Decision-making in English Clinical Commissioning groups: A mixed methods study

My research primarily investigated the Clinical Commissioning Groups (CCGs) in the English National Health Service (NHS) to identify factors influencing effective decision-making as perceived by General Practitioners (GPs) with formal roles in CCGs. A study by the British Medical Association (BMA) (2014) revealed that GPs at practice level felt that CCGs were developing policies that restrict efficient delivery of health care. As such, I developed a hypothesised conceptual model demonstrating factors at play in the decision-making process, which I tested using Partial Least Squares Structural Equation Modelling (PLS-SEM). Alongside, informed by the conceptual model, was the qualitative strand, with the data that I analysed under interpretative phenomenological analysis (IPA). Quantitative and qualitative data were collected simultaneously through a survey using a questionnaire in a convergent parallel mixed methods design, underpinned by a philosophical position of pragmatism. Data was collected in 2017. Usable responses comprised of 73 GPs in England. The study results, which contribute to theory and practice, discovered that; for practice, autonomy only was not enough to ensure efficiency of the CCGs. Other aspects like Finance and GP Proportion came to the fore. For example, many concerns about CCG policies perceived as adverse were attributed to Finance, while GP Proportion was found to have a significant effect on the perceived decision-making process effectiveness. For theory, the intention behind the setting up of the CCGs, to move, effectively, from a bureaucratic model of organisational structure to a professional model (Mintzberg 1979) was found to be threatened

An investigation into internetworking education

Computer network technology and the Internet grew rapidly in recent years. Their growth created a large demand from industry for the development of IT and internetworking professionals. These professionals need to be equipped with both technical hands-on skills and non-technical or soft skills. In order to supply new professionals to the industry, educational institutions need to address these skills training in their curricula. Technical hands-on skills in internetworking education can be emphasised through the practical use of equipment in classrooms. The provision of the networking equipment to the internetworking students is a challenge. Particularly, university students in developing countries may find that this equipment is ineffectively provided by their teaching institutions, because of the expense. Modern online learning tools, such as remote access laboratories, may be used to address this need. However, the provision of such tools will also need to concentrate upon the pedagogical values. In addition, traditional remote access laboratories provide only text-based access, which was originally designed for highly professional use. Novice students may struggle with learning in these virtual environments, especially when the physical equipment is not available locally. Furthermore, non-technical skills or soft skills are social skills that should not be neglected in graduates’ future workplaces. A traditional model of developing soft skills that was used in face-to-face classroom may not be as effective when applied in an online classroom. Research on students’ opinions about their soft skills development during attending internetworking courses is needed to be conducted. In order to address both research needs, this study was focused on two research aspects related to online learning in internetworking education. The first focus was on research into providing a suitable technical learning environment to distance internetworking students. The second focus was on the students’ opinions about their non-technical skills development. To provide a close equivalent of a face-to-face internetworking learning environment to remote students in Thailand, a transformation of a local internetworking laboratory was conducted. A new multimedia online learning environment integrated pedagogically-rich tools such as state model diagrams (SMDs), a real-time video streaming of equipment and a voice communication tool. Mixed research data were gathered from remote online and local student participants. The remote online participants were invited to use the new learning environment developed in this study. Qualitative research data were collected from twelve remote online students after their trial usage. Concurrently, another set of research data were collected from local students asking their opinion about the development of soft skills in the internetworking course. There were sixty six participants in this second set of research data. Although the research data was limited, restricting the researcher’s ability to generalise, it can be concluded that the provision of multimedia tools in an online internetworking learning environment was beneficial to distant students. The superiority of the traditional physical internetworking laboratory cannot be overlooked; however, the remote laboratory could be used as a supplementary self-practice tool. A concrete learning element such as a real-time video stream and diagrams simplified students learning processes in the virtual environment. Faster communication with the remote instructors and the equipment are also critical factors for a remote access network to be successful. However, unlike the face-to-face laboratory, the future challenge of the online laboratory will creating materials which will encourage students to build soft skills in their laboratory sessions

Decision-making in English Clinical Commissioning Groups: A Mixed Methods Study

This research primarily investigated the Clinical Commissioning Groups (CCGs) in the English NHS to identify factors influencing effective decision-making as perceived by General Practitioners (GPs) with formal roles in CCGs. A study by the British Medical Association (BMA) (2014a) revealed that GPs at practice level felt that CCGs were developing policies that restrict efficient delivery of health care. As such, I developed a hypothesised conceptual model demonstrating factors at play in the decision-making process, which I tested using Partial Least Squares Structural Equation Modelling (PLSSEM). Alongside, informed by the conceptual model, was the qualitative strand, with the data that I analysed under interpretative phenomenological analysis (IPA). Quantitative and qualitative data were collected simultaneously through a survey using a questionnaire in a convergent parallel mixed methods design, underpinned by a philosophical position of pragmatism. Data was collected in 2017. Research sample consists of 73 GPs in the UK. The hypothesis testing results show that GP Proportion has a significant and positive effect on Decision-making Process Effectiveness. Similarly, the effect of GP Influence has been found to be significant and positive on Satisfaction. In contrast, the effect of GP Influence on Decision-making Process Effectiveness has been found to be insignificant. This result is also observed regarding the effect of GP Influence on Member Practice Wishes Met. Five key themes were identified from the qualitative data analysis – namely, (1) Financial, focused on decisions influenced by financial concerns, (2) Bureaucracy, centred on decisions influenced by the bureaucratic hierarchy, (3) Clinical, to do with decisions that were perceived as having clinical implications, (4) Workplace culture, focused on behavioural patterns affecting decision-making within the organisation, and (5) CCG role, based on the way the role of CCGs was understood by member practices and the way that engagement of member practices was achieved by the respective CCGs. The results contribute to theory and practice. Regarding practice, notwithstanding the intended autonomy for the CCGs, which was aimed at improving patient care by aligning health care commissioning decisions with local needs, structure alone appears not enough to deliver effectiveness, as perceived by GPs. The proportion of GPs was found to be a relevant factor, while leadership and local CCG level culture, coupled with communication and governance, are also important. Finance was found to be significant, with many concerns about CCG policies attributed to this factor. On contribution to theory, the general observation is that the CCGs appear to be moving from professional to bureaucratic organisational model (Mintzberg 1979), thereby threatening the purported autonomy. This study also revealed new information on the formal roles that GPs occupy in CCGs, as previous research showed limited awareness in this regard (Checkland et al. 2016). Information gathered on committee memberships and the positions GPs occupy highlights the complexity and diversity of GP roles in CCGs