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Dwyer, Alison J. "Medical managers in contemporary healthcare organisations: a consideration of the literature." Australian Health Review 34, no. 4 (2010): 514. http://dx.doi.org/10.1071/ah09736.
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Objectives. To consider the literature supporting the evolution of the roles of a Medical Manager within contemporary healthcare organisations. Design. Consideration of available literature. Results. Limited dedicated literature available. Consideration of available studies and expert opinion reveals benefit of doctors in management positions within healthcare organisations. The roles of Medical Managers arise from: organisational structure-theory of healthcare’s ‘professional bureaucracy’; clinical directorate models; clinical governance, legislative and public health requirements; and the duality of combining medical knowledge with business and healthcare management training. Roles identified are: (1) leadership and management of medical staff including appointments and credentialing, and mentoring of medical staff in Clinical Directorate roles; (2) strategy development including Medical Advisory Role to Executive; (3) clinical governance including quality and risk management and legislative requirements; and (4) operational areas that benefit from clinical and management skills. Discussion. Strengths of this review include considering contexts of Medical Managers in medical and healthcare management literature. Weaknesses include drawing inferences from theory. Future recommendations include formal studies and systematic reviews of available literature of the subject. Conclusions. In light of falling Medical Management trainee numbers, this study highlights the value to the health system of a dwindling Medical Management profession, the urgent need to encourage more medical practitioners into management and for organisations to further embrace Medical Managers in key leadership roles. What is known about the topic? Although there is general acknowledgement about the benefits of medical leaders within health services, the exact nature and evidence for the Medical Manager role in current health services has not been comprehensively explored and articulated. What does this paper add? The aim of this consideration of the literature is to explore the evidence-base supporting the roles for Medical Managers within contemporary healthcare organisations, and articulate the exact nature and scope of the role. A concordance of studies and expert opinion highlights the benefits of Medical Managers within contemporary healthcare organisations, illustrating a theoretical basis for the differing roles. The nature of the roles include: leadership and management of medical staff (from organisational structure theory); leadership of the organisation within the executive team; clinical governance oversight; and operational management of medical areas with a business focus. What are the implications for practitioners? In light of falling Medical Management trainee numbers, this study highlights the value to the health system of a dwindling Medical Management profession, the urgent need to encourage more medical practitioners into management and for organisations to further embrace Medical Managers in key leadership roles.
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Stafrace, Simon, and Alan Lilly. "Turnaround in an aged persons' mental health service in crisis: a case study of organisational renewal." Australian Health Review 32, no. 3 (2008): 577. http://dx.doi.org/10.1071/ah080577.
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This case study demonstrates how leadership was harnessed to turn around a decline in the performance of an aged persons? mental health service ? the Namarra Nursing Home at Caulfield General Medical Centre in Melbourne, Australia. In 2000 the nursing home faced a crisis of public confidence due to failings in the management of quality, clinical risk and human resources within the service. These problems reflected structural and operational shortcomings in the clinical directorate and wider organisation. In this article, we detail the process of turnaround from the perspective of senior executive managers with professional and operational responsibility for the service. This turnaround required attention to local clinical accountability and transformation of the mental health program from a collocated but operationally isolated service to one integrated within the governance structures of the auspicing organisation.
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Isherwood, Jim. "Clinical governance in mental health services." Psychiatric Bulletin 23, no. 12 (December 1999): 718–20. http://dx.doi.org/10.1192/pb.23.12.718.
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In this paper, I explain the strategy for achieving clinical governance within the trust's mental health directorate, and describe the role that clinicians and managers would like the chief executive to play in helping us to achieve our targets.
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Romano, Mauro, and Christian Favino. "Broken ties and corporate governance changes under uncertainty conditions. A longitudinal study of Italian boardroom network evolution." Corporate Ownership and Control 11, no. 3 (2014): 399–419. http://dx.doi.org/10.22495/cocv11i3conf2p2.
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The recent systemic crisis that has affected the financial markets and real economies of major industrialized countries has had significant effects on the corporate governance and key organizational choices of large firms. In this context, the present study aims to verify whether the international crisis has significantly changed the structure of the interlocking directorate network that links large firms in the regulated Italian market. Furthermore the paper, which is a development of a preceding research study, also investigates the changes that have occurred in the interpersonal network of directors of the same firms previously observed. To this end, we present a preliminary analysis of the evolution of corporate governance in the main European regulated markets through a dynamic comparison of some synthetic statistical data observed at the end of the years 2006, 2008 and 2010. In the second part, after framing the interlocking directorate concept, we examine the evolution of the interlocking directorate network during the aforementioned observation period (2006-2010) with respect to larger Italian listed companies (FTSE MIB) and their directors
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Romano, Mauro, and Christian Favino. "Board composition and interlocking directorate evolution as a consequence of the recent financial crisis: evidence from Italian listed companies." Corporate Ownership and Control 11, no. 1 (2013): 175–92. http://dx.doi.org/10.22495/cocv11i1c1art5.
