Organisational drivers of performance in mental health providers

Purpose: This study aims to compare and contrast the core organisational processes across high and low performing mental health providers in the English National Health Service (NHS).Design/methodology/approach: A multiple case study qualitative design incorporating a full sample of low and high performing mental health providers.Findings: This study suggests that the organisational approaches used to govern and manage mental health providers are associated with their performance, and the study’s findings give clues as to what areas might need attention. They include, but are not limited to: developing appropriate governance frameworks and organisational cultures, ensuring that staff across the organisation feel “psychologically safe” and able to speak up when they see things that are going wrong; a focus on enhancing quality of services rather than prioritising cost-reduction; investing in new technology and digital applications; and nurturing positive inter-organisational relationships across the local health economy.Originality/value: Highlights considerable divergence in organisation and management practices that are associated with the performance of mental health trusts in the English NH

Changing leadership, management and culture in mental health trusts

Purpose - To explore how leadership, management practices and organisational cultures have changed in low and high performing mental health providers between 2015 and 2020 in the English National Health Service (NHS). Design/methodology/approach - We used a qualitative case study design comprising a purposeful sample of two low performing and two high performing mental health providers, based on . The main form of data collection was semistructured interviews with 60 key informants (mostly internal to the organisation with some external informants from local Clinical Commissioning Groups). Findings - We found major differences regarding leadership, management and organisational culture between low and high performing mental health providers in 2015/2016, and that the differences had diminished considerably by 2019/20. In 2015/16, low performing providers were characterised by a ‘top-down’ style of leadership, centralised decision-making, and ‘blame cultures’. In contrast, the high performing providers were characterised as having more distributed, collaborative and inclusive styles of leadership/management, with open and supportive cultures. As the low performing providers changed and adapted their styles of leadership and management and organisational culture over the five-year period, they more closely resembled those of the high performing trusts. Originality/value - This is the first study to explore the relationship between changing organisational factors (leadership, culture, management practices) and the performance of mental health care providers. It provides evidence that it is possible for radical changes in leadership, management and organisational culture to be enacted over a relatively short period of time and that such changes may help low performing providers to turnaround their underperformance

IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England

Background: In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision. Objective: This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data. Methods: We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members. Results: Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy. Conclusions: Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research

Overseeing oversight: governance of quality and safety by hospital boards in the English NHS

Objectives: To contribute towards an understanding of hospital Board composition and oversight of patient safety and health care quality in the NHS. Methods: A review of the theory related to hospital Board governance and two national surveys undertaken about Board management in NHS hospital trusts in England. The first was issued to 150 Trusts in 2011/12 and completed online via a dedicated web tool. A total of 145 replies were received (97% response rate). The second online survey undertaken in 2012/13 targeted individual Board members using the Board Self Assessment Questionnaire (BSAQ). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS Trusts then in existence (66% response rate). Results: Around 42% of Boards had 10-12 members and around 51% had 13-15 members. We found no significant difference in Board size between Foundation and non Foundation trusts. Around 62% of Boards had three or fewer serving Board members with clinical backgrounds. For about two-thirds of the Trusts (63%), Board members with a clinical background comprised less than 30% of the Board members. Boards were using a wide range of hard performance metrics and soft intelligence to monitor their organisation with regard to patient safety. Hard, quantitative data were reportedly used at every Board meeting across most hospital Trusts (>80%), including a range of clinical outcomes measures, infection rates and process measures such as medication errors and readmission rates. A much smaller proportion of Trusts (57%) routinely report morbidity rates at every Board meeting. Softer intelligence, used organisationally and reported at all Board meetings, was more variably reported, with discussions with clinicians (in 89% of Trusts) and executive walk-arounds (88%) being most often reported, alongside use of patient stories (83%). However, in only about two-thirds of Trusts did Board members shadow clinicians and report back to the Board (65%). The BSAQ data showed general high or very high levels of agreement with desirable statements of practice in each of the six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (interpersonal) to 85% (political). Conclusions: The study provides the best account to-date of English NHS Boards and their actions around health care quality and patient safety. While systematic differences between Trusts of different types were rare, there was nonetheless variation between individual Trusts on both Board composition and Board practices. These findings lay the groundwork for further empirical research exploring the dynamics, influences and impacts of Boards

Are patients willing participants in the new wave of community-based medical education in regional and rural Australia?

