Leadership of healthcare commissioning networks in England : a mixed-methods study on clinical commissioning groups

Objective: To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation. Design: Mixed-method, multisite and case study research. Setting: Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 population. Methods: Semistructured interviews with 56 lead GPs, practice managers and staff from the local health authorities (primary care trusts, PCT) as well as various healthcare professionals; 21 observations of clinical commissioning group (CCG) board and executive meetings; electronic survey of 58 CCG board members (these included GPs, practice managers, PCT employees, nurses and patient representatives) and subsequent social network analysis. Main outcome measures: Collaborative relationships between CCG board members and stakeholders from their healthcare network; clarifying the role of GPs as network leaders; strengths and areas for development of CCGs. Results: Drawing upon innovation network theory provides unique insights of the CCG leaders’ activities in establishing best practices and introducing new clinical pathways. In this context we identified three network leadership roles: managing knowledge flows, managing network coherence and managing network stability. Knowledge sharing and effective collaboration among GPs enable network stability and the alignment of CCG objectives with those of the wider health system (network coherence). Even though activities varied between commissioning groups, collaborative initiatives were common. However, there was significant variation among CCGs around the level of engagement with providers, patients and local authorities. Locality (sub) groups played an important role because they linked commissioning decisions with patient needs and brought the leaders closer to frontline stakeholders. Conclusions: With the new commissioning arrangements, the leaders should seek to move away from dyadic and transactional relationships to a network structure, thereby emphasising on the emerging relational focus of their roles. Managing knowledge mobility, healthcare network coherence and network stability are the three clinical leadership processes that CCG leaders need to consider in coordinating their network and facilitating the development of good clinical commissioning decisions, best practices and innovative services. To successfully manage these processes, CCG leaders need to leverage the relational capabilities of their network as well as their clinical expertise to establish appropriate collaborations that may improve the healthcare services in England. Lack of local GP engagement adds uncertainty to the system and increases the risk of commissioning decisions being irrelevant and inefficient from patient and provider perspectives

Impacts of Advanced Travel Information Systems on Travel Behaviour: Smartmoov’ case study

What are the effects of multimodal real-time information on travel behaviour? Large amounts of money have been invested to implement in the cities such systems, but until now few assessments have been done to verify if it contributes to a real modal shift and, in the higher end, to a more sustainable mobility. This research aims at thoroughly assessing the effectiveness of multimodal real-time information systems, pointing out the limitations before their use and recording the changes induced on the travel behaviour. Two wave questionnaires were designed and administered to a sample of 46 persons before and after a five months experimentation where a multimodal real-time information application for Smartphones (Smartmoov’) was tested after its implemented in the city of Lyon, in 2013. Besides the questionnaires twelve focus groups were conducted with the same sample, six before and six after the experimentation. The survey was aimed at investigating the potential changes of travel behaviour of the sample. Descriptive analysis, parametric and non-parametric tests, factor analysis and binary logistic regression were used as statistical approaches to analyse the collected data and evaluate the effectiviness of Smartmoov’. Before the experimentation, it was understood that participants had no constrains towards the use of the Smartmoov’, being its use under a positive outlook: almost everyone was expert in the technology and was familiar with the concept of Smartmoov’. The travellers’ assessment of the travel planner was initially modestly positive, but it decreased over time and, after the experimentation, the use of the different modes remained stable while a small increase of the car for the most frequent trip was observed. The perceived behaviour control and the intentions to change mode did not show variations after the experimentation; this fact points out that the behaviour is not completely reasoned, being partly under the influence of the habitual performance. The stability of the mode used, of the perceived behavioural control and of the intentions show that mobility is strongly influenced by the high frequency of the past behaviour. In fact, the mobility habits are a heavy burden on the process of modal choice. Nevertheless, information can play a role on modal shift, but only if it is strong enough to interrupt the patterns of routine commutes. The results of the experimentation were in line with previous studies; few people used this app on a daily basis or for planning daily commuting, but they most often used Smartmoov’ to plan occasional travels. Furthermore, people did not show any willingness to pay to use Smartmoov’ neither before or after the experimentation