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The recent systemic crisis that has affected the financial markets and real economies of major industrialized countries has had significant effects on the corporate governance and key organizational choices of large firms. In this context, the present study aims to verify whether the international crisis has significantly changed the structure of the interlocking directorate network that links large firms in the regulated Italian market. To this end, the first part of the paper presents an analysis of the evolution of corporate governance in the main European regulated markets through a comparative analysis of some synthetic statistical data observed at the end of the years 2006, 2008 and 2010. In the second part, after framing the concept of interlocking directorate in a theoretical perspective, we examine the evolution of the network of personal ties between large Italian listed companies in the period of observation (2006-2010) using Social Network Analysis
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Sheard, David John, Gregory Clydesdale, and Gillis Maclean. "Governance structure and public health provision." Journal of Health Organization and Management 33, no. 4 (June 28, 2019): 426–42. http://dx.doi.org/10.1108/jhom-11-2018-0336.
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Purpose A key question in the provision of public health concerns how that provision is governed. The purpose of this paper is to examine the governance structure of a public health board and its perceived impact on the efficacy of clinical operations. Design/methodology/approach Structural issues examined the level of centralisation and public participation, and whether governance should occur through elected boards or appointed managers. These issues were examined through multiple lenses. First was the intention of the structure, examining the issues identified by parliament when the new structure was created. Second, the activities of the board were examined through an analysis of board meetings. Finally, hospital clinicians were surveyed through semi-structured interviews with both quantitative and qualitative questioning. Findings A contradiction was revealed between intention, perception and actual activities. This raises concerns over whether the public are significantly informed to elect the best-skilled appointees to governance positions. Practical implications This research holds implications for selecting governance structures of public health providers. Originality/value Few studies have looked at the role of a publicly elected healthcare governance structure from the perspective of the clinicians. Hence, this study contributes to the literature on healthcare structure and its impact on clinical operations, by including a clinician’s perspective. However, this paper goes beyond the survey and also considers the intention of the structure as proposed by parliament, and board activities or what the board actually does. This enables a comparison of intention with outcomes and perception of those outcomes.
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Johnston, P., R. Blackburn, C. Causton, L. Davis, B. Dela Cruz, and J. Jewell. "Improving clinical and operational outcomes through a shared governance practice council structure." Biology of Blood and Marrow Transplantation 10 (February 2004): 94–95. http://dx.doi.org/10.1016/j.bbmt.2003.12.226.
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Mirza, M. S., J. Madill, W. Parsons, and H. Gajraj. "Safe introduction of the VNUS Closure procedure: a multidisciplinary approach." Phlebology: The Journal of Venous Disease 21, no. 3 (September 15, 2006): 122–26. http://dx.doi.org/10.1258/026835506778253300.
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Objectives: The National Institute for Health and Clinical Excellence supports the use of radiofrequency ablation (VNUS Closure) of the long saphenous vein (LSV) as an alternative to stripping. An increase in interest in the procedure is anticipated. The technique can produce serious complications not commonly associated with conventional surgery, and safety is a major concern with its introduction. The aim was to introduce the new technique into a district hospital, without major complications or failures. Methods: A multidisciplinary team was developed consisting of consultant surgeon, vascular technologist and theatre nurse, who received intensive training and mentoring from a group with considerable experience. All members attended operating theatre and duplex imaging sessions over a period of six months. Approval for the introduction of the technique into our institution was sought from the Medical Director and Clinical Governance Directorate. The results of VNUS Closure surgery were included in the monthly clinical governance and audit meetings. During the consent process, the first patient was informed that the team had not yet undertaken the procedure, but had taken all necessary measures to ensure its competence. Subsequently, patients were advised of our experience and the results. Results: Of the 18 patients who consented for the study, 13 (72%) were found on duplex scanning to have saphenofemoral reflux suitable for VNUS Closure. VNUS Closure was attempted in 22 LSVs in 13 patients; 21 LSVs (95%) in 12 patients were closed at surgery and 19 (86%) remained completely closed at a median of 12 months (range 3–24 months). There were no deaths and no major complications. Conclusion: The safe introduction of VNUS Closure in a district hospital can be accomplished through intensive training and a process of mentoring from experienced practitioners, a multidisciplinary approach with a vascular technologist in theatre and attention to governance issues, in particular audit and consent.
