132 research outputs found
Rapid Evaluation of the Special Measures for Quality and Challenged Provider Regimes: A Mixed-Methods Study
Background: Healthcare organisations in England rated as inadequate for leadership and one other domain enter Special Measures for Quality (SMQ) to receive support and oversight. A âwatch listâ of challenged providers (CPs) at risk of entering SMQ also receive support. Knowledge is limited about whether the support interventions drive improvements in quality, their costs, and whether they strike the right balance between support and scrutiny. Objective: Analyse trust responses to the implementation of a) interventions for SMQ trusts and b) interventions for CP trusts to determine their impact on these organisations' capacity to achieve and sustain quality improvements. Design: Rapid research comprising five inter-related workstreams: 1. Literature review using systematic methods. 2. Analysis of policy documents and interviews at national level. 3. Eight multi-site, mixed method trust case studies. 4. Analysis of national performance and workforce indicators. 5. Economic analysis. Results: SMQ/CP were intended to be âsupportâ programmes. SMQ/CP had an emotional impact on staff. Perceptions of NHSI interventions were mixed overall. Senior leadership teams were a key driver of change, with strong clinical input vital. Local systems have a role in improvement. Trusts focus efforts to improve across multiple domains. Internal and external factors contribute to positive performance trajectories. Nationally, only 15.8% of SMQ trusts exited within 24 months. Relative to national trends, entry into SMQ/CP corresponded to positive changes in 4-hour waits in Emergency Departments, mortality and delayed transfers of care. Trends in staff sickness and absence improved after trusts left SMQ/CP. There was some evidence that staff survey results improve. No association was found between SMQ/CP and referral to treatment times or cancer waiting times. The largest components of NHSI spending in case studies were interventions directed at 'training on cultural change' (33.6%), 'workforce quality and safety' (21.7%) and 'governance and assurance' (18.4%). Impact of SMQ on financial stability was equivocal; most trusts exiting SMQ experienced the same financial stability before and after exiting. Limitations: The rapid research design and one-year timeframe precludes longitudinal observations of trusts and local systems. The small number of indicators limited the quantitative analysis of impact. Measuring workforce effects was limited by data availability. Conclusions: Empirical evidence of positive impacts from SMQ/CP were identified, however, perceptions were mixed. Key lessons: ⢠Time is needed to implement and embed changes. ⢠Ways to mitigate emotional costs and stigma are needed. ⢠Support strategies should be more trust specific. ⢠Poor organisational performance needs to be addressed within local systems. ⢠Senior leadership teams with stability, strong clinical input and previous SMQ experience helped enact change. ⢠Organisation-wide quality improvement strategies and capabilities are needed. ⢠Staff engagement and an open listening culture promote continuous learning and a quality improvement âmindsetâ, critical for sustainable improvement. ⢠Need to consider level of sustainable funds required to improve patientsâ outcomes. Future work: Evaluating recent changes to the regimes; role of local systems; longitudinal approaches. Study registration: Review protocol registered with PROSPERO (CRD: 42019131024). Funding: The National Institute for Health Research Health Services and Delivery Research programme (16/138/17 â Rapid Service Evaluation Research Team)
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Historical Documents of the Irish Avant-Garde
The contributors who wrote the texts and scores are:
John Berndt, Felicity Ford, Panos Ghikas, Paul Gilgunn, Stephen Graham, Majella Munro, Simon OâConnor, RĂan OâRahallaigh, Nick Roth, Benedict Schlepper-Connolly, Jennifer Walshe. Thanks very much to Richard Devine for his recordings which brought Zaftig to life and Jack McMahon for his performance as Ultan OâFarrell, and to Malcolm Tyrrell for his dream of an episode of Hands focussing on Irish performance art.Before you begin reading the articles in this book and listening to the recordings on the Aisteach Foundationâs website, I have a confession to make â all of the composers and artists are fictional. The Aisteach Foundation and the Historical Documents of the Irish Avant-Garde are a communal thought experiment, a revisionist exercise in âwhat if?â, a huge effort by many people to create an alternative history of avant-garde music in Ireland, to write our ancestors into being and shape their stories with care. We played fast and loose with history and the truth and we like to think Flann OâBrien would have approved.
I am extremely grateful to the Arts Council of Ireland for funding this project and allowing me to collaborate with the contributors listed below.
