An evaluation of properties related to wear time of four dressings during a five-day period

This study evaluated skin tolerance and other properties relating to wear time, such as conformability and comfort, pain on dressing removal, adhesion and premature detachment, of four advanced hydrated dressings applied to the knees and elbows of 22 healthy volunteers over a fixed five-day period. The dressings all incorporate silicone-based adhesives and are designed to provide a moist wound environment while managing exudate. Skin tolerance was good for all four dressings but there was variation in regards to wear time and fluid-handling properties. Conflict of interest: this work was supported by a grant from Mölnlycke Health Care, Swede

Inside co-production: ruling, resistance, and practice

It might be argued that a narrative of co-production has come to re-define contemporary social and public policy. Elinor Ostrom’s pioneering work on co-production, that started in the 1970s and was awards the Nobel prize for economics in 2009, offers a way to bridge the gap between the market and the state through involving citizens in the production of common goods (Ostrom et al. 1978; Ostrom 2015). This ‘disarmingly simple’ idea (Alford 2014) is now engrained within contemporary policy-making and public service delivery (Ansell and Gash 2008), symbolising a more humane and inclusive alternative to New Pubic Management (Newman 2005) and cornerstone to New Public Governance (Osborne et al. 2016)

Forests and Decarbonization : roles of natural and planted forests

Acknowledgements ICP acknowledges funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No: 787203 REALM). MN acknowledges support from the Austrian Science Fund (FWF), grant No. J4211- N29.Peer reviewedPublisher PD

Healthcare leadership with political astuteness (HeLPA): a qualitative study of how service leaders understand and mediate the informal ‘power and politics’ of major health system change

Background: The implementation of strategic health system change is often complicated by the informal politics and power of health systems, such as competing interests and resistant groups. Evidence from other industries shows that strategic leaders need to be aware of and manage such ‘organisational politics’ when implementing change, which involves developing and using forms of political ‘skill’, ‘savvy’ or ‘astuteness’. The purpose of this study is to investigate the acquisition, use and contribution of political ‘astuteness’ in the implementation of strategic health system change. Methods: The qualitative study comprises four linked work packages. First, we will complete a systematic ‘review of reviews’ on the topic of political skill and astuteness, and related social science concepts, which will be used to then review the existing health services research literature to identify exemplars of political astuteness in health care systems. Second, we will carry out semi-structured biographical interviews with regional and national service leaders, and recent recipients of leadership training, to understand their acquisition and use of political astuteness. Third, we will carry out in-depth ethnographic research looking at the utilisation and contribution of political astuteness in three contemporary examples of strategic health system change. Finally, we will explore and discuss the study findings through a series of co-production workshops to inform the development and testing of new learning resources and materials for future NHS leaders. Discussion: The research will produce evidence about the relatively under-researched contribution that political skill and astuteness makes in the implementation of strategic health system change. It intends to offer new understanding of these skills and capabilities that takes greater account of the wider social, cultural organisational landscape, and offers tangible lessons and case examples for service leaders. The study will inform future learning materials and processes, and create spaces for future leaders to reflect upon their political astuteness in a constructive and development way

The contribution of political skill to the implementation of health services change: a systematic review and narrative synthesis

Background: The implementation of strategic health system change is often complicated by informal ‘politics’ in healthcare organisations. Leadership development programmes increasingly call for the development and use of ‘political skill’ as a means for understanding and managing the politics of healthcare organisations. The primary purpose of this review is to determine how political skill contributes to the implementation of health services change, within and across organisations. The secondary purpose is to demonstrate the conceptual variations within the literature. Methods: The article is based upon a narrative synthesis that included quantitative, qualitative and mixed methods research papers, review articles and professional commentaries that deployed the concept of political skill (or associated terms) to describe and analyse the implementation of change in healthcare services. Results: Sixty-two papers were included for review drawn from over four decades of empirically and conceptually diverse research. The literature is comprised of four distinct literatures with a lack of conceptual coherence. Within and across these domains, political skill is described as influencing health services change through five dimensions of leadership: personal performance; contextual awareness; inter-personal influence; stakeholder engagement, networks and alliances; and influence on policy processes. Conclusion: There is a growing body of evidence showing how political skill can contribute to the implementation of health services change, but the evidence on explanatory processes is weak. Moreover, the conceptualisation of political skill is variable making comparative analysis difficult, with research often favouring individual-level psychological and behavioural properties over more social or group processes

El estatus de la profesión médica : ¿reforzado o debilitado por la nueva gestión pública?

This article aims to assess if the status of the medical profession has been reinforced or weakened with the new public management. With this purpose, it collects the opinion of two international experts regarding situation in the United Kingdom, in order to apply some lessons to the Spanish case. Both agree that, far from losing status and power with the healthcare reform, the medical profession has protected its status and autonomy against other social agents such as managers, politicians and patients. However, the maintenance of the status quo has been at the expense of an intra-professional stratification that has caused status inequalities linked to social class within the medical profession

Navigating the micro-politics of major system change: the implementation of Sustainability Transformation Partnerships in the English health and care system

Objective: To investigated how health and care leaders navigate the micro-politics of major system change as manifest in the formulation and implementation of Sustainability and Transformation Partnerships (STPs) in the English National Health Service. Methods: A comparative qualitative case study of three STPs carried out between 2018-21. Data collection comprises 72 semi-structured interviews with STP leaders and stakeholders; 49 hours of observations of STP executive meetings, management teams and thematic committees; and documentary sources. Interpretative analysis involved developing individual and cross case reports to understand the 'disagreements, 'people and interests', and the 'skills, behaviours and practice'. Findings: Three linked political fault-lines underpin the micro-politics of formulating and implementing STPs: differences in meaning and value, perceptions of winners and losers and structural differences in power and influence. In managing these issues, STP leaders engaged in a range of complementary strategies to understand and reconcile meanings, appraise and manage risks and benefits, and to redress longstanding power imbalances, as well as those related to their own ambiguous position.Conclusion: Given the lack of formal authority and breadth of system change, navigating the micro-politics of major system change requires political skills in listening and engagement, strategic appraisal of the political landscape, and effective negotiation and consensus-building

Strategies supporting sustainable prescribing safety improvement interventions in English primary care: A qualitative study

Background: While the use of prescribing safety indicators (PSI) can reduce potentially hazardous prescribing, there is a need to identify actionable strategies for the successful implementation and sustainable delivery of PSI-based interventions in general practice.Aim: To identify strategies for the successful implementation and sustainable use of PSI-based interventions in routine primary care.Design & setting: Qualitative study in primary care settings across England.Method: Anchoring on a complex pharmacist-led IT-based intervention (PINCER) and clinical decision support (CDS) for prescribing and medicines management, a qualitative study was conducted using sequential, multiple methods. The methods comprised documentary analysis, semi-structured interviews, and online workshops to identify challenges and possible solutions to the longer-term sustainability of PINCER and CDS. Thematic analysis was used for the documentary analysis and stakeholder workshops, while template analysis was used for the semi-structured interviews. Findings across the three methods were synthesised using the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework.Results: Forty-eight documents were analysed, and 27 interviews and two workshops involving 20 participants were undertaken. Five main issues were identified, which aligned with the adoption and maintenance dimensions of RE-AIM: fitting into current context (adoption); engaging hearts and minds (maintenance); building resilience (maintenance); achieving engagement with secondary care (maintenance); and emphasising complementarity (maintenance).Conclusion: Extending ownership of prescribing safety beyond primary care-based pharmacists, and achieving greater alignment between general practice and hospital prescribing safety initiatives, is fundamental to achieve sustained impact of PSI-based interventions in primary care