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Joarder, Taufique, Md Aslam Parvage, Lal B. Rawal, and Syed Masud Ahmed. "A Policy Analysis Regarding Education, Career, and Governance of the Nurses in Bangladesh: A Qualitative Exploration." Policy, Politics, & Nursing Practice 22, no. 2 (January 18, 2021): 114–25. http://dx.doi.org/10.1177/1527154420988003.
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Nurses, short in production and inequitable in the distribution in Bangladesh, require the government’s efforts to increase enrolment in nursing education and a smooth career progression. Given the importance of an assessment of the current nursing scenario to inform the decision makers and practitioners to implement the new policies successfully, we analyzed relevant policies on education, career, and governance of nurses in Bangladesh. We used documents review and qualitative methods such as key informant interviews ( n = 13) and stakeholder analysis. We found that nursing education faced several backlashes: resistance from diploma nurses while attempting to establish a graduate (bachelor) course in 1977, and the reluctance of politicians and entrepreneurs to establish nursing institutions. Many challenges with the implementation of nursing policies are attributable to social, cultural, religious, and historical factors. For example, Hindus considered touching the bodily excretions as the task of the lower castes, while Muslims considered women touching the body of the men immoral. Nurses also face governance challenges linked with their performance and reward. For example, nurses have little voice over the decisions related to their profession, and they are not allowed to perform clinical duties unsupervised. To improve the situation, the government has made new policies, including upliftment of nurses’ position in public service, the creation of an independent Directorate General, and improvement of nursing education and service. New policies often come with new apprehensions. Therefore, nurses should be included in the policy processes, and their capacity should be developed in nursing leadership and health system governance.
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Aljohani, Eman H., Ghada M. Hamouda, and Maram A. Banakhar. "Nurses' Perception toward Shared Governance in Clinical Practice at General Hospitals in Jeddah City." Evidence-Based Nursing Research 2, no. 3 (July 17, 2020): 11. http://dx.doi.org/10.47104/ebnrojs3.v2i3.143.
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Context: Shared governance is an evidence-based approach. The characteristics of the work environment of shared governance are autonomous and empowering, where nurses providing direct care have a voice in influencing areas that have been controlled previously by the managers. Shared governance structure aims to improve communication, increases personal growth and nurse satisfaction, and improves patient outcomes.
Aim: To assess nurses' perception toward shared governance at general hospitals in Jeddah city.
Methods: A quantitative descriptive cross-sectional study design was conducted. The study was carried out at three general ministry of health hospitals in Jeddah city. The study sample involved 321 registered nurses using stratified random sampling. The data were collected by using one tool. The index of the Professional Nursing Governance (IPNG) tool was used to measure the nurses' perceptions of governance.
Results: The overall mean score of nurses' perceptions toward shared governance was 118.70±40.85, which scored within the shared governance range. The highest mean score was Resources subscale with 24.74±7.75, while the Goals subscale had the lowest mean score (12.54±5.12). Statically significant differences were found in nurses' perceptions toward shared governance according to their educational degree, current position title, and the working unit at p-value ≤ 0.05.
Conclusion: This study has shown that nurses perceived the governance in the first level of shared governance, which indicates that the decision is made primarily by management with some staff input. Therefore, continuous education and training are needed for nurses to increase their knowledge about shared governance, conflict management, and decision-making skills.
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Et.al, Ani Kusbandiyah. "Determinants of Tax Avoidance of Public Listed Companies in Indonesia." Turkish Journal of Computer and Mathematics Education (TURCOMAT) 12, no. 3 (April 11, 2021): 592–601. http://dx.doi.org/10.17762/turcomat.v12i3.764.
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Current literatures on the factors that effects tax avoidance in corporation produced mix result. Therefore, this study aims to obtain empirical evidence on the influence of ownership structure and corporate governance on tax avoidance and to examine the differences in the tax avoidance before and after-tax amnesty. The population of the study is public listed companies in the Indonesia Stock Exchange for the period of 2012-2017. Data was collected using a purposive sampling method. This study uses multiple regression analysis to investigate determinants of tax avoidance of public listed companies. The results showed that foreign ownership, family ownership and independent directors did not significantly influence tax avoidance. However, the CG-score Index has a significant effect on tax avoidance. The finding also showed there was no difference in the tax avoidance before and after the application of tax amnesty. The result of this study provides more and accurate information including the recognition of permanent and temporary differences that are commonly used as loopholes in tax avoidance action. It can be utilized as input for the Directorate General of Tax (DJP) to evaluate tax regulations, with the hope of increasing taxpayer compliance.
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Bedford, Colleen, Priyanka Jain, Deanna Langer, David Kwan, and Julian Dobranowski. "Standardizing architecture and governance of radiology clinical checklist development." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 193. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.193.
