Partner Experiences of “Near-Miss” Events in Pregnancy and Childbirth in the UK : A Qualitative Study

Funding: This article presents independent research funded by the National Institute for Health Research (NIHR) under the “Beyond maternal death: Improving the quality of maternity care through national studies of ‘near-miss’ maternal morbidity” programme (Programme Grant RP-PG-0608-10038). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Acknowledgments The authors are grateful to all the women and men who contributed to the study, and the reviewers’ comments on the previous version of this article.Peer reviewedPublisher PD

Maternal critical care: what can we learn from patient experience? A qualitative study.

ElectronicPeer reviewedPublisher PD

A Realist Evaluation of ICS Leadership

Extended abstract submitted for the Faculty of Business and Law Research Day 2022

Integrated Care System Leadership: A Realist Evaluation

Introduction Health and social care services in England have moved towards a system of partnership working known as Integrated Care Systems (ICSs) consisting of all NHS Provider Trusts, Primary Care Services including GP Practices, Local Authorities, Care Providers, and Voluntary, Community and Social Enterprise organisations involved in the provision of health and social care. As complex systems covering large geographical areas, ICSs are led by senior leaders to improve population health, reduce health inequities, and enhance value for money. Given their recent formation, little is known about their leadership. Available sources are either dated within the academic literature or are described in the grey literature with little reference to theoretical or empirical foundations. This research is intended to contribute to the gap in theoretical and practical knowledge by developing a framework to explain effective leadership in ICSs. Aim, Research Questions, and Objectives 2.1       Aim To evaluate leadership in Cheshire & Merseyside ICS and provide a framework on effective leadership in ICSs. 2.2       Research Question(s) How does ICSs leadership work, for whom, and in what circumstances? What are the activities and behaviour of leadership utilised by senior leaders within an ICS? Which contextual factors influence these activities and behaviours? Which Context-Mechanisms-Outcomes (CMO) configurations explain leadership within an ICS? 2.3       Objectives To identify senior leaders' leadership activities and behaviours in an ICS. To identify the contextual factors that influence the activities and behaviours leaders utilise within an ICS. To utilise context (C), mechanisms (M) and outcome (O) chains to explain what works (outcome), how (mechanisms) and under what conditions (context). To develop a framework that explains effective leadership in ICSs To provide recommendations for practice that support effective leadership of ICSs. Justification & Literature Review Within both the academic and grey literature there is a general agreement that leadership and leadership approaches are critical factors in the ability of organisations to implement, develop, and sustain integrated care; however, despite the whole-scale implementation of this approach to health and social care commissioning and delivery across England limited empirical studies have been conducted. Research in the wider field has focused on the skills, qualities, and abilities of leaders rather than the action and behaviour of leadership, tending to consider who a leader is rather than what they do (Sims et al., 2021, p.13), which limits the ability of ICSs to understand and utilise leadership practices that respond to the complex needs of partnership working across systems. Successful integration requires a combination of strong leadership and governance from senior leaders at the system level across health and social care (Asthana et al., 2020). Furthermore, research examining the functioning of integrated health systems has identified leadership ability as a key factor (Bhat et al., 2022). It has also been suggested that an ICS's operation and sustainability are significantly influenced by a leader's ability to move from an organisation-centred leadership style to one that focuses on leading across multiple organisations (Charles et al., 2018). However, there appears to be an implicit assumption within the literature that senior leaders can apply their existing leadership approach to the newly formed structures and governance of ICSs with limited guidance underpinning the actions or function of leadership styles. Theoretical Foundation Phase 1 (Realist Review) of this study will draw on theories of collective and systems leadership, the results of a realist review, and primary data collection to develop initial theories of effective leadership in ICSs; these will be refined and tested in Phase 2 (Realist Evaluation). The complexity of ICSs alongside an identified lack of theoretical foundations for understanding their leadership, supports the adoption of a realist evaluation (Greenhalgh et al., 2009). Furthermore, given the emerging nature of ICSs,  a realist evaluation can go further than asking ‘does it work’ by asking ‘what works, how, in which conditions and for whom’ (Pawson and Tilley, 1997, p.210). Realist research is underpinned by a critical realist ontology; one that takes the position that there is a ‘real’ world that is independent of our experience or interpretation of it. Epistemologically, this research takes a position that focuses on causal explanations which assumes underlying causal processes, termed mechanisms, can have multiple outcomes and that different contexts can precipitate different actions or events. It is concerned with developing and testing 'programme theories'; multiple causal chains describing the context, mechanisms, and outcomes of a particular phenomenon, in this case, leadership within an ICS. Research Design A case study strategy has been selected as it aligns with a realist approach to research and is ‘particularly suited to research questions which require a detailed understanding of the social or organisational processes because of the rich data collected in context’ (Hartley, 2004, p.323). In line with a theory-driven realist approach a multi-method qualitative approach to data collection has been adopted to allow for the richness of contexts and mechanisms to be examined; programme theories will be tested and refined through non-participant observations, document analysis of strategic publications, and interviews with key stakeholders within the ICS. Initial Theories of Effective ICS Leadership (Phase 1 Findings)Table 1: Initial theories of effective ICS leadership utilising Doing Things Differently: Rethinking Leadership Behaviours as an organising framework for theories (NHS North West Leadership Academy, 2021). Delivering   Effective Integrated Care System leaders hold themselves and others to account for improving outcomes for the local population. They utilise available intelligence to take actions that support targeting and prioritisation of local communities. Effective Integrated Care System leaders support and encourage learning, curiosity, and calculated risk-taking enabling innovative approaches that lead to service improvements. Being Effective Integrated Care System Leaders communicate a clear vision, fostering a sense of purpose across the system regarding the achievement of agreed Integrated Care System outcomes. Leading & Visioning Effective Integrated Care System leaders have a clear vision that promotes a sense of mutual accountability, providing opportunities for others to develop, make decisions, and take ownership of problem solving through the engagement of all partners in the reduction of health and social care inequalities Relating & Communicating Effective Integrated Care System leaders build relationships at all levels of the system, they promote partnership and collaboration. Leaders encourage a collective agreement about what needs to be achieved and communicate openly about how and why decisions are made   Relevance & Contribution This study will provide valuable information to those who work within such systems to help them understand and support leadership development more effectively. Furthermore, this study is expected to contribute to closing the gap in the academic literature regarding the leadership of ICSs by using a novel approach to leadership evaluation; in doing so it will make explicit the underlying causal processes and influencing contexts that shape leadership in ICSs, providing a clear and accessible framework to explain effective leadership practice. References Asthana, S., Gradinger, F., Elston, J., Martin, S. and Byng, R., (2020) Capturing the Role of Context in Complex System Change: An Application of the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to an Integrated Care Organisation in the UK. International Journal of Integrated Care, 201, p.4. Bhat, K., Easwarathasan, R., Jacob, M., Poole, W., Sapaetharan, V., Sidhu, M. and Thomas, A., (2022) Identifying and understanding the factors that influence the functioning of integrated healthcare systems in the NHS: a systematic literature review. BMJ Open, [online] 124. Available at: https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2021-049296. Charles, A., Wenzel, L., Kershaw, M., Ham, C. and Walsh, N., (2018) A year of integrated care systems: reviewing the journey so far. The Kings Fund. Deffenbaugh, J., (2018) Becoming an integrated (accountable) care system. British Journal of Healthcare Management, 244, pp.175-180. Erens, B., Wistow, G., Mounier-Jack, S., Douglas, N., Jones, L., Manacorda, T. and Mays, N., (2016) Early evaluation of the Integrated Care and Support Pioneers Programme. Policy Innovation Research Unit, p.183. Evans, J.M., Daub, S., Goldhar, J., Wojtak, A. and Purbhoo, D., (2016) Leading Integrated Health and Social Care Systems: Perspectives from Research and Practice. Healthcare Quarterly, 184, pp.30-35. González-Ortiz, L.G., Calciolari, S., Goodwin, N. and Stein, V., (2018) The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care. International Journal of Integrated Care, 183, p.10. Goodwin, N. and Smith, J., (2011) The evidence base for integrated care. [online] Available at: https://www.kingsfund.org.uk/audio-video/evidence-base-integrated-care [Accessed 16 Apr. 2022]. Greenhalgh, T., Humphrey, C., Hughes, J., Macfarlane, F., Butler, C. and Pawson, R., (2009) How Do You Modernize a Health Service? A Realist Evaluation of Whole-Scale Transformation in London: Modernizing a Health Service, in London. Milbank Quarterly, 872, pp.391-416.Ham, C., Smith, J. and Eastmure, E., (2011) Commissioning integrated care in a liberated NHS. The Nuffield Trust, p.68. Hartley, J., (2004) Case study research. In: C. Cassell and G. Symon, eds. London: Sage Publications Ltd, pp.323-333. Maruthappu, M., Hasan, A. and Zeltner, T., (2015) Enablers and Barriers in Implementing Integrated Care. Health Systems & Reform, 14, pp.250-256. NHS North West Leadership Academy, (2021) Doing Things Differently: Rethinking Leadership Behaviours. [online] Available at: https://www.nwacademy.nhs.uk/sites/default/files/resource_files/System%20Leadership%20Behaviours_Indicators.pdf [Accessed 21 Nov. 2022]. Pawson, R. and Tilley, N., (1997) Realistic evaluation. London ; Thousand Oaks, Calif: Sage. Sims, S., Fletcher, S., Brearley, S., Ross, F., Manthorpe, J. and Harris, R., (2021) What does Success Look Like for Leaders of Integrated Health and Social Care Systems? a Realist Review. International Journal of Integrated Care, 214, p.26. Tweed, A., Singfield, A., Taylor, J.R.A., Gilbert, L. and Mount, P., (2018) Creating allegiance: leading transformational change within the NHS. BMJ Leader, 23, pp.110-114. Wistow, G., Gaskins, M., Holder, H. and Smith, J., (2016) Why Implementing Integrated Care is so much harder than designing it: experience in North West London. England. International Journal of Integrated Care, 166, p.308. &nbsp

