Following Francis: reversing performance in the NHS from targets to teams

Between 400 and 1200 people died unnecessarily in just four years at the Mid Staffordshire National Health Service Foundation Trust in the UK. Two inquiries carried out by Robert Francis QC, the second one producing a report of 1700 pages with 290 recommendations, have proposed a range of changes to the regulatory framework and legal duties placed on hospitals throughout England. It proposes better warning signals, greater accountability of senior managers and NHS staff facing possible criminal prosecution for non-reporting of clinical error. The report also identifies that the model of performance management dominant in the NHS compounded the already delicate balance between available resources and quality of care such that, “quality wasn’t the organising principle of the NHS, it wasn’t the thing that was driving us during that period”(David Nicholson, NHS Chief Executive. Evidence 28th September 2011, Francis Report).Virtually no organisation emerges from the inquiry with credit except the local campaigns set up by the relatives of the victims.The NHS is now facing a major culture change in relation to performance management if it is to improve outcomes for patients

Reversing performance in the UK National Health Service: from targets to teams

The UK’s 2010 and 2013 public inquiries into the Mid Staffordshire hospital scandal estimated that between 400 and 1,200 people died unnecessarily in just a four-year period. The inquiries, carried out by Robert Francis QC, identified a range of performance management problems within the National Health Service (NHS) stemming from a widespread preoccupation with nationally set targets, emphasizing an organizing principle of reducing costs rather than delivering quality patient care. The inquiries conclude that there had been a systemic failure at Mid Staffs; including a culture of bullying and secrecy regarding patient care, a focus on achieving externally set targets and budgeting, and low staff morale. This was explained, in part, by the performance culture in place where frontline staff worked within an “endemic culture of bullying” (Francis, 2010: Vol 1. B.38), forced to prioritize targets over patient welfare for fear of victimization and job loss which incentivized short cuts and “unacceptable standards of performance” (Francis, 2013: 111). Virtually no organization emerges from the inquiries with credit except the local campaign set up by the relatives of the victims. The reports provide few concrete recommendations to improve performance despite an emphasis within the Francis report on the urgent need for the NHS to reform its performance management. Although we offer no magic solutions to the structural problems across the organization, our proposal is that an important aspect of reform should be a reorientation away from targets and top-down management toward a model of inter-disciplinary and inter-organizational team working

Dynamic Mechanical Behavior of Black Cherry (Prunus Serotina EHRH.)

The dynamic mechanical properties of black cherry (Prunus serotina Ehrh.) have been investigated as a function of temperature at audio frequencies. Relaxation processes are evident near 200, 360, and 510 K. The process near 200 K was investigated as a function of initial moisture content (based on mass measurements prior to testing). At moisture contents greater than about 20%, the damping peak is centered near 185 K. This relaxation shifts with moisture content, and at moisture contents below 6%, the peak is centered near 225 K. The relaxation in the 360 K region is also associated with initial moisture content. For oven-dry black cherry specimens, the dynamic mechanical properties in the 360 K region are nearly temperature-independent. The relaxation near 510 K is believed to be associated with thermal degradation of wood constituents that are known to degrade in that temperature region

Gravitational Repulsion within a Black-Hole using the Stueckelberg Quantum Formalism

We wish to study an application of Stueckelberg's relativistic quantum theory in the framework of general relativity. We study the form of the wave equation of a massive body in the presence of a Schwarzschild gravitational field. We treat the mathematical behavior of the wavefunction also around and beyond the horizon (r=2M). Classically, within the horizon, the time component of the metric becomes spacelike and distance from the origin singularity becomes timelike, suggesting an inevitable propagation of all matter within the horizon to a total collapse at r=0. However, the quantum description of the wave function provides a different understanding of the behavior of matter within the horizon. We find that a test particle can almost never be found at the origin and is more probable to be found at the horizon. Matter outside the horizon has a very small wave length and therefore interference effects can be found only on a very small atomic scale. However, within the horizon, matter becomes totally "tachionic" and is potentially "spread" over all space. Small location uncertainties on the atomic scale become large around the horizon, and different mass components of the wave function can therefore interfere on a stellar scale. This interference phenomenon, where the probability of finding matter decreases as a function of the distance from the horizon, appears as an effective gravitational repulsion.Comment: 20 pages, 6 figure

Some Physical Properties of Birch Carbonized in A Nitrogen Atmosphere

The dynamic mechanical properties, mass loss, and shrinkage data of birch carbonized in a nitrogen atmosphere to different temperatures from 473 to 973 K have been investigated. The dynamic elastic modulus data decreased as the heat treatment temperatures approached 673 K. Major mass loss and shrinkage accompanied the decrease in the modulus data. Treatments at higher temperatures (> 673 K) produced substantially less additional mass loss and shrinkage but produced increased rigidity in the char. The internal friction behavior of the char was complex

Diffractive effects in spin-flip pp amplitudes and predictions for relativistic energies

We analyze the diffractive (Pomeron) contribution to pp spin-flip amplitude and discuss the possible scenarios for energies available at the Relativistic Heavy-Ion Collider (RHIC). In particular, we show that RHIC data will be instrumental in assessing the real contribution of diffraction to spin amplitudes.Comment: 11 pages, 12 Encapsulated PostScript files, LaTeX2e use

How much laser power can propagate through fusion plasma?

Propagation of intense laser beams is crucial for inertial confinement fusion, which requires precise beam control to achieve the compression and heating necessary to ignite the fusion reaction. The National Ignition Facility (NIF), where fusion will be attempted, is now under construction. Control of intense beam propagation may be ruined by laser beam self-focusing. We have identified the maximum laser beam power that can propagate through fusion plasma without significant self-focusing and have found excellent agreement with recent experimental data, and suggest a way to increase that maximum by appropriate choice of plasma composition with implication for NIF designs. Our theory also leads to the prediction of anti-correlation between beam spray and backscatter and suggests the indirect control of backscatter through manipulation of plasma ionization state or acoustic damping.Comment: 15 pages, 4 figures, submitted to Plasma Physics and Controlled Fusio