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193 Background: To improve quality of radiology reporting, Cancer Care Ontario’s (CCO) Cancer Imaging Program established synoptic radiology reporting as a priority area. Program goals are to implement standardized radiology reports across the province, improving communication between referring and interpreting physicians and providing a standardized foundation for staging data collection and population health research. Although there are libraries of structured radiology clinical checklists, development methodologies quality vary. To support ongoing development and provide a framework to assess existing checklists, the program developed and published two white papers. Methods: To ensure checklists are consistent in format, the first white paper provides guidance on ‘architecture’ (high-level elements) of a cancer imaging report. To ensure the content of adopted checklists are based on high-quality evidence, the second white paper focuses on clinical checklist development governance. Both white papers were developed in consultation with multidisciplinary expert panels assembled by CCO and underwent peer review prior to being made available. Results: The architecture white paper outlines the minimum mandatory elements for cancer imaging reports. The elements to be included in these reports are: demographics, relevant clinical information, body of the report, and impression. This paper provides specific guidance for expert panels in the development of new clinical checklists as well as criteria for reviewing existing checklists. The governance white paper provides a clear methodology for a systematic approach to clinical checklist development for synoptic radiology. Included are recommendations on the constitution of the clinical expert panels, the level of evidence needed to support checklist items, external review of the checklist, and periodic checklist maintenance. Conclusions: CCO has developed two white papers that serve as a guide for both CCO and external parties in the creation of high-quality clinical checklists. Improved standardization of the structure and development approach for clinical checklists facilitates both in-house development and adoption of third party checklists.
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Whyte, C. R. "Staffing a district psychotherapy service: further developments." Psychiatric Bulletin 19, no. 1 (January 1995): 21–23. http://dx.doi.org/10.1192/pb.19.1.21.
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The adult psychotherapist model of staffing is considerably strengthened by a clinical directorate management structure with a specific local pay scale for psychotherapists. When such arrangements exist they are usually welcomed by clinicians and managers. One reason for this is that they make it possible to ensure that services maintain good clinical standards while meeting the managerial objectives of the unit or trust. Underlying the success of these arrangements is the fact that by promoting separation and individuation they give services a firm identity. This is good for the service itself and also for the unit or trust as a whole, because separation and individuation are the basis of co-operation and integration.
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Looi, Jeffrey CL, Stephen Allison, and Tarun Bastiampillai. "Commonwealth of common mental health: the need for a comprehensive overhaul of corporate governance in mental healthcare in Australia." Australasian Psychiatry 28, no. 3 (December 23, 2019): 300–302. http://dx.doi.org/10.1177/1039856219891657.
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Objective: We aim to spark renewed discussion of the need for a more effective corporate governance structure for mental health services in Australia. While acknowledging clinical governance faces challenges, we focus here on corporate governance as the overarching level of administration, which profoundly influences delivery of mental healthcare in Australia. Conclusion: Australia’s mental health services are ineffectively governed. Improved corporate governance, including psychiatric expertise, is fundamental to create a comprehensive, effective mental healthcare system in Australia.
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Utami, Eristy Minda, Fani Nuryani, and Deden Novan Setiawan Nugraha. "The Effects of Capital Structure and Good Corporate Governance on Company Value." International Journal of Psychosocial Rehabilitation 24, no. 02 (February 12, 2020): 3002–11. http://dx.doi.org/10.37200/ijpr/v24i2/pr200601.
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Callaly, Tom, Dinesh Arya, and Harry Minas. "Quality, Risk Management and Governance in Mental Health: An Overview." Australasian Psychiatry 13, no. 1 (March 2005): 16–20. http://dx.doi.org/10.1080/j.1440-1665.2004.02144.x.
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Objective: To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health. Conclusions: Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.
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Deva, Anand K., and Mark Ashton. "Toolkit for the management of breast implants and the importance of Informed educated consent." Australasian Journal of Plastic Surgery 5, no. 1 (March 31, 2022): 9–12. http://dx.doi.org/10.34239/ajops.v5n1.385.
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Breast implants have had a long and chequered history of periodic regulatory activity and class actions and are associated with significant medium and long term health risks, including the development breast implant associated anaplastic large cell lymphoma (BIA-ALCL).1–3. NSW Health through the Agency of Clinical Innovation has just released a toolkit for the management of breast implants.4 These are the result of collaborative clinical consensus across leaders in plastic and reconstructive surgery, breast surgery and radiology with support from the Surgical Services Taskforce and evidence directorate of the agency. Input was also sought from health consumers to ensure that the language and structure of the information was both comprehensive and accessible to women who were either considering either cosmetic augmentation or reconstruction and/or have breast implants in place.
