Back pain outcomes in primary care following a practice improvement intervention:- a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Back pain is one of the UK's costliest and least understood health problems, whose prevalence still seems to be increasing. Educational interventions for general practitioners on back pain appear to have had little impact on practice, but these did not include quality improvement learning, involve patients in the learning, record costs or document practice activities as well as patient outcomes.</p> <p>Methods</p> <p>We assessed the outcome of providing information about quality improvement techniques and evidence-based practice for back pain using the Clinical Value Compass. This included clinical outcomes (Roland and Morris Disability Questionnaire), functional outcomes, costs of care and patient satisfaction. We provided workshops which used an action learning approach and collected before and after data on routine practice activity from practice electronic databases. In parallel, we studied outcomes in a separate cohort of patients with acute and sub-acute non-specific back pain recruited from the same practices over the same time period. Patient data were analysed as a prospective, split-cohort study with assessments at baseline and eight weeks following the first consultation.</p> <p>Results</p> <p>Data for 1014 patients were recorded in the practice database study, and 101 patients in the prospective cohort study. We found that practice activities, costs and patient outcomes changed little after the intervention. However, the intervention was associated with a small, but statistically significant reduction in disability in female patients. Additionally, baseline disability, downheartedness, self-rated health and leg pain had small but statistically significant effects (p < 0.05) on follow-up disability scores in some subgroups.</p> <p>Conclusions</p> <p>GP education for back pain that both includes health improvement methodologies and involves patients may yield additional benefits for some patients without large changes in patterns of practice activity. The effects in this study were small and limited and the reasons for them remain obscure. However, such is the impact of back pain and its frequency of consultation in general practice that this kind of improvement methodology deserves further consideration.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN30420389">ISRCTN30420389</a></p

University–industry collaboration: using meta-rules to overcome barriers to knowledge transfer

This is the final version of the article. Available from Springer Verlag via the DOI in this record.University–industry knowledge transfer is an important source wealth of creation for all partners; however, the practical management of this activity within universities is often hampered by procedural rigidity either through the absence of decision-making protocols to reconcile conflicting priorities or through the inconsistent implementation of existing policies. This is problematic, since it can impede operational effectiveness, prevent inter-organisational knowledge-creation and hamper organisational learning. This paper addresses this issue by adopting a cross-discipline approach and presenting meta-rules as a solution to aid organisational decision making. It is proposed that meta-rules can help resolve tensions arising from conflicting priorities between academics, knowledge transfer offices and industry and help facilitate strategic alignment of processes and policies within and between organisations. This research contributes to the growing debate on the strategic challenges of managing knowledge transfer and presents meta-rules as a practical solution to facilitate strategic alignment of internal and external stakeholder tensions. Meta-rules has previously only been applied in a computer intelligence context however, this research proves the efficacy of meta rules in a university–industry knowledge transfer context. This research also has practical implications for knowledge transfer office managers who can use meta-rules to help overcome resource limitations, conflicting priorities and goals of diverse internal and external stakeholders

A community of practice or a working psychological group? Group dynamics in core and peripheral community participation

The concept of communities of practice (CoP) has become increasingly influential in management literature. Yet, many scholars regard the term as too homogenous and lacking in empirical support. Our study explores the Silver Academy, a project involving over 100 unemployed and self-employed managers over the age of 50, who came together with the purpose of sharing knowledge and experience in starting up their own businesses. The study shows how the Academy matches the notion of CoP including mutual relationships, shared engagement and a common consensus of membership. However, applying Bion’s (1961) theory of groups, we challenge the homogenous and consensual notion of a community of practice, illustrating how, through unconscious group processes, some group members exhibit workgroup mentality and the capacity for realistic hard work (and leadership), while others are caught in a basic-assumption mentality, prone to feelings of anxiety, guilt and depression. This is particularly so for a group that has gone through the recent trauma of unemployment

