The role of professional elites in healthcare governance:Exploring the work of the medical director

Medical leaders occupy a prominent position in healthcare policy in many countries, both in terms of the governance of quality and safety within healthcare organisations, and in broader system-wide governance. There is evidence that having doctors on hospital boards is associated with higher quality services. What is not known is how they have this effect. Analysing data collected from observations, interviews and documents from 15 healthcare providers in England (2014-2019), we elaborate the role of medical directors in healthcare governance as 'translation work', 'diplomatic work', and 'repair work'. Our study highlights the often enduring emotional effects of repeated structural changes to clinical services. It also contributes to theories of professional restratification, showing the work of medical directors as regional 'political elites', and as 'corporate elites' in publicly-funded healthcare systems

Gender, parenthood and health: a study of mothers' and fathers' experiences of health and illness.

This study makes an original contribution to the literature on gender differences in\ud health and illness which attempts to explain why 'women get sick and men die'. It\ud focuses on how women and men as parents experience health and illness. It also\ud contributes to studies of motherhood, specifically women's experiences, and extends\ud this by making visible men's experiences of fatherhood.\ud A qualitative study of fifteen working class families, involving both parents, was\ud undertaken. Using a feminist theoretical framework based on parents' lived\ud experiences' of health, I explored gender differences in health status, attitudes and\ud behaviour; and the additional role of material and social resources. Each parent was\ud interviewed three times over the course of a year. Data were also collected using\ud health diaries.\ud The mothers reported more health problems than the fathers. The data lend support\ud to the 'nurturant role hypothesis' ie. that mothers' social role as carer leads them to\ud have different experiences of health and illness from fathers. The mothers experience\ud their role as more stressful than the fathers, particularly with regard to the lack of\ud opportunity to rest. The finding that the 'mothering' role has a significant negative\ud impact on health is supported by data that show that fathers who are more involved\ud in childcare report more health problems than fathers less involved.\ud Three typologies of parenthood have been developed which extend the hypothesis in\ud important ways: (a) the congruence between mothers' ideologies of parenthood and\ud their actual situation; (b) fathers' degree of involvement in childcare; and (c) the\ud congruence between mothers' and fathers' ideologies. An analysis of gender\ud differences in concepts of health adds to the explanation of parents' different health\ud experiences. Finally, the structural context within which women and men carry out\ud their roles as parents helps to account for the health differences found

Using visualisation methods to analyse referral networks within community health care among patients aged 65 years and over

Community health care services are considered integral to overcoming future problems in health care. However, this sector faces its own challenges, such as how to organise services to provide coordinated care given: their physical distribution, patients using multiple services, increased patient use and differing patient needs. The aim of this work was to explore, analyse and understand patterns in community referrals for patients aged 65 years and over, and their use of multiple services through data visualisation. Working with a large community provider, these methods helped researchers and service managers to investigate questions that were otherwise difficult to answer from raw data. Each map focuses on a different characteristic of community referrals: patients reusing services, concurrent uses of different services and patterns of subsequent referrals. We apply these methods to routine patient data and discuss their implications in designing of a single point of access - a service for streamlining referrals

Investigating healthcare IT innovations:A ‘conceptual blending’ approach

PURPOSE: The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS). DESIGN/METHODOLOGY/APPROACH: To analyse these multi-level dynamics, the authors blend Rogers' diffusion of innovations theory (DoIT) with Webster's sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts. FINDINGS: Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application - in particular speed, ease of use, reliability and flexibility and levels of readiness - were highly relevant but their influence was modulated through interaction with complex structural and relational issues. PRACTICAL IMPLICATIONS: Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of "co-construction" between designers and end-users. ORIGINALITY/VALUE: The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes

Implementation of computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) in the NHS: quantitative before and after study

Objective To assess the impact of components of the national programme for information technology (NPfIT) on measures of clinical and operational efficiency