Smarter choices - changing the way we travel

Summary: In recent years, there has been growing interest in a range of initiatives, which are now widelydescribed as 'soft' transport policy measures. These seek to give better information and opportunities,aimed at helping people to choose to reduce their car use while enhancing the attractiveness ofalternatives. They are fairly new as part of mainstream transport policy, mostly relativelyuncontroversial, and often popular. They include:. Workplace and school travel plans;. Personalised travel planning, travel awareness campaigns, and public transport information andmarketing;. Car clubs and car sharing schemes;. Teleworking, teleconferencing and home shopping.This report draws on earlier studies of the impact of soft measures, new evidence from the UK andabroad, case study interviews relating to 24 specific initiatives, and the experience of commercial,public and voluntary stakeholders involved in organising such schemes. Each of the soft factors isanalysed separately, followed by an assessment of their combined potential impact.The assessment focuses on two different policy scenarios for the next ten years. The 'high intensity'scenario identifies the potential provided by a significant expansion of activity to a much morewidespread implementation of present good practice, albeit to a realistic level which still recognisesthe constraints of money and other resources, and variation in the suitability and effectiveness of softfactors according to local circumstances. The 'low intensity' scenario is broadly defined as aprojection of the present (2003-4) levels of local and national activity on soft measures.The main features of the high intensity scenario would be. A reduction in peak period urban traffic of about 21% (off-peak 13%);. A reduction of peak period non-urban traffic of about 14% (off-peak 7%);. A nationwide reduction in all traffic of about 11%.These projected changes in traffic levels are quite large (though consistent with other evidence onbehavioural change at the individual level), and would produce substantial reductions in congestion.However, this would tend to attract more car use, by other people, which could offset the impact ofthose who reduce their car use unless there are measures in place to prevent this. Therefore, thoseexperienced in the implementation of soft factors locally usually emphasise that success depends onsome or all of such supportive policies as re-allocation of road capacity and other measures toimprove public transport service levels, parking control, traffic calming, pedestrianisation, cyclenetworks, congestion charging or other traffic restraint, other use of transport prices and fares, speedregulation, or stronger legal enforcement levels. The report also records a number of suggestionsabout local and national policy measures that could facilitate the expansion of soft measures.The effects of the low intensity scenario, in which soft factors are not given increased policy prioritycompared with present practice, are estimated to be considerably less than those of the high intensityscenario, including a reduction in peak period urban traffic of about 5%, and a nationwide reductionin all traffic of 2%-3%. These smaller figures also assume that sufficient other supporting policies areused to prevent induced traffic from eroding the effects, notably at peak periods and in congestedconditions. Without these supportive measures, the effects could be lower, temporary, and perhapsinvisible.Previous advice given by the Department for Transport in relation to multi-modal studies was that softfactors might achieve a nationwide traffic reduction of about 5%. The policy assumptionsunderpinning this advice were similar to those used in our low intensity scenario: our estimate isslightly less, but the difference is probably within the range of error of such projections.The public expenditure cost of achieving reduced car use by soft measures, on average, is estimated atabout 1.5 pence per car kilometre, i.e. £15 for removing each 1000 vehicle kilometres of traffic.Current official practice calculates the benefit of reduced traffic congestion, on average, to be about15p per car kilometre removed, and more than three times this level in congested urban conditions.Thus every £1 spent on well-designed soft measures could bring about £10 of benefit in reducedcongestion alone, more in the most congested conditions, and with further potential gains fromenvironmental improvements and other effects, provided that the tendency of induced traffic to erodesuch benefits is controlled. There are also opportunities for private business expenditure on some softmeasures, which can result in offsetting cost savings.Much of the experience of implementing soft factors is recent, and the evidence is of variable quality.Therefore, there are inevitably uncertainties in the results. With this caveat, the main conclusion isthat, provided they are implemented within a supportive policy context, soft measures can besufficiently effective in facilitating choices to reduce car use, and offer sufficiently good value formoney, that they merit serious consideration for an expanded role in local and national transportstrategy.AcknowledgementsWe gratefully acknowledge the many contributions made by organisations and individuals consultedas part of the research, and by the authors of previous studies and literature reviews which we havecited. Specific acknowledgements are given at the end of each chapter.We have made extensive use of our own previous work including research by Lynn Sloman funded bythe Royal Commission for the Exhibition of 1851 on the traffic impact of soft factors and localtransport schemes (in part previously published as 'Less Traffic Where People Live'); and by SallyCairns and Phil Goodwin as part of the research programme of TSU supported by the Economic andSocial Research Council, and particularly research on school and workplace travel plans funded bythe DfT (and managed by Transport 2000 Trust), on car dependence funded by the RAC Foundation,on travel demand analysis funded by DfT and its predecessors, and on home shopping funded byEUCAR. Case studies to accompany this report are available at: http://eprints.ucl.ac.uk/archive/00001233

