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

Il costo dell’intervento chirurgico in laparoscopia con l’Activity Based Costing

The purpose of this research is to analyze the role of the Management Control System (MCS) and of the Management Accounting System (MAS) in healthcare (HC) organizations. It aims at studying if and how managerial considerations affect the clinical culture. Results are based on the findings of a research developed within 12 Local Health Authorities (Aziende Sanitarie Locali LHAs) and 4 Teaching Hospital (Aziende Ospedaliere Universitarie THs) in Italian Tuscany Region and address the possibility to develop an alternative model from those of accountingization or legitimation proposed in literature to understand the role of these systems in healthcare. Results highlight that the economic language may assume a great importance in clinicians’ decision making and penetrates into clinical culture. Most important factor affecting results is the development of an alliance between controllers and clinicians, based trust and collaboration. The paper is a contribution to the literature about the role of MCS and MAS in healthcare and it is developed within the schemes traced by Habermas and refined by Laughlin and by Broadbent and Laughlin. The original value stands on the individuation of a model where the “integrative interactive” management model is able to penetrate clinical discourse and the conditions at which it can be developed.Management Accounting Change, Management Control Change, Healthcare Accounting, Professional organization, accountinization, legitimation, Habermas

Fostering Innovation in Philanthropy

Innovation is a buzzword with growing resonance in the philanthropic community. But how are foundations going about adopting innovative practices? In this guide, you'll learn the definition of "innovation"; 8 approaches to philanthropic innovation; key practices of innovative funders; recommendations to become innovative and support innovation; and more

Sentara Healthcare: A Case Study Series on Disruptive Innovation Within Integrated Health Systems

Examines how integration and ties with health plans, physicians, and hospitals helped protect against revenue volatility and enabled experimentation; factors that facilitate integration; innovative practices; lessons learned; and policy implications

Investing in Entry-Level Talent

Even in today's competitive economic environment, there is much that companies can do to reduce entry-level turnover costs, increase employee engagement and retention, and create a talent pipeline for the future. Many companies pursue basic strategies to address turnover and promote advancement, such as offering competitive benefits and developing internal career paths. But our research found pioneering companies that are going beyond the basics and addressing turnover in remarkable ways. In examining the practices of these leading companies, we identified four strategies, outlined below, that markedly improve entry-level retention and advancement. This report is designed to share those strategies and practical suggestions for implementation with corporate leaders across the United States who are seeking to engage, retain, and advance their entry-level workforce

Practitioner Perceptions of the A3 Method for Process Improvement in Health Care

The focus of this article is to present students’ perceptions of the recently developed A3 method, a structured problem-solving approach based on lean concepts and tools that have been adapted to the health care environment. The students were all employees of a large health care provider and were enrolled in a customized health care executive MBA Program. Each student was required to complete an individual A3 Project in order to improve a process at the department for which they worked. At the end of the semester the students presented their A3 projects to their peers who voted on the best projects. A survey measuring perceptions of the A3 method for problem solving in health care was administered and from it we present propositions for A3 implementation. These propositions are applicable both to health care practitioners and to academic researchers

Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication

Reflections from Participants

The Road Ahead: Public Dialogue on Science and Technology brings together some of the UK’s leading thinkers and practitioners in science and society to ask where we have got to, how we have got here, why we are doing what we are doing and what we should do next. The collection of essays aims to provide policy makers and dialogue deliverers with insights into how dialogue could be used in the future to strengthen the links between science and society. It is introduced by Professor Kathy Sykes, one of the UK’s best known science communicators, who is also the head of the Sciencewise-ERC Steering Group, and Jack Stilgoe, a DEMOS associate, who compiled the collection

The UK National Health Service’s 'innovation agenda': lessons on commercialization and trust

The UK National Health Service (the 'NHS'), encouraged by the 2011 report Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS, and empowered by the Health and Social Care Act 2012, is in the process of adopting a new agenda for stimulating innovation in healthcare. For this, the bodies, body materials, and confidential health information of NHS patients may be co-opted. We explain why this brings the NHS into a moral conflict with its basic goal of providing a universal healthcare service. Putting NHS databases at the disposal of industry, without addressing ethical concerns regarding the privacy, autonomy, and moral integrity of patients and without requiring a 'kick-back' to enhance the service that the NHS provides, is inappropriate. As this article shows, with reference to the commercial arena of direct-to-consumer genetic testing, it is crucial that patient and public trust in the NHS is not eroded