Primary care networks: navigating new organisational forms.

National Health Service England (NHSE) instigated Primary Care Networks (PCNs) as a collaboration of general practices working together at scale to improve population health in the local community. The aim of the study was to capture general practitioner PCN leaders' perceptions of the opportunities and pitfalls of PCNs, as well as points of learning, during their inception and development, in order to guide the future development of PCN form and function. The study, carried out in primary care, took a qualitative design. Nine PCN general practitioner leaders were interviewed in depth to gather their views and experiences of PCNs. We also collated 31 free-text survey responses pertaining to how participants perceived the purpose of PCNs. The key themes were - defining purpose and managing ambiguity; bureaucracy vs. local autonomy; relational working; facilitative leadership. The need for purpose setting to remain adaptive was seen as crucial in avoiding the constraints of too rigid a structure in order to retain local ownership, whilst remaining focussed around meeting complex population needs and reducing variation. Participants reported navigating their way through striking a balance between the 'top down' mandate and recognising local need. Of importance to the success of PCNs was the necessity of effective relational working and facilitative leadership CONCLUSION: Whilst the desire to be proactive and collaborative was emphasised by the PCN leaders, the importance of distributed leadership and time given to building trust and effective working relationships within new organisational forms cannot be underestimated. [Abstract copyright: Copyright © 2021, The Authors.

Multiple channel crosstalk removal using limited connectivity neural networks

Limited connectivity neural network architectures are investigated for the removal of crosstalk in systems using mutually overlapping sub-channels for the communication of multiple signals, either analogue or digital. The crosstalk error is modelled such that a fixed proportion of the signals in adjacent channels is added to the main signal. Different types of neural networks, trained using gradient descent algorithms, are tested as to their suitability for reducing the errors caused by a combination of crosstalk and additional gaussian noise. In particular we propose a single layer limited connectivity neural network since it promises to be the most easily implemented in hardware. A variable gain neuron structure is described which can be used for both analogue and digital data

Challenges and Insights in Inter-Organizational Collaborative Healthcare Networks: An Empirical Case Study of a Place-Based Network

Purpose Public sectors have responded to grand societal challenges by establishing Collaboratives – new inter-organisational partnerships to secure better quality health services. In the UK, a proliferation of collaboration-based healthcare networks exists that could help to both enhance the value of investments in quality improvement programmes. The nature and organisational form of such improvements is still a subject of debate within the public-sector literature. Placed-based collaboration has been proposed as a possible solution. In response, this research paper presents the results and findings of a placed-based collaborative network, highlighting challenges and insights. Design/methodology/approach This study adopted a social constructionist epistemological approach, using a qualitative methodology. A single case study was used, and data collected in three different stages over a two-year period. Findings The study finds that leadership, data-enabled learning through system-wide training and development, and the provision of an enabling environment that is facilitated by an academic partner, can go a long way in the managing of healthcare networks for improving quality. Research limitations/implications Regardless of the tensions and challenges with placed-based networks, they could still be a solution in maximising the public value required by government investments in the healthcare sector since they offer a more innovative structure that can help to address complex issues beyond the remit of hierarchical structures. This research is limited by the use of a single case study. Practical implications Across countries health systems are moving away from markets to collaborative models for health care delivery and from individual services to population based approaches. This paper provides insights to inform leaders of collaborative health models in the design and delivery of these new collaborations. Social implications As demand rises (as a result of increasing complexity and demographics) in the western world, health systems are seeking to redefine the boundaries between health service provision and community self-reliance and resilience. This paper provides insights into the new partnership between health institutions and communities, providing opportunities for more social-based and solidarity-based healthcare models which place patients and the public at the heart of change

Longitudinal Study of the Impact of the London Darzi fellowship Programmes years 1-8.

This report is based on a retrospective evaluation of the Darzi Fellows in Clinical Leadership Programme, supporting multidisciplinary clinicians and allied healthcare professionals (AHPs) in project-based attachments to NHS organisations across London. The Darzi Alumni and London South Bank University collaborated to develop a longer-term review of the impact of the Darzi programme (currently in Cohort 9). This evaluation complements the in-programme evaluations of each cohort demonstrating the immediate success of eight previous cohorts of ‘Darzi’ Fellowships in London. The fellowship combines a work-based change project and a Leadership Development Programme incorporating a Post Graduate Certificate over the course of a year. This longitudinal study demonstrates that overall there is much evidence that the Darzi programme has practically and intuitively shown Fellows how to think first and then act differently for alternative outcomes. Fellows are much more proactive than reactive because of the programme. Many responses carried a central message of empowered, enlightened and highly skilled individuals who are actively and uniquely challenging the status quo. Thus, there is clear evidence that the Darzi programme has created a plethora of systems thinkers and doers, with a greater understanding of how to use data to bring about system change. A picture emerged of often bold individuals with a determination to actively instigate change across London and beyond. There is evidence that many Fellows are emerging as leaders, acting as catalysts for sustainable change in the healthcare environment. By any reasonable measurement, the Darzi programme continues to be successful with learning and behavioural change sustained after the Fellowship year

Innovation and Sustainability in Large-Scale Healthcare Improvement Collaborative – Seven Propositions for Achieving System-wide Innovation and Sustainability