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Naeem, Salman, Christopher Edmunds, Thomas Hirst, Julia Williams, Amir Alzarrad, James Ronaldson, Jon Barratt, East Anglian Air Ambulance Research, Audit, Innovation and Development Group, and Pre-hospital Trainee Operated Research Network. "A National Survey of Prehospital Care Services of United Kingdom for Use, Governance and Perception of Prehospital Point of Care Ultrasound." POCUS Journal 7, no. 2 (November 21, 2022): 232–38. http://dx.doi.org/10.24908/pocus.v7i2.15739.
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Introduction: Point of care ultrasound (POCUS) has become a common practice in prehospital care over the last 10 years. There is lack of literature on its use and governance structure in United Kingdom (UK) prehospital care services. We aimed to survey the use, governance of prehospital POCUS among UK prehospital services and perceptions of clinicians and services regarding its utility and barriers to its implementation. Methods: Four electronic questionnaire surveys were delivered to UK helicopter emergency medical service (HEMS) & clinicians, ambulance and community emergency medicine (CEM) services between 1st of April and 31st of July 2021 investigating current use, governance structure for POCUS and perception about its benefits and barriers. Invitations were sent via email to medical directors or research leads of services and using social media. Survey links remained live for two months each. Results: Overall, 90%, 62% and 60% of UK HEMS, ambulance and CEM services respectively, responded to surveys. Most of the services used prehospital POCUS, however only two HEMS organisations fulfilled the Royal College of Radiology governance criteria for POCUS. The most commonly performed POCUS modality was echo in cardiac arrest. Majority of clinicians judged POCUS to be beneficial and the common perceived benefit was promotion of enhanced and effective clinical care. Major barriers to its implementation included a lack of formal governance, limited literature supporting its use and difficulties in performing POCUS in prehospital environment. Conclusion: This survey demonstrates that prehospital POCUS is being provided by a majority of the prehospital care services and clinicians have found it beneficial in providing enhanced clinical care to their patients. However, the barriers to its implementation are relative lack of governance structure and supportive literature.
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Derbali, Abdelkader, Lamia Jamel, Ali Lamouchi, Ahmed K. Elnagar, and Monia Ben Ltaifa. "The effect of the board of directors on the performance: Case of Tunisian banks." Corporate Law and Governance Review 2, no. 2 (2020): 8–17. http://dx.doi.org/10.22495/clgrv2i2p1.
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The board of directors plays a crucial role as an internal structure of corporate governance. Certainly, its efficiency is needy on the existence of numerous issues; the greatest significance is correlated to its characteristics that relay principally to the individuality of its memberships, board dimension, combining the purposes of pronouncement and regulator as well the grade of the individuality of the audit board and the diverse gender of the committee. To assess the authenticity of our assumptions, which stipulate the presence of deterministic characteristics of the committee on the profitability of Tunisian banks, we evaluated by three different ratios i.e., ROA (return on asset), ROE (return on equity), and MP (market performance); and we estimate three models with linear regressions. The empirical findings were performed on a data sample composed of 11 Tunisian banks listed on the Stock Exchange of Tunisia (SET) during the period from 1999 to 2018. From the estimated regressions, we find a satisfactory outcome indicating the significance of the influence of the characteristics of the committee on the banking performance in Tunisia. Then, the percentage of outside directors negatively affects the level of the financial performance of banks. The number of institutional administrators performs an essential role in improving financial performance. Finally, the duality of the Presidency of the Council General-Directorate has a negative effect on the level of stock market performance of Tunisian banks.
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Arduini, Remo. "La "clinical governance" č una prospettiva innovativa per le aziende ospedaliere?" ECONOMIA PUBBLICA, no. 1 (December 2012): 5–34. http://dx.doi.org/10.3280/ep2010-001001.
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In public health care organizations, the doctor is not only important as a provider of medical services but also as the individual that determines the demand of medical services; the doctor is both a participant in the definition of demand for services and the actual person representing the offer of them. Therefore health care organizations must guarantee the possibility for the doctor to act independently. On the other hand this autonomy is limited by the fact that doctors must act within the boundaries of structures that impose rules, hierarchies and adherence to organizational levels. This is the reason why in a hospital structure the doctor does not have the possibility to act in total autonomy. Within the hospital organization conflicts arise that must be either prevented and/or managed trough both coordination and integration of processes. The 2004 reform proposed by minister Sirchia constitutes an answer to the above conflict. It was inspired by the British experience with "clinical governance". Mr. Sirchia's law proposal creates the so called "clinical coordinator" and provides it with a position in the clinical organization's top management with the responsibility of definition of policies as well as coordination and controls. He will act as a medical director too. But the creation of the "clinical coordinator" position rather than solve the integration problems, would have generated permanent conflicts at top management level. Luckily the law proposal did not become an act of Parliament; but the problem of finding real solutions to the conflicts arising from the diversity of medical and economic cultures remains.
