposeIn all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers This paper aims to develop a model that can be used to empirically investigate a number of complex issues and relationships associated with competition in the health care industry.Design/methodology/approachA literature review was conducted. A total of 50 items of literature related to the subject were reviewed.. Various perspectives of competition, the nature of service quality, health system costs, and patient satisfaction in health care are examinedFindingsA model of the relationship among these variables is developed. The model depicts patient satisfaction as an outcome measure directly dependent on competition. Quality of care and health care systems costs, while also directly dependent on the strategic mission and goals, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research.Practical implicationsEmpirical studies based on the model proposed in this paper should help identify areas with significant impact on patient satisfaction while maintaining high quality of service at lower costs in a competitive environment.Originality/valueThe authors develop a research model which included propositions to examine the complex issues of competition in the health care industry.
Healthcare governance and organizational barriers to learning from mistakes
Authors: Storey John , Buchanan David 
Published: October 2008

PurposeThe purpose of this article is to advance critical debate in relation to a very critical issue in current healthcare management – namely “patient safety”. This is currently a very high profile issue. In its various guises such as clinical governance, integrated governance and healthcare governance the question of avoiding or at least minimising harm to patients is attracting a huge amount of attention. Considerable resources especially within the acute sector are allocated to the problem. But, despite the systematic attention, progress in healthcare compared with certain other sectors is slow and mistakes continue to occur. Hospital acquired infections and clinical errors have become a matter of acute public concern. Evaluations of the health service are critically influenced by adverse judgements on this dimension of care.Design/methodology/approachThe authors draw primarily upon relevant literature in order to make sense of recent empirical research in eight acute hospital trusts in the UK. The analysis, however, is relevant to healthcare systems around the world.FindingsThe authors reveal how the massive investment in systems, service improvement mechanisms and clinical government regimes may not in themselves be enough. One reason why they may not be enough is that there can be a problem of gaining acceptance and legitimacy. Staff may see such managers as “policing” and “interfering”. There is then the danger of a vicious circle – more control but less effective control because of a feeling of alienation. The policing element is at best a final safety net not the prompt for improvement. They then identify six barriers and each is accompanied by a recommendation for its resolution.Practical implicationsThere are a number of implications for practice and for systems reform, which stem from the analysis. Two main recommendations stand out: they need to be handled together. First, the traditional model of the autonomous professional needs to be challenged by subjecting clinical practice to shared clinical governance procedures. Second, and simultaneously, there is a need to attend to underlying values. There is a need to revisit the issue of underpinning values so that clinical values and system‐wide/managerial values are congruent rather than separate or even in conflict. At this point, governance and leadership should come together.Originality/valueThis paper provides useful information from the literature on current healthcare management.
Delays to operating encountered by plastic surgery trauma patients
Authors: Exton R. , Gillespie P. , Schreuder F. 
Published: October 2008

PurposeNCEPOD states that all emergency patients must have prompt access to theatres, critical care facilities, and appropriately trained staff 24 hours/day, every day of the year. The purpose of this paper is to determine waiting time for plastic surgery trauma patients and the financial implications to the NHS.Design/methodology/approachThe approach was a prospective audit of emergency surgery (Lister Hospital, Stevenage) from July 2005‐January 2006. Delay times were calculated from booking time to time of operation. These were assessed on a standard of a day surgery unit, where the ideal maximum is a half day wait. Financial implications were calculated. The number of UK units without a dedicated list is highlighted.FindingsA total of 615 operations were booked, 60 per cent of which were assessed as suitable for a DSU set up. With an ideal standard of half a day's wait, an average 22 per cent of patients achieved this, with 64 per cent of patients waiting one excess day. On average patients waited an excess of 1.3 days. An average of 24 excess bed days/week (bed cost £300/day) were used waiting for surgery. This equates to 1,400 bed days (£400,000/annum).Originality/valueThe paper shows how it is possible that 1,000 bed days/annum (£300,000) could be saved by a DSU type setup. With 61 plastic surgery units in the UK, 40 per cent reported no dedicated trauma list (93 per cent response rate). This is a potential saving of £8,400,000 per annum. From this audit a half day dedicated DSU list was created, and a re‐auditing process will occur.
Improving patient care and clinical governance through the utilisation of a clinical information system
Authors: Park John , McAlaney Catherine , Connolly Moira 
Published: October 2008

PurposeThis paper seeks to provide an overview of how the involvement of clinicians in the design and implementation of an electronic clinical information system has contributed towards more effective clinical governance, while improving the care of patients with a diagnosis of psychosis.Design/methodology/approachA data collection form was designed by a consultant in public health and a group of consultant psychiatrists to facilitate and standardise the data to be collected and stored on the information system. Two research nurses conducted a retrospective case note audit to record specified data on all existing patients from an inclusive diagnosis list in contact with CMHTs.FindingsThe establishment of PsyCIS has increased the understanding of the nature and prevalence of psychosis in Greater Glasgow for patients aged 18‐65. As well as giving some insight into how the needs of this patient group are being addressed, it has also provided clinicians with the ability to benefit from their collective experience on the treatment and support of this patient group.Practical implicationsTo ensure excellent data quality and information management systems, it is essential to involve clinicians in their design and validation. The primary goal of information should be to aid clinical practice and patient care. Well designed datasets will also provide information that can inform clinical governance as well as the management of services and resources.Originality/valueThis paper supports the view that clinical audit and electronic clinical information systems are imperative for effective clinical governance.
Referrals between consultants. The wait to be seen in a specialist plastic surgery hand clinic
Authors: O'Neill Jennifer K. , Laina V. , Wilson S. 
Published: October 2008