Change and reform in the Healthcare system, and policy determination to reduce costs has now necessitated a rethink and more innovation for this sector. In the healthcare sector, leadership needs to strengthen professionals who have the dual responsibility for ensuring the quality and effectiveness of healthcare and this requires new organisational forms beyond the traditional hierarchical organisational structures. Drawing upon strategic management and leadership discourse to underpin the study into sustainable and high performing systems, we then look at seven key lessons (propositions) from a mixed-methods study of a live city-wide large-scale collaborative in Leeds, UK. These seven propositions are framed in the context of leadership and strategy, however interesting and emergent findings also emerged as a result of the study. We thereby illuminate the challenges and opportunities to the collaboratives development in the context of global government calls for better healthcare management within the sector. We found that in the sustainability of such collaboratives, requires a more effective structure could be local city-wide collaborative in contrast to national or regional collaborative, however there are also several unknowns in such novel organisational structures. The shared and distributive form of leadership is underpinned with an energetic strategic leader who holds the centre whilst inspiring and empowering the collective nature of all members. This is also effectively achieved through promotion of a professional culture that is sustained through structured organisational learning. This paper adds to the small but growing body of knowledge in Improvement Collaboratives in the Health sector

A hybrid neural network/rule-based technique for on-line gesture and hand-written character recognition

A technique is presented which combines rule-based and neural network pattern recognition methods in an integrated system in order to perform learning and recognition of hand-written characters and gestures in realtime. The GesRec system is introduced which provides a framework for data acquisition, training, recognition, and gesture-to-speech transcription in a Windows environment. A recognition accuracy of 92.5% was obtained for the hybrid system, compared to 89.6% for the neural network only and 82.7% for rules only. Training and recognition times are given for an able-bodied and a disabled user

Skeletal muscle dysfunction is associated with derangements in mitochondrial bioenergetics (but not UCP3) in a rodent model of sepsis

Muscle dysfunction is a common feature of severe sepsis and multi-organ failure. Recent evidence implicates bioenergetic dysfunction and oxidative damage as important underlying pathophysiological mechanisms. Increased abundance of uncoupling protein-3 (UCP-3) in sepsis suggests increased mitochondrial proton leak, which may reduce mitochondrial coupling efficiency but limit ROS production. Using a murine model, we examined metabolic, cardiovascular and skeletal muscle contractile changes following induction of peritoneal sepsis in wild-type and Ucp3(-/-) mice. Mitochondrial membrane potential (Δψm) was measured using two-photon microscopy in living diaphragm, and contractile function was measured in diaphragm muscle strips. The kinetic relationship between membrane potential and oxygen consumption was determined using a modular kinetic approach in isolated mitochondria. Sepsis was associated with significant whole body metabolic suppression, hypothermia and cardiovascular dysfunction. Maximal force generation was reduced and fatigue accelerated in ex vivo diaphragm muscle strips from septic mice. Mitochondrial membrane potential was lower in the isolated diaphragm from septic mice despite normal substrate oxidation kinetics and proton leak in skeletal muscle mitochondria. Even though wild-type mice exhibited an absolute 26 ± 6% higher UCP-3 protein abundance at 24 hours, no differences were seen in whole animal or diaphragm physiology, nor in survival rates, between wild-type and Ucp3(-/-) mice. In conclusion, this murine sepsis model shows a hypometabolic phenotype with evidence of significant cardiovascular and muscle dysfunction. This was associated with lower Δψm and alterations in mitochondrial ATP turnover and phosphorylation pathway. However, UCP-3 does not play an important functional role, despite its upregulation

Factors that Influence Teachers’ Views on Standardized Tests

The central aim of this study was to explore K-12 teachers’ (N = 183) attitudes about standardized tests as a function of experience, instructional level, student population, and type of school. The Teachers’ Views on Standardized Tests Questionnaire was developed to assess teachers’ perceptions of the impact of standardized tests on practice. All survey items were intended to measure a facet of teachers’ attitudes regarding the necessity of standardized tests and their influence on best practices. Findings from this study indicated that special education and inclusion teachers viewed standardized tests as more negatively influencing instruction than general education teachers. There were also significant differences by instructional level and type of school (i.e., public vs. independent). Compared to elementary teachers, middle and high school teachers’ views were more negative, and public school educators perceived standardized assessments as having a more negative influence on instruction than teachers in independent schools. Finally, elementary school teachers reported that the standards of learning were more appropriate in contrast to middle and high school teachers

The Use of Tools and Frameworks by SMEs in the Strategy Formation Process

PurposeThe purpose of this study is to examine the use of tools and techniques of strategy and strategic analysis within small- and medium-sized enterprises (SMEs) as a part of the strategy formation process.Design/methodology/approachThis study uses a qualitative, multiple-case-based investigation with semi-structured interviews and secondary data sources to create a context-rich insight to the area examined.FindingsThe findings indicate a strong orientation towards operational tools deployment aligned with financial management and resources and process planning, monitoring and control. Strategic perspectives of the respondents indicate an implicit, rather than explicit deployment of strategy tools and unstructured deployment, but general awareness of the resulting component issues. Clearer strategic approaches and strong implementation appear to positively influence success, when measured by growth.Research limitations/implicationsThis study is limited to nine organisations within a UK geographic region, and therefore, larger-scale investigation would be beneficial to extend and confirm the findings in differing contexts.Practical implicationsWith resource scarcity potentially stymying the opportunity for owner-managers to develop more structured approaches to strategic analysis and development, consideration should be given to how owner-managers can further develop their strategic thinking to support enhanced strategic outcomes for their organisations. Furthermore, strategy educationalists may wish to reflect upon the manner in which they prepare delegates for strategic roles, where the SME context may differ radically from corporate experience.Originality/valueThe methodology for this study differs substantially from previous investigations within the field, which has had relatively few contributions, as it uses in-depth, context-rich qualitative techniques to investigate the micro-processes at play. The conclusions capture new insights and indications and identify areas for further investigation, hence adding to the understanding of a complex and heterogeneous field.</jats:sec