The nature of action learning

Action Learning has developed to such an extent that there is now a demand to 'know' what it is. There is one way, and one way alone, of getting to 'know' what action learning is, and that is by doing it. For those who most clamour to 'know' what something might be are usually the victims of an educational system that leaves the vast majority who pass through it ignorant of the meaning of the verb to 'know' ... If, for example, I am asked "Do you know that woman?", it is most probable that the questioner does not 'know' what he is asking me. Does he mean "Do I know her name? Or where she lives? Or am I able to introduce him to her? Or what she does for a living? Or do I recognise her by sight? Or have I been to bed with her? And, if so, what progress did I make?..." Thus, with action learning: "Have I read a book about it? Or attended a seminar at which somebody was trying to sell places on an action learning programme? Or visited a set of participants meeting as part of such a programme? Or tried to organise real persons tackling real problems in real time, and trying thereby to learn with and from each other? Or been an active participant myself in such a programme?..." To 'know' what action learning is, one must have been responsibly involved in it; since this cannot have been done merely by reading about action learning, it is impossible in this, or any other, note to convey more than the vaguest impression of what this educational approach may be. The day action learning becomes explicable in words alone will be the day to abandon the practice of it.

Manufacturing productivity

The general theory of engineering systems suggests that to produce desired order (to make a machine that works, to reduce the entropy, or even to improve productivity) the agent needs access to sources of (i) information, or useful messages; (ii) energy, or motivation; (iii) resources, including skills. A manufacturing economy, being an engineering system, obeys the same rules, so that an objective examination of 11 of them may be instructive. Since Belgium has no native energy and very few native resources, her post-1968 success in raising her productivity suggests significant improvement in her information systems. The author suggests what this improvement may have been.

Management, productivity and risk--The way ahead

Any world in transition is not short of things to argue about and we are now in transition. How our arguments are settled, whatsoever may be the virtue of the settlements, may be important. It has recently been suggested, for example, that 10 British governments have made over thirty fiscal interventions in the conduct of manufacturing industry since the Second World War, in addition to such general economic encouragements as tinkering with the minimum lending rate and the exchange value of the currency. A few of these ups-and-downs are the result of policies argued about during general election campaigns, to be sure, but even they, as well as all the others, are largely based on the advice of experts of one kind or another. But when we ask ourselves from where these experts seek the foundations of their advice, we discover a professional world no less short of its internal dissensions; when successive governments take sides with the different schools of experts, we may expect to find our transitional world also in violent oscillation. Expert controversy then may become mere intellectual brawling; this can be noticed within the professions and even lead to some soul searching... As Johnson observed, after his efforts to secure the reprieve of a well-known preacher had failed: "Depend upon it, Sir, when a man knows he is to be hanged in fortnight, it concentrates his attention wonderfully". There is much concentrating of the attention just now. But we need to ask what to concentrate it on; nothing is as bad as the ill-conceived plan efficiently carried out, with its insistence on answering the wrong questions rather than in identifying the right ones. In the regenerative confusion of these iron times, our first need is to recognise the most discriminating questions obscured beneath the distractions of constant change; it is a need no less imperative for a profession like operational research than for the most quick-witted and evasive of party politicians. The doubts thrown on the credentials of our trade by Russell Ackoff's two recent papers are no more than the sentiment of the music hall song: "All dressed up but nowhere to go!" It is, in other words, easy to arm oneself with technique--indeed, with an arsenal of different techniques--but much more difficult to know what to do with it. There is no general theory of search, because if you do not know what you are looking for you do not know how to sample your experience. You must therefore start to guess. Decisions about the future, whether or not taken on the advice of experts, call for intelligent conjecture (if they are to be thought out) or just for simple guesswork (if they need not be). But since experts do not like risking their reputations, they are averse to guessing; they prefer to bank on the certainties of the elapsed past rather than to grope blindfold into the future. This paper suggests that action learning may be one means of concentrating attention upon the questions dying to be asked.