Are Beverage Categories Separable?

Food Consumption/Nutrition/Food Safety,

Are Fruit Juice Categories Separable?

Supermarket shelves are saturated with numerous varieties and brands of juice beverages. This high level of assortment has dramatically changed beverage consumption patterns and trends throughout the United States. In fact, during 2004-2005, energy and sport drinks experienced significant increases in sales, 65.9% and 20.6 %, respectively. During the same period of time, refrigerated juice sales increased a mere 2.2%, shelved non-fruit drinks decreased 0.9%, bottled juices and cocktails both decreased 1.5 % and frozen juice decreased by 12.8% (Food Industry Review 2006). The beverage industry has undergone many transformations, but consumer theory states that a shift in demand for one good has to be compensated by a shift in the opposite directions in the demand for the other good. Thus, with more brands competing for consumers’ dollars, it is important for brand managers, retailers, and other industry officials to understand demand interrelationships among various beverages. This study examines the competitiveness and structure of the beverage industry. Existing research suggests the demand for fruit beverages is independent from other food and non-food groups (Heien 1982; Lee 1984); therefore, information pertaining to other goods can be omitted without compromising the validity of the study. Our study will allow us to better understand how consumers make decisions concerning purchases patterns of beverage expenditures.Agribusiness, Agricultural and Food Policy, Farm Management, Food Consumption/Nutrition/Food Safety, Industrial Organization,

Space Shuttle 2 Advanced Space Transportation System. Volume 1: Executive Summary

An investigation into the feasibility of establishing a second generation space transportation system is summarized. Incorporating successful systems from the Space Shuttle and technological advances made since its conception, the second generation shuttle was designed to be a lower-cost, reliable system which would guarantee access to space well into the next century. A fully reusable, all-liquid propellant booster/orbiter combination using parallel burn was selected as the base configuration. Vehicle characteristics were determined from NASA ground rules and optimization evaluations. The launch profile was constructed from particulars of the vehicle design and known orbital requirements. A stability and control analysis was performed for the landing phase of the orbiter's flight. Finally, a preliminary safety analysis was performed to indicate possible failure modes and consequences

Space Shuttle 2 advanced space transportation system, volume 2

To determine the best configuration from all candidate configurations, it was necessary first to calculate minimum system weights and performance. To optimize the design, it is necessary to vary configuration-specific variables such as total system weight, thrust-to-weight ratios, burn durations, total thrust available, and mass fraction for the system. Optimizing each of these variables at the same time is technically unfeasible and not necessarily mathematically possible. However, discrete sets of data can be generated which will eliminate many candidate configurations. From the most promising remaining designs, a final configuration can be selected. Included are the three most important designs considered: one which closely approximates the design criteria set forth in a Marshall Space Flight Center study of the Shuttle 2; the configuration used in the initial proposal; and the final configuration. A listing by cell of the formulas used to generate the aforementioned data is included for reference

How Agricultural Economists Increase the Value of Agribusiness Research

Historically, there has been declining cooperation between agribusiness firms and agricultural economists. In new product marketing research, firms' tend to conduct their own analyses, partially due to confidentiality, usually consisting of simple univariate or bivariate statistics such as chi-squared tests of independence. The primary objective of this paper is to demonstrate, through a case study, one way in which agricultural economists can add value to agribusiness firms research. Results from the econometric model offer a richer explanation of consumer behavior and may be more useful to agribusiness firms.Teaching/Communication/Extension/Profession,