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Di Betta, Paolo. "Moral governance: politicians, ownership, and control." Corporate Ownership and Control 6, no. 3 (2009): 260–73. http://dx.doi.org/10.22495/cocv6i3c2p1.
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We investigate upon the influences exerted by politicians on the Board and on ownership structure, as an application of political power to corporations. We characterize moral governance as the joint result of these efforts on managerial turnover and ownership turnover. We comment upon two Italian clinical cases of private, listed firms in which politicians enter the scene when a major event occurs (i.e., reorganization, merger, and acquisition activity). Our model could serve as a guideline and checklist for insiders to interact with politicians. We suggest this could be of interest in countries where there is a common level ground – such as in Europe – but with different cultures on the role of the politician in the business environment. It could be an instrument to detect political intervention in the economy to be also used for cross-country comparisons of business environment and for assessing transparency of companies in developed and developing countries. Recent events from the financial crisis in 2008 have increased the urge to investigate these themes.
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Bhatt, Sureshkumar. "Governance of Protecting Patients." BJPsych Open 7, S1 (June 2021): S126. http://dx.doi.org/10.1192/bjo.2021.364.
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AimsInvoluntary commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into inpatient or outpatient treatment. These criteria vary between nations. The goal of this presentation is to compare the governance of protecting patients among different parts of the world.BackgroundUnderstanding the relevance of the judicial committeemen in psychiatry is an essential part of good psychiatric practice. A majority of patients who need inpatient psychiatric treatment fall into one of the following categories: dangerous to self, dangerous to others, or gravely disabled.In the United States, the Parens Patriate doctrine has had great application in the treatment of mentally ill persons, children, and other individuals who are legally incompetent to manage their affairs. The states, which act as parens patriae, can make decisions regarding mental health treatment. State law governs involuntary commitment, and procedures may vary among states.MethodOne of the essential duties of St. Tammany Parish Coroner Office, Louisiana, USA is Mental Health Service, From January 2017 to October 2019, 887 Order of Protective Custody (OPC), 17,838 Physician Emergency Certificates (PEC), and 13096 Coroner Emergency Certificates (CEC) were issued. These certificates allow legal authority to transport a patient to the nearest ER for assessment by physician and mental health providers.ResultPatients with active Physician Certificate are examined by a coroner according to patient's mental history and clinical presentation. Coroner Certificate helps the treatment facilty detail the patient for diagnosis and treatment for fifteen days.ConclusionSt. Tammany Parish Coroner Office is fulfilling its responsibility to provide proper mental health to psychiatric patients. It is necessary for each country/state/parish to have legal structure and provide proper care who are dangerous to self or others, or gravely disabled. The procedures of OPC, PEC, and CEC will be presented.
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Hoff, Julian T. "Toward better balance." Journal of Neurosurgery 81, no. 5 (November 1994): 651–55. http://dx.doi.org/10.3171/jns.1994.81.5.0651.
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✓ The AANS was founded in 1931 as an educational and scientific organization whose principal purpose was to foster optimum neurosurgical care. Because socioeconomic and political pressures on medicine generally and neurosurgery specifically have escalated in recent years, the American Association of Neurological Surgeons (AANS) has been required to respond effectively to matters beyond its traditional role. However, the AANS has lacked an effective, focused policymaking process to deal with socioeconomic concerns despite existing expertise within the specialty. The AANS now needs to develop a comprehensive socioeconomic effort that is consistent with its more traditional educational and scientific activities. A Task Force on Governance has been appointed to address how the Association's governance structure can reflect all the needs of our specialty in times of economic uncertainty and health care reform.
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Lunny, Carole, Wasifa Zarin, Sabrina Chaudhry, Sonia M. Thomas, Annie LeBlanc, Sophie Desroches, Tanya Horsley, et al. "An inclusive and diverse governance structure of the strategy for patient-oriented research (SPOR) Evidence Alliance." FACETS 7 (January 1, 2022): 435–47. http://dx.doi.org/10.1139/facets-2021-0129.
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The Strategy for Patient Oriented Research (SPOR) Evidence Alliance is a research initiative in Canada whose mission is to promote the synthesis, dissemination, and integration of research results into health care and public health decision-making and clinical practice. The aim of this paper is to ( i) outline the governance and committee structure of the SPOR Evidence Alliance, ( ii) outline the procedures for patient and health system decision-maker engagement, and ( iii) present the capacity-building strategy for governance members. The governance structure includes the following six standing committees: the International Advisory Committee, Steering Committee, Executive Committee, Knowledge Translation Committee, Partnerships Committee, and Training and Capacity Development Committee. The guiding principles embrace inclusiveness, support, mutual respect, transparency, and co-building. There are currently 64 committee members across the six committees, 13 patient and public partners, 8 health system decision-makers, 7 research trainees, and 36 researchers. A multi-disciplinary and diverse group of people in Canada are represented from all regions and at various levels of training in knowledge generation, exchange, and translation. This collaborative model makes the SPOR Evidence Alliance strong and sustainable by leveraging the knowledge, lived experiences, expertise, skills, and networks among its 342 members and 12 principal investigators.
