Constrained by managerialism : caring as participation in the voluntary social services

The data in this study show that care is a connective process, underlying and motivating participation and as a force that compels involvement in the lives of others, care is at least a micro-participative process. Care or affinity not only persisted in the face of opposition, but it was also used by workers as a counter discourse and set of practices with which to resist the erosion of worker participation and open up less autonomized practices and ways of connecting with fellow staff, clients and the communities they served. The data suggest that while managerialism and taylorised practice models may remove or reduce opportunities for worker participation, care is a theme or storyline that gave workers other ways to understand their work and why they did it, as well as ways they were prepared to resist managerial priorities and directives, including the erosion of various kinds of direct and indirect participation. The degree of resistance possible, even in the highly technocratic worksite in Australia, shows that cracks and fissures exist within managerialism

Identifying, Monitoring, and Assessing Promising Innovations: Using Evaluation to Support Rapid-Cycle Change

Examines the new Center for Medicare and Medicaid Innovation's mission, critical issues, and challenges in finding effective ways to raise healthcare quality and lower costs, documenting innovation, and providing evidence to support broad policy change

Why is it difficult to implement e-health initiatives? A qualitative study

<b>Background</b> The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.<p></p> <b>Methods</b> We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT).<p></p> <b>Results</b> Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization.<p></p> <b>Conclusions</b> Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning

Electronically Assisting Communication for Health Professionals

New information and computing technologies offer cost efficient and effective learning opportunities for health care professionals. The Assisted Electronic Communication project is prototyping, administering and evaluating a digital discourse system for health care professionals within an acute Hospital. Health care staff participating in the study are able to access and contribute to threaded, asynchronous discussions and themed information in the context of critical work documents. Early indications are that the system is viewed very positively, and seen as a way of critically engaging with new material that is getting closer to an idealized learning in the workplace

National evaluation of Partnerships for Older People Projects

Executive Summary The Partnership for Older People Projects (POPP) were funded by the Department of Health to develop services for older people, aimed at promoting their health, well-being and independence and preventing or delaying their need for higher intensity or institutional care. The evaluation found that a wide range of projects resulted in improved quality of life for participants and considerable savings, as well as better local working relationships. • Twenty-nine local authorities were involved as pilot sites, working with health and voluntary sector partners to develop services, with funding of £60m • Those projects developed ranged from low level services, such as lunch-clubs, to more formal preventive initiatives, such as hospital discharge and rapid response services • Over a quarter of a million people (264,637) used one or more of these services • The reduction in hospital emergency bed days resulted in considerable savings, to the extent that for every extra £1 spent on the POPP services, there has been approximately a £1.20 additional benefit in savings on emergency bed days. This is the headline estimate drawn from a statistically valid range of £0.80 to £1.60 saving on emergency bed days for every extra £1 spent on the projects. • Overnight hospital stays were seemingly reduced by 47% and use of Accident & Emergency departments by 29%. Reductions were also seen in physiotherapy/occupational therapy and clinic or outpatient appointments with a total cost reduction of £2,166 per person • A practical example of what works is pro-active case coordination services, where visits to A&E departments fell by 60%, hospital overnight stays were reduced by 48%, phone calls to GPs fell by 28%, visits to practice nurses reduced by 25% and GP appointments reduced by 10% • Efficiency gains in health service use appear to have been achieved without any adverse impact on the use of social care resources • The overwhelming majority of the POPP projects have been sustained, with only 3% being closed – either because they did not deliver the intended outcomes or because local strategic priorities had changed • PCTs have contributed to the sustainability of the POPP projects within all 29 pilot sites. Moreover, within almost half of the sites, one or more of the projects are being entirely sustained through PCT funding – a total of 20% of POPP projects. There are a further 14% of projects for which PCTs are providing at least half of the necessary ongoing funding • POPP services appear to have improved users’ quality of life, varying with the nature of individual projects; those providing services to individuals with complex needs were particularly successful, but low-level preventive projects also had an impact • All local projects involved older people in their design and management, although to varying degrees, including as members of steering or programme boards, in staff recruitment panels, as volunteers or in the evaluation • Improved relationships with health agencies and the voluntary sector in the locality were generally reported as a result of partnership working, although there were some difficulties securing the involvement of GP

The evidence-base for stroke education in care homes

<b>Summary.</b> <b>Research questions:</b> 1. What are registered care home nurses’ educational priorities regarding stroke care? 2. What are senior care home assistants’ educational priorities regarding stroke care? 3. How do care home nurses conceive stroke care will be delivered in 2010? <b>Study design:</b> This was a 2-year study using focus groups, stroke guidelines, professional recommendations and stroke literature for the development of a questionnaire survey for data collection. Workshops provided study feedback to participants. Data were collected in 2005–2006. <b>Study site:</b> Greater Glasgow NHS Health Board. <b>Population and sample:</b> A stratified random selection of 16 private, 3 voluntary and 6 NHS continuing care homes from which a sample of 115 trained nurses and 19 senior care assistants was drawn. <b>Results:</b> The overall response rate for care home nurses was 64.3% and for senior care assistants, 73.6%. Both care home nurses and senior care assistants preferred accredited stroke education. Care home nurses wanted more training in stroke assessment, rehabilitation and acute interventions whereas senior care assistants wanted more in managing depression, general stroke information and communicating with dysphasic residents. Senior care assistants needed more information on multidisciplinary team working while care home nurses were more concerned with ethical decision-making, accountability and goal setting. <b>Conclusions:</b> Care home staff need and want more stroke training. They are clear that stroke education should be to the benefit of their resident population. Guidelines on stroke care should be developed for care homes and these should incorporate support for continuing professional learning in relation to the resident who has had a stroke

First impressions: introducing the 'Real Times' third sector case studies

‘Real Times’ is the Third Sector Research Centre’s qualitative longitudinal study of third sector organisations, groups and activities. Over a three year period the study is following the fortunes, strategies, challenges and performance of a diverse set of fifteen ‘core’ case studies of third sector activity, and their relations with a number ‘complementary’ case studies. This report introduces the core case studies through summary sketches, and provides a descriptive account of the research up to the end of the first wave of fieldwork

Shaping the future for primary care education and training project. Finding the evidence for education & training to deliver integrated health and social care: the primary care workforce perspective

This report is one of a series of outputs from the Shaping the Future in Primary Care Education and Training project (www.pcet.org.uk) funded by the North West Development Agency (NWDA). It is the result of a collaborative initiative between the NWDA, the North West Universities Association and seven Higher Education Institutions in the North West of England. The report presents an evidence base drawn from the analysis of the experiences and aspirations of integrated health and social care, as reported by members of the current primary health and social care workforce working in or with Primary Care Trusts (PCTs) in the North West region