Health care process modelling: which method when?

Objective The role of process modelling has been widely recognized for effective quality improvement. However, application in health care is somewhat limited since the health care community lacks knowledge about a broad range of methods and their applicability to health care. Therefore, the objectives of this paper are to present a summary description of a limited number of distinct modelling methods and evaluate how health care workers perceive them. Methods Various process modelling methods from several different disciplines were reviewed and characterized. Case studies in three different health care scenarios were carried out to model those processes and evaluate how health care workers perceive the usability and utility of the process models. Results Eight distinct modelling methods were identified and characterized by what the modelling elements in each explicitly represents. Flowcharts, which had been most extensively used by the participants, were most favoured in terms of their usability and utility. However, some alternative methods, although having been used by a much smaller number of participants, were considered to be helpful, specifically in understanding certain aspects of complex processes, e.g. communication diagrams for understanding interactions, swim lane activity diagrams for roles and responsibilities and state transition diagrams for a patient-centred perspective. Discussion We believe that it is important to make the various process modelling methods more easily accessible to health care by providing clear guidelines or computer-based tool support for health care-specific process modelling. These supports can assist health care workers to apply initially unfamiliar, but eventually more effective modelling methods

Modelling and simulation techniques for supporting healthcare decision making : a selection framework

The development of this workbook has been led by a team of researchers from five UK universities with a grant from the UK Engineering and Physical Sciences Research Council (EPSRC). They are investigating the use of modelling and simulation in healthcare as part of the RIGHT (Research Into Global Healthcare Tools) project. The workbook was developed following an extensive review of literature on the application of modelling and simulation in healthcare and other safety- critical industries, supplemented by the team’s extensive expertise of modelling and simulation in healthcare. In order to produce this summary guide, thousands of articles were categorised according to the techniques used, when they were used, and with what resources.peer-reviewe

Involving the Public in Healthcare Policy: An Update of the Research Evidence and Proposed Evaluation Framework

Offers an assessment tool to inform the design and evaluation of strategies for involving the public in healthcare policies to make healthcare systems more responsive. Reviews research on the role of public involvement and considers risks and limitations

Higher Education development in Greater Peterborough: a case study of public policy

The aim of the research was to examine the impact of power on public policy using higher education development in Greater Peterborough as a case study. The research focused on the 'Towards Peterborough's University' project managed by Greater Peterborough Training & Enterprise Council (GPtec), funded by Government Office Eastern Region (GOER), and which aimed to establish quality university education in Greater Peterborough. It represents an ethnographic study (chiefly participant observation) concentrating on the first two years of development—from the setting up of the project in October 1994 to establishment and formal registration of a project company in December 1996. [Continues.

Caring for the oldest old

As the population ages the costs of care will ris

Developing engagement, linkage and exchange between health services managers and researchers: Experience from the UK

Objectives The UK National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO) Management Fellowship programme enabled health services managers and university researchers to collaborate on research projects with the aim of improving research, managers’ research knowledge and skills, and the use of research in management. Our aim was to evaluate whether the programme encouraged greater engagement, linkage and exchange between researchers and managers. Methods A case-study approach with each case-study centred on 11 health care managers appointed as Fellows, chief investigators (n = 13) and Fellows’ line managers (n = 12). Data were collected through semi-structured face-to-face and telephone interviews. Interviews were analysed thematically to explore the impact of the programme, reported issues and to identify any lessons learned. Results Researchers benefited from the flow of (insider) knowledge and contacts from the workplace via the Fellow to the project. Engagement, linkage and exchange as a result of the Fellowship were less developed for the workplace. Reasons for this related to the fit of the research project with workplace interests, Fellows’ contact with the health care organization, feedback structures and training. The potential for co-production of knowledge was under-developed. A transactional notion of exchange was found in operation in workplaces. Conclusions The programme’s aim to enhance engagement, linkage and exchange was largely achieved, although exchange tended to be narrowly conceived. Knowing how models of exchange work in practice can ensure effort is put to best use

Getting the most out of knowledge and innovation transfer agents in health care: a qualitative study

Background: Knowledge and innovation transfer (KIT) is recognised internationally as a complex, dynamic process that is difficult to embed in organisations. There is growing use of health service–academic–industry collaborations in the UK, with knowledge brokers linking producers with the users of knowledge and innovation. Aim: Focusing on KIT ‘agent’ roles within Academic Health Science Networks in England and Partnerships in Wales, we show how individual dispositions, processes and content contribute to desired outcomes. Methods: We studied the KIT intentions of all Academic Health Science Networks in England, and the South East Wales Academic Health Science Partnership. Using a qualitative case study design, we studied the work of 13 KIT agents purposively sampled from five networks, by collecting data from observation of meetings, documentation, KIT agent audio-diaries, and semistructured interviews with KIT agents, their line managers and those they supported (‘Links’). We also used a consensus method in a meeting of experts (nominal group technique) to discuss the measurement of outcomes of KIT agent activity. Findings: The case study KIT agents were predominantly from a clinical background with differing levels of experience and expertise, with the shared aim of improving services and patient care. Although outside of recognised career structures, the flexibility afforded to KIT agents to define their role was an enabler of success. Other helpful factors included (1) time and resources to devote to KIT activity; (2) line manager support and a team to assist in the work; and (3) access and the means to use data for improvement projects. The organisational and political context could be challenging. KIT agents not only tackled local barriers such as siloed working, but also navigated shifting regional and national policies. Board-level support for knowledge mobilisation together with a culture of reflection (listening to front-line staff), openness to challenges and receptivity to research all enabled KIT agents to achieve desired outcomes. Nominal group findings underscored the importance of relating measures to specific intended outcomes. However, the case studies highlighted that few measures were employed by KIT agents and their managers. Using social marketing theory helped to show linkages between processes, outcomes and impact, and drew attention to how KIT agents developed insight into their clients’ needs and tailored work accordingly. Limitations: Level of KIT agent participation varied; line managers and Links were interviewed only once; and outcomes were self-reported. Conclusions: Social marketing theory provided a framework for analysing KIT agent activity. The preparatory work KIT agents do in listening, understanding local context and building relationships enabled them to develop ‘insight’ and adapt their ‘offer’ to clients to achieve desired outcomes. Future work: The complexity of the role and the environment in which it is played out justifies more research on KIT agents. Suggestions include (1) longitudinal study of career pathways; (2) how roles are negotiated within teams and how competing priorities are managed; (3) how success is measured; (4) the place of improvement methodologies within KIT work; (5) the application of social marketing theory to comparative study of similar roles; and (6) patients as KIT agents. Funding: The National Institute for Health Research Health Services and Delivery Research programme