Initial impacts of global risk mitigation measures taken during the combatting of the COVID-19 pandemic

This paper presents an analysis of risk mitigation measures taken by countries around the world facing the current COVID-19 outbreak. In light of the current pandemic the authors collated and clustered (using harmonised terminology) the risk mitigation measures taken around the globe in the combat to contain, and since March 11 2020, to limiting the spread of the SARS-CoV-2 virus known to cause the Coronavirus disease 2019 (COVID-19). This overview gathers lessons learnt, provides an update on the current knowledge for authorities, sectors and first responders on the effectiveness and may allow enhanced prevention, preparedness and response for future outbreaks. Various measures such as mobility restrictions, physical distancing, hygienic measures, socio economic restrictions, communication and international support mechanisms have been clustered and are reviewed in terms of the nature of the actions taken and their qualitative early-perceived impact. At the time of writing, it is still too premature to express the quantitative effectiveness of each risk mitigation cluster, but it seems that the best mitigation results are reported when applying a combination of voluntary and enforceable measures.JRC.E.7-Knowledge for Security and Migratio

PROPEL: implementation of an evidence based pelvic floor muscle training intervention for women with pelvic organ prolapse: a realist evaluation and outcomes study protocol

Abstract Background Pelvic Organ Prolapse (POP) is estimated to affect 41%–50% of women aged over 40. Findings from the multi-centre randomised controlled “Pelvic Organ Prolapse PhysiotherapY” (POPPY) trial showed that individualised pelvic floor muscle training (PFMT) was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. However, provision of PFMT for prolapse continues to vary across the UK, with limited numbers of women’s health physiotherapists specialising in its delivery. Implementation of this robust evidence from the POPPY trial will require attention to different models of delivery (e.g. staff skill mix) to fit with differing care environments. Methods A Realist Evaluation (RE) of implementation and outcomes of PFMT delivery in contrasting NHS settings will be conducted using multiple case study sites. Involving substantial local stakeholder engagement will permit a detailed exploration of how local sites make decisions on how to deliver PFMT and how these lead to service change. The RE will track how implementation is working; identify what influences outcomes; and, guided by the RE-AIM framework, will collect robust outcomes data. This will require mixed methods data collection and analysis. Qualitative data will be collected at four time-points across each site to understand local contexts and decisions regarding options for intervention delivery and to monitor implementation, uptake, adherence and outcomes. Patient outcome data will be collected at baseline, six months and one year follow-up for 120 women. Primary outcome will be the Pelvic Organ Prolapse Symptom Score (POP-SS). An economic evaluation will assess the costs and benefits associated with different delivery models taking account of further health care resource use by the women. Cost data will be combined with the primary outcome in a cost effectiveness analysis, and the EQ-5D-5L data in a cost utility analysis for each of the different models of delivery. Discussion Study of the implementation of varying models of service delivery of PFMT across contrasting sites combined with outcomes data and a cost effectiveness analysis will provide insight into the implementation and value of different models of PFMT service delivery and the cost benefits to the NHS in the longer term

Shopping alone online vs. co-browsing: a physiological and perceptual comparison

Although shopping is a social activity frequently performed with friends and family members, most online shopping is done alone. With the development of Web 2.0 technologies and the increasing popularity of social networking sites, online social shopping has emerged as a new phenomenon that allows more social interaction, participation, and satisfaction for customers while shopping online. Therefore, companies have started to use social shopping tools in their e-commerce websites to facilitate online social shopping. Co-browsing is one of the more recent online social shopping tools available, enabling users to shop or browse together by offering synchronized web views and chat facilities. Prior research in co-browsing focused primarily on the technical and design aspects of co-browsing. More needs to be done to understand the behavioral, emotional, and social aspect of co-browsing. In this study, we focus on the social aspect of co-browsing and explore the following research questions: (1) How does co-browsing affect consumers\u27 cognitive beliefs, emotions, and behaviors? (2) How is co-browsing different than shopping alone online? To address these questions, an experimental study is performed, which includes shopping alone and shopping with a companion by using a co-browsing tool. By recording and analyzing physiological responses such as eye gaze and skin conductance, we are able to gain better insight into how individuals react--both physically and perceptually--to co-browsing during an online shopping task --Abstract, page ii