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Leu, Michael G., Diego Ize-Ludlow, Adam B. Landman, Hamed Abbaszadegan, and Craig B. Monsen. "IT Department Demand Governance in Health Care: Reflections on a Case Series." ACI Open 06, no. 01 (January 2022): e39-e43. http://dx.doi.org/10.1055/s-0042-1749194.
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Abstract Background Little is written on how best to structure IT governance in health care organizations. Governance is challenging because these groups may contain administrators, clinicians, and staff in addition to IT employees; projects may be complex and have significant impact on the teams that provide patient care. Methods Peer organizations in health care were purposefully selected and C-suite executives were interviewed about their IT governance. Notes taken from these conversations were analyzed for guiding principles. Results We interviewed leaders from five peer organizations. Consensus principles included: (1) minimize unwarranted variation; (2) evolve governance with the organization but independently of projects; (3) govern all clinical applications; (4) be flexible with intake, yet clear on decision-making; (5) have a tiered approach to governance; and (6) be multidisciplinary. Emerging principles included: (1) assign an IT business relationship manager to each high priority initiative, (2) have a clear escalation path to a small number of decision-makers, (3) include analytics to inform governance, (4) leverage Informatics expertise, and (5) use structured tools to streamline the process. Conclusion While IT governance is very different across distinct health care organizations, there are some general principles that many share.
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Abbood Bandar, Mohsin, Muntadher Kadhim Shamran, and Abeer M. Mahdi AL-shammari. "A STUDY OF RELATIONSHIP BETWEEN EMPLOYEE ENGAGEMENT AND JOB SATISFACTION IN THE KARBALA HEALTH DIRECTORATE." Humanities & Social Sciences Reviews 8, no. 4 (September 2, 2020): 774–79. http://dx.doi.org/10.18510/hssr.2020.8477.
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Purpose: The study aims at identifying the relationship between employee engagement and job satisfaction in health institutions in Karbala city through a sample of health workers and administrators.
Methodology: To achieve this goal, the theoretical literature on the two variables was reviewed. In addition, 240 questionnaires were distributed in these institutions using a random selection method. Finally, SPSS was used to analyze in this study. The researchers relied statistically on a model which indicated the statistical equation against which the minimum sample size required to represent the community can be correctly determined (N> 50 + 8 (P)) (Natarajan, 2006: 42), and this means that the sample size should be greater than of the number of independent sub-variables in the value of the constant (8) plus even a fixed amount of (50) views.
Main Findings: The most significant consequences of the investigation are the enlistment techniques that guarantee the determination of the perfect individuals to work in occupations equivalent with their capabilities, and Ensuring the support of representatives in the structure of employment and dynamic procedure, just as interest in the improvement of clinical administrations.
Application of Study: Effective human resource management and optimal investment of skills and abilities that can lead to the growth and survival of Karbala's health organizations and institutions.
Novelty/Originality: This investigation attempts to investigate the most unmistakable news esteems on the front pages of Al Ghad and Al Rai papers just as recognize the contrasts between them regarding the sorts of the news, the sources, and the method of showing them.
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Cotter, S. M., M. McKee, and P. M. Strong. "Who Decides Which Pharmacy Services are Provided in UK National Health Service Hospitals?" Health Services Management Research 10, no. 1-2 (February 1997): 7–12. http://dx.doi.org/10.1177/095148489701000102.
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An interview survey of 129 UK National Health Service doctors, nurses, pharmacists and managers at eight acute care hospitals was conducted in 1994. The survey examined several topics including whether the introduction of the internal market had affected hospital pharmacy services and what those effects had been. An internal market has been introduced and it has had significant effects on the nature and structure of hospital pharmacy services. Directorate pharmacy services were available at six sites. Contracts for specific, usually novel, services had been implemented at one site and contracts had been introduced widely at another hospital. However, all the features of a market were not present at any site. Market orientation also has implications for the equity of service provision, primarily because decision-making regarding service provision is increasingly in the hands of the clinical directors, rather than pharmacy managers. The effects of this change are not yet clear.
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Jones, G. T. "Indicator-Based Systems of Performance Management in the National Health Service: A Comparison of the Perceptions of Local- and National-Level Managers." Health Services Management Research 13, no. 1 (February 2000): 16–26. http://dx.doi.org/10.1177/095148480001300103.
