"I'm a doctor for God's sake" The GP as Manager: A multi-theory perspective

The primary care sector is nationally and globally recognised as being important in the efficient and effective delivery of healthcare. A key component of this sector is the General Practitioner, or GP. As a clinical professional, the GP has a traditional focus on the needs of patients. While this may constitute their primary role, GPs are also in business, creating other needs as well. Therefore, the GP – and owner specifically – is not just a clinician but is also a business manager. While previous studies have examined this latter role empirically, further theory-informed research is needed to acquire a deeper understanding of both the role itself and the context within which it exists. This study is based on semi-structured interviews with 35 GPs, thematically analysed and underpinned by literature from management, professions and role theory. The research finds that GPs manage principally at an operational oversight level, where the owner is a dominant force and in close control though potentially lacking in formal management training. While supports exist, and are valuable, they appear to be underutilised in a management capacity. Role conflict can be experienced by those GPs with managerial responsibility, as they seek to balance expectations stemming from organisational and professional demands. A lack of time compounds their difficulties in this respect, potentially giving rise to role overload and the need for some compromise. In seeking to understand what underlies the work performed and the conflicts encountered, the study also identifies a number of key influences. Contributions from this research include a more theory-based, empirically-informed understanding of the managerial role in a professional context, and a consideration of the value of such a role where resource constraints are salient concerns. In addition, the study highlights the need to consider how Organisational-Professional Conflict is conceptualised, and adds to the debate surrounding whether doctors are altruistic or self-interested. Practical implications for general practice are also identified, including the need to reconsider the role of practice managers and to address the capacity for new GPs to apply their training in a management context

Development of an Academic Risk Model to support Higher Education Quality Assurance

[EN] This paper presents a model of risk management in higher education, to support the quality assurance framework and the activities, more generally, of a Higher Education Institute. Its purpose is to define the Institute’s approach to academic risk and its management and to inform decision-making. Academic risk is defined and contextualized in terms of published literature. Decision-making and judgement is at the centre of all academic activities and accordingly inherent risk will always exist, through the exercise of judgement, the operation of academic policies and procedures and through compliance. A normative model of academic risk assessment is proposed, based on three levels: isolated academic risk, repeated academic risk and systemic academic risk. This is followed by a proposed model for action according to the level of risk. Finally the operation of the model in our higher education institute is presentedMcdonald, T.; O'byrne, D.; O'leary, P.; O'riordan, C. (2020). Development of an Academic Risk Model to support Higher Education Quality Assurance. En 6th International Conference on Higher Education Advances (HEAd'20). Editorial Universitat Politècnica de València. (30-05-2020):1323-1329. https://doi.org/10.4995/HEAd20.2020.11261OCS1323132930-05-202

International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students.

Persistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain and that this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students' pain-related knowledge and attitudes. The secondary aim was to explore the factors influencing students' pain-related knowledge and attitudes. This cross-sectional study included 1154 first and final year healthcare students, from 12 universities in five different countries. Participants completed the Revised Neurophysiology of Pain Quiz (RNPQ) knowledge and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) attitudes. Physiotherapy was the only student group with statistically and clinically improved pain-related knowledge mean difference, 95% CI (3.4, 3.0 to 3.9, p=0.01) and attitudes (-17.2, -19.2 to 15.2, p=0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 hours), with greater levels of pain-related knowledge and attitudes associated with higher volumes of pain-specific teaching. There was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students' understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outsider leadership: Insights and interviews from business leaders

Encompassing interviews with managing directors and CEOs, this book explores the role of business outsiders as leaders. Viewing the term ‘outsider’ in a broad sense, the book considers leader background, perspective, gender, training and family membership and examines the implications, challenges and benefits brought by outsider leaders to their respective business environments. The authors explore questions and themes such as how outsider leaders can enrich an organisation, the importance of relationships and adopting a ‘hybrid’ approach, illuminated by interviewee perspectives. Introducing discussion and analysis through these narratives, Outsider Leadership distils commonalities to frame understanding of their experiences

Clinical-managers in the primary-care sector: do the benefits stack up?

Purpose - The purpose of this paper is to explore the nature and value of the clinical-management role undertaken by primary-care doctors in Ireland. To date, a majority of research has focused on clinical-management roles in the acute sector. Design/methodology/approach - The paper presents a sub-set of data from a mixed methods study. Fourteen semi-structured interviews are drawn upon to identify the nature and value of the clinical-management role in primary-care. Findings - Comparison with acute sector research identifies considerable differences in the nature of the clinical-management role across sectors – and in the associated value proposition. Structural and role-related contingencies affecting the potential value of clinical-management roles in Irish primary-care are discussed. Structural influences include the private ownership structure, low complexity and limited requirement for cross-professional coordination. Role-related influences include the primacy of the clinical identity, time constraints and lack of managerial training. Research limitations/implications - The findings provide a limited basis for generalisation, premised on fourteen interviews in one national context. However, given the international shift towards the provision of health services in primary-care, they provide a research agenda for an important healthcare context. Practical implications - The findings draw attention to the need for policy consideration of the value of the clinical-manager role in primary-care; how policy can support effective primary-care management and; the need for specialised management training, which takes account of the small-firm context. Originality/value - The paper identifies that primary-care clinical-management roles focus on operational management and oversight and discusses the structural and role-related factors which affect their efficacy