If you feel thereâs something we missed, something you want to have happened and would like to bring into being, please let us know.
This project is dedicated with love to Bob Gilmore.
Dr. Jennifer Walshe, President, Aisteach FoundationArts Council of Irelandhttp://www.lulu.com/shop/http://www.lulu.com/shop/jennifer-walshe/historical-documents-of-the-irish-avant-garde/paperback/product-22906851.html#productDetail
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Rapid evaluation of the Special Measures for Quality and challenged provider regimes: a mixed-methods study
Background:âHealth-care organisations in England that are rated as inadequate for leadership and one other domain enter the Special Measures for Quality regime to receive support and oversight. A âwatch listâ of challenged providers that are at risk of entering Special Measures for Quality also receive support. Knowledge is limited about whether or not the support interventions drive improvements in quality, the costs of the support interventions and whether or not the support interventions strike the right balance between support and scrutiny.
Objective:âTo analyse the responses of trusts to the implementation of (1) interventions for Special Measures for Quality trusts and (2) interventions for challenged provider trusts to determine their impact on these organisationsâ capacity to achieve and sustain quality improvements. Design:âThis was rapid research comprising five interrelated workstreams: (1) a literature review using systematic methods; (2) an analysis of policy documents and interviews at the national level; (3) eight multisite, mixed-methods trust case studies; (4) an analysis of national performance and workforce indicators; and (5) an economic analysis.
Results:âThe Special Measures for Quality/challenged provider regimes were intended to be âsupportâ programmes. Special Measures for Quality/challenged provider regimes had an emotional impact on staff. Perceptions of NHS Improvement interventions were mixed overall. Senior leadership teams were a key driver of change, with strong clinical input being vital. Local systems have a role in improvement. Trusts focus efforts to improve across multiple domains. Internal and external factors contribute to positive performance trajectories. Nationally, only 15.8% of Special Measures for Quality trusts exited the regime in 24 months. Entry into Special Measures for Quality/challenged provider regimes resulted in changes in quality indicators (such the number of patients waiting in emergency departments for more than 4 hours, mortality and the number of delayed transfers of care) that were more positive than national trends. The trends in staff sickness and absence improved after trusts left Special Measures for Quality/challenged provider regimes. There was some evidence that staff survey results improved. No association was found between Special Measures for Quality/challenged provider regimes and referral to treatment times or cancer treatment waiting times. NHS Improvement spending in case study trusts was mostly directed at interventions addressing âtraining on cultural changeâ (33.6%), âworkforce quality and safetyâ (21.7%) and âgovernance and assuranceâ (18.4%). The impact of Special Measures for Quality on financial stability was equivocal; most trusts exiting Special Measures for Quality experienced the same financial stability before and after exiting.
Limitations:âThe rapid research design and 1-year time frame precludes longitudinal observations of trusts and local systems. The small number of indicators limited the quantitative analysis of impact. Measurement of workforce effects was limited by data availability.
Conclusions:âEmpirical evidence of positive impacts of Special Measures for Quality/challenged provider regimes were identified; however, perceptions were mixed. Key lessons were that (1) time is needed to implement and embed changes; (2) ways to mitigate emotional costs and stigma are needed; (3) support strategies should be more trust specific; (4) poor organisational performance needs to be addressed within local systems; (5) senior leadership teams with stability, strong clinical input and previous Special Measures for Quality experience helped to enact change; (6) organisation-wide quality improvement strategies and capabilities are needed; (7) staff engagement and an open-listening culture promote continuous learning and a quality improvement âmindsetâ, which is critical for sustainable improvement; and (8) consideration of the level of sustainable funds required to improve patientsâ outcomes is needed.
Future work:âFuture work could include evaluating recent changes to the regimes, the role of local systems and longitudinal approaches.
Study registration:âThe review protocol is registered with PROSPERO (CRD42019131024).
Funding:âThis project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 19. See the NIHR Journals Library website for further project information
Influence of geometric errors in quantitative angiography on the evaluation of stenotic hemodynamics
Termination of paroxysmal supraventricular tachycardia with a single oral dose of diltiazem and propranolol.
Effects of oral verapamil in patients with atrioventricular reentrant tachycardia incorporating an accessory pathway.
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