PurposeThe purpose of this article to study referrals to our hand service to find out how long they had been waiting and with what sort of clinical conditions. The Department of Health monitors outpatient's waiting time as the percentage of patients seen within a 13‐week target. This target does not include patients referred by consultants or other health professionals.Design/methodology/approachAll the referral letters from other consultants or healthcare professionals still awaiting appointments were collected. The referrals were read and studied to ascertain the most likely diagnosis. This was recorded along with the source of the referral and the details to whom the referral was made. The date of the referral letter being received by the department (date stamped) was also noted.FindingsA total of 157 referrals from consultants or healthcare professionals were waiting outpatient dates. The median waiting time was 448 days (range 20‐952 days). The most frequent source of referrals was from the orthopaedic department. Carpal tunnel syndrome was the most common problem awaiting an outpatient appointment.Originality/valueThe wait for a clinic appointment for these patients is long. This has come about as the result of the fact that the government targets for outpatient waiting times have been set for GP referrals alone and exclude referrals that have been made by other consultants or other healthcare professionals. This is a clinical governance issue for the Hospital Trust, the Primary Care Trust and for general practitioners.
Validity and reliability of the CARE Measure in secondary care
Authors: Mercer S.W. , Murphy D.J. 
Published: October 2008

PurposeThe Consultation and Relational Empathy (CARE) Measure is a validated tool for assessing the patients' perception of the doctors' communication in primary care. The present study aims to evaluate the potential usefulness of the CARE Measure in secondary care in a single Hospital Trust in Scotland.Design/methodology/approachA total of 1,015 out‐patients attending 25 consultants across ten specialities anonymously completed the questionnaire immediately after their appointment. Overall satisfaction, estimated consultation length, satisfaction with consultation length, and demographic and socio‐economic variables were also recorded.FindingsThe number of missing values and “not applicable” responses to the ten CARE Measure items was extremely low (3.4 per cent). Almost 90 per cent of patients felt the CARE Measure items were of major importance. The measure had a high internal reliability (Cronbach's alpha 0.94) and reduced to a single factor. Overall CARE Measure score correlated with overall satisfaction (r=0.7, p<0.0001), whether patients would recommend the doctor (r=0.6, p<0.0001), and satisfaction with consultation length (r=0.6, p<0.0001). Multi‐regression analysis showed that personal continuity of care, consultation length, and patient age positively influenced CARE Measure score, but the effect size was small. Patients' gender, marital status, general health, and socio‐economic factors did not influence scores. Reliability analysis indicated that 40 patients were required per doctor in order to achieve an overall reliability co‐efficient of above 0.7.Practical implicationsSecondary care patients across a range of specialities have endorsed the CARE Measure as a relevant tool. It has high face and concurrent validity, internal and structural reliability and is not subject to major influences by demographic or socio‐economic factors. These findings support the feasibility and reliability of the CARE Measure in secondary care.Originality/valueThis pilot study indicates that the CARE Measure is considered by most patients to be of high relevance to everyday out‐patient consultations in secondary care.
Adverse incidents in gynaecology: anything for doctors?
Authors: Basu Abhijit , Theophilou Georgios , Howell Rosemary 
Published: October 2008

PurposeThe purpose of this study is to determine the effectiveness of incident reporting within the Department of Gynaecology at Trafford General Hospital.Design/methodology/approachA list of all reported clinical incidents in relation to gynaecology at the Trafford General Hospital over a period of two years (January 2005 to December 2006) was obtained. The complaints and claims related to gynaecology were also obtained for the same time period. All complaints and claims were correlated with the reported adverse incidents.FindingsOf the reported 111 adverse incidents, none resulted in either complaint or claim. None of the complaints resulted in claims but there was no corresponding incident reporting. All the claims were directly related to surgical procedures but no incident reporting was done either. The nursing staff filled in all the 111 adverse incident forms.Research limitations/implicationsThis study is only limited to adverse incidents in gynaecology over a short period of time (two years) at a District General Hospital.Practical implicationsThis study demonstrates the need to stress the importance of incident reporting to the doctors. It is suggested that a session be dedicated to incident reporting as a part of in‐house training for medical staff of all grades.Originality/valueThis paper highlights the need to impress on the medical staff about the importance of adverse clinical incident reporting.
Overzealous oversight of healthcare quality improvement projects
Authors: Birnbaum David , Ratcliffe Rita L. 
Published: October 2008

PurposeThis paper seeks to describe a recent impasse resulting from failure of a federal oversight agency to distinguish between observational studies documenting the impact of quality improvement activities versus experimental clinical trials research.Design/methodology/approachThis paper provides a review of popular press accounts, regulations, and relevant correspondence; and interviews with project leaders.FindingsA controversial federal decision in the USA quickly galvanized unusually harsh criticism from a very wide range of professional associations, healthcare researchers, and patient safety advocacy groups.Originality/valueThis incident, at a time when application of quality improvement methods and public reporting networks are becoming more widespread in healthcare, illustrates the urgent need for better distinction between clinical trials research versus quality improvement research projects. Institutional review boards are ill‐advised to apply familiar ethical safeguard reviews appropriate to the former to the latter.