Community-based medical education is escalating to meet the increased demand for quality clinical education in expanded settings and patient participation is vital to the sustainability of this endeavour. This study aimed to investigate patients’ views on being used as an educational resource in medical student teaching, and whether they are being under- or over-used

Systematic Discovery of New Recognition Peptides Mediating Protein Interaction Networks

Many aspects of cell signalling, trafficking, and targeting are governed by interactions between globular protein domains and short peptide segments. These domains often bind multiple peptides that share a common sequence pattern, or “linear motif” (e.g., SH3 binding to PxxP). Many domains are known, though comparatively few linear motifs have been discovered. Their short length (three to eight residues), and the fact that they often reside in disordered regions in proteins makes them difficult to detect through sequence comparison or experiment. Nevertheless, each new motif provides critical molecular details of how interaction networks are constructed, and can explain how one protein is able to bind to very different partners. Here we show that binding motifs can be detected using data from genome-scale interaction studies, and thus avoid the normally slow discovery process. Our approach based on motif over-representation in non-homologous sequences, rediscovers known motifs and predicts dozens of others. Direct binding experiments reveal that two predicted motifs are indeed protein-binding modules: a DxxDxxxD protein phosphatase 1 binding motif with a K (D) of 22 μM and a VxxxRxYS motif that binds Translin with a K (D) of 43 μM. We estimate that there are dozens or even hundreds of linear motifs yet to be discovered that will give molecular insight into protein networks and greatly illuminate cellular processes

Adult Patients’ Perspectives on the Benefits and Harms of Overused Screening Tests: a Qualitative Study

BACKGROUND: In recent years, there has been a growing interest in reducing the overuse of healthcare services. However, little is known about how patients conceptualize the benefits and harms of overused screening tests or how patients make decisions regarding these tests. OBJECTIVE: To determine how patients think about the harms and benefits of overused screening tests and how they consider these and other factors when making decisions. DESIGN: Semi-structured, qualitative interviews. PARTICIPANTS: The study comprised 50 patients, ages 50-84, who had previously received or not received any of four overused screening services: 1) prostate cancer screening (men ages 50-69), 2) colon cancer screening (men and women ages 76-85), 3) osteoporosis screening (low-risk women ages 50-64), or 4) cardiovascular disease screening (low-risk men and women ages 50-85). APPROACH: We conducted a thematic analysis, using a hybrid inductive-deductive approach. Two independent coders analyzed interview transcriptions to identify themes and exemplifying quotes. KEY RESULTS: Many patients could not name a harm of screening. When they did name harms, patients often focused on only the harms of the screening test itself and rarely mentioned harms further along the screening cascade (e.g., from follow-up testing and treatment). In contrast, patients could easily name benefits of screening, although many seemed to misunderstand or overestimate the magnitude of the benefits. Furthermore, patients described many additional factors they considered when making screening decisions, including their clinicians' recommendations, their age, family or friends' experiences with disease, and insurance coverage. CONCLUSIONS: This study highlights the need to help adults recognize and understand the benefits and harms of screening and make appropriate decisions about overused screening tests

Community-based fish culture in seasonal floodplains and irrigation systems

The overall objective of the project was to enhance fish production from seasonally flooding areas and irrigation systems using a collective approach to fish culture. The project sought to examine the institutions necessary to support community-approaches to fish culture in a range of social, cultural and economic conditions, in Bangladesh, Cambodia, China, Vietnam and Mali. Technical designs for fish culture were also tested, building on successes achieved in earlier trials in Bangladesh, with an emphasis on adapting the model to develop locally appropriate culture systems. The project showed that the model is able to generate important benefits for communities in Bangladesh, China and Mali, and may have the potential to so in other countries. However, it was found that introducing fish culture into complex and dynamic institutional contexts, whereby open access waters lie over private property required a range of social, environmental and economic conditions to be in place for the adoption and continuance of the fish culture model