Performance measurement for the strategic management of healthcare estates

Purpose The purpose of this study is to explore the role of performance measurement in current practices for strategic management of health-care estates. Design/methodology/approach The research adopts a constructivist grounded theory approach, combining different methodologies of a pan-European qualitative questionnaire, interviews with international health-care providers and a case study of National Health Services (NHS) Scotland. Here, documentation analysis, observations and in-depth interviews involving NHS stakeholders were undertaken. Findings The analysis shows evidence that measuring estate performance has limited value for individual NHS boards regarding strategic decisions related to long-term planning and investment. This was due to design issues and the prioritisation of clinical delivery, which contribute to the neglect of the estate as a consideration in long-term strategic planning. This misalignment results in a tool which is valuable for accountability but which is less helpful to NHS boards in shaping future decisions around the estate. Practical implications Responding to a gap in understanding of the application of performance measurement in the context of health-care estates, this research provides three recommendations to promote a more effective and relevant performance measurement system. These actively recognise the importance of the estate within strategic decision-making as helping to inform the long-term planning and management of the estate within the individual NHS boards. Originality/value This paper shows the current role of performance measurement for the strategic management of health-care estates and identifies issues related to its applicability and value. </jats:sec

Quantifying extreme behaviour in geomagnetic activity

Understanding the extremes in geomagnetic activity is an important component in understanding just how severe conditions can become in the terrestrial space environment. Extreme activity also has consequences for technological systems. On the ground, extreme geomagnetic behavior has an impact on navigation and position accuracy and the operation of power grids and pipeline networks. We therefore use a number of decades of one-minute mean magnetic data from magnetic observatories in Europe, together with the technique of extreme value statistics, to provide a preliminary exploration of the extremes in magnetic field variations and their one-minute rates of change. These extremes are expressed in terms of the variations that might be observed every 100 and 200 years in the horizontal strength and in the declination of the field. We find that both measured and extrapolated extreme values generally increase with geomagnetic latitude (as might be expected), though there is a marked maximum in estimated extreme levels between about 53 and 62 degrees north. At typical midlatitude European observatories (55–60 degrees geomagnetic latitude), compass variations may reach approximately 3–8 degrees/minute, and horizontal field changes may reach 1000–4000 nT/minute, in one magnetic storm once every 100 years. For storm return periods of 200 years the equivalent figures are 4–11 degrees/minute and 1000–6000 nT/minute

Examples of individual supported living for adults with intellectual disability

Background: This article provides a qualitative account of four models of support for adults with intellectual disability in individual supported living (ISL) arrangements. Materials and Methods: Completion of the first 50 evaluations of 150 arrangements for the third phase of the ISL project provided the examples. Results: Four approaches are described: living alone, co-residency, relationship and host family. Within each type, wide variations occur particularly based on security of tenure, formal and informal support and management variations. Conclusion: Fifty evaluations so far illustrated a wide range of approaches to ISL, providing evidence of the critical importance of the formal and informal support environment and reinforcing the contention that ISL is appropriate for people with high support needs

Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training

Factors affecting the intention of providers to deliver more effective continuing medical education to general practitioners: a pilot study

BACKGROUND: Despite the importance of continuing medical education (CME) for GPs, there has been little research into how providers decide what types of CME to deliver to GPs. This study aimed to identify factors affecting the intention of providers to provide more effective types of CME; and to design a survey instrument which can be used to test the applicability of Triandis' model of social behaviour to the provision of CME to general practitioners. METHODS: This was a cross-sectional study on a convenience sample of 11 Australian providers of CME for interviews and a random sample of 25 providers for the pilot test. Open-ended interviews structured on Triandis' theory were performed with key informants who provide CME to GPs. These were used to develop a pilot survey instrument to measure the factors affecting intention, resulting in a revised instrument for use in further research. RESULTS: There was a broad range of factors affecting providers' intention to deliver more effective forms of CME identified, and these were classifiable in a manner which was consistent with Triandis' model. Key factors affecting providers' intention were the attitude toward CME within organisations and the time and extra work involved. CONCLUSIONS: We identified a range of potential factors influencing the intention of providers to provide more effective forms of CME, in all categories of Triandis model. Those interested in increasing the choice of more effective CME activities available to GPs may need to broaden the methods used in working with providers to influence them to use more effective CME techniques. The interview material and questionnaire analysis of the pilot survey support the use of Triandis model. Further research is needed to validate Triandis'model for the intention to deliver more effective forms of CME. Such research will inform future strategies aimed at increasing the amount and choice of effective CME activities available for GPs

Listening to the parent voice to inform person-centred neonatal care.

Family integrated care (FIC), where parents are an integral part of their baby’s care and decision-making can enhance parental involvement and empowerment, contributing to decreased parental separation and stress. It follows that parents can also be a central part of neonatal education for staff in the neonatal speciality. This paper focuses on what students and staff can learn from parents about what they feel is important to make their experience better. A narrative, interpretive approach was undertaken to collect and analyse parent interview narratives. A specific question was posed to a purposive sample of parents who have had premature babies about what health professionals can learn from them. Thematic analysis revealed five key themes relating to the importance of: communicating; listening; empathising; acknowledging (the parent’s role); realising (what matters to parents). These elements were incorporated into a framework named by the mnemonic, ‘CLEAR’. This highlights what parents want staff to be cognisant of when caring for them and their babies. Learning from the parents in our care enables a greater understanding of their experiences at difficult and challenging times. Having a deeper understanding of parents’ experiences can contribute to enhanced empathic learning.Peer reviewedFinal Accepted Versio

Safe spaces, support, social capital: a critical analysis of artists working with vulnerable young people in educational contexts

This article provides a critical and thematic analysis of three research projects involving artists working with vulnerable young people in educational contexts. It argues that artists create safe spaces in contrast to traditional educational activities but it will also raise questions about what constitutes such a space for participants. It will then show that skilled artists often mediate dichotomous pedagogical positions, characterised by competency and performance. It will employ the metaphor of a trellis to illustrate how artists provide flexible structure and support whilst allowing freedom and growth. Finally, it will discuss the social impact of the arts through the lens of social capital theory, highlighting the utility of the approach whilst also indicating areas for critical refinement