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Historically, the UK Government has policed the use of National Health Service (NHS) resources through the centralization of control. With the majority of resource-draining decisions being taken by clinicians, however, professional financial accountability is becoming more important within the NHS management structure. Variations in clinical performance can be monitored through the use of performance indicators, although these are not without their problems. The use of league tables of such indicators in the national press is now infamous and there is much anecdotal evidence about the intraorganizational conflict arising from the use of such tables. A questionnaire survey and interview study of clinical directors, clinical service directors and business managers in several Scottish NHS Trusts was undertaken to ascertain the perceptions of local-level managers on the issue of performance indicators. Interviews were also carried out with a number of personnel in the Scottish Office Department of Economics and Information, the Division of Health Gain and the Finance Directorate. This paper explores the differences between the perceptions of the managers at these two levels of the NHS with regards to issues of performance measurement, intraorganizational conflict and corporate vision.
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Abou Hashish, Ebtsam Aly, and Sally Mohamed Fargally. "Assessment of professional nursing governance and hospital magnet components at Alexandria Medical Research Institute, Egypt." Journal of Nursing Education and Practice 8, no. 3 (October 29, 2017): 37. http://dx.doi.org/10.5430/jnep.v8n3p37.
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Background and objective: In the context of a rapidly evolving health care system, health care institutions strive to set a path towards an excellent professional practice environment. Since improving clinical nurse work environments is a major issue faced by nurse executives and administrators, they become challenged to establish nursing governance models, and leadership practices so that clinical nurses can engage in the work processes and relationships that are empirically linked to quality patient outcomes. The main aim of this study was to assess the current status of professional nursing governance and hospital magnet components at Alexandria Medical Research Institute, Egypt.Methods: A descriptive research design was conducted at Alexandria Medical Research Institute hospital, using a convenience sample (N = 220) that composed of two groups including; all hospital medical administrators (n = 10) and hospital nursing workforce (n = 210). Index of Professional Nursing Governance Questionnaire (IPNGQ) and Magnet Hospital Forces Interview were proved valid and reliable to measure study variables.Results: The overall mean score of professional nursing governance was (187.59 ± 63.74) reflected that staff nurses practice the first level of nursing shared governance (primarily nursing management who take the decision with some staff input). In addition, both medical administrators and nursing staff identified the hospital has a good structure, nursing leadership practices that support shared governance and magnet recognition. Structural equation model and correlation analysis revealed a positive association between overall professional nursing governance and hospital magnet components (p < .05).Conclusions and recommendations: The study emphasized the hospital administrators’ important role for providing supportive organizational structures and leadership practices for increasing participation of nursing staff in work design, problem-solving, conflict resolution, committees and organizational decision-making as “key ingredients to a successful organization” in turn, lead to a healthy and magnet-like work environment. Training programs for nurses’ professional development are recommended which enhance and increases their autonomy and empowerment.
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Paul Okudolo, Ikemefuna Taire, and Victor Ojakorotu. "Promoting Disabled Persons’ Belongingness in Elite Circles of Nigerian Public Administration Setups: Diagnosis and Treatment." Journal of Intellectual Disability - Diagnosis and Treatment 10, no. 1 (February 9, 2022): 43–55. http://dx.doi.org/10.6000/2292-2598.2022.10.01.6.
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This study analyzes the intrinsic causes of disabled persons' marginalization from elite circles in Nigerian public administration organizations. Its foci among other things are to proffer measures for Nigeria's context of disabled persons' advancement into public bureaucracies' assembly of decision-makers, promote their topmost belongingness in public policy governance, offer ways to sustain disability-friendly public personnel promotion stratagem, propose means to realize public sector-friendly disability inclusivity. Political culture theory is espoused as the theoretical framework. The study parallels the qualitative methodology of a phenomenological inclination. Perceptions, views, and notions on how to promote disability-friendly policies, across all Nigerian public ministries, departments, and agencies (MDGs), toward facilitating upward mobility of disabled public administrators into directorate positions in the public services, derived from questionnaires, interviews, and correlated document analysis constituted data for the study. Content analysis approach guided by heuristic re-constructionism epistemology was adopted for analyzing data. Data from questionnaires were presented in quantitative content analysis. The study finds that there persist low political will towards domestication and implementation of globally agreed affirmative statutes for sustainable advancement of the education, talents, employment, promotion, and generally inclusion of disabled persons, particularly into the elite circle of Nigerian public bureaucracies. The finding mentioned above highlights the immanent variables that constitute major obstacles to the disabled public personnel belongingness as elite public administrators in determining the outputs and outcomes of public administration in Nigeria. It recommends, amongst others, prioritization of disabled persons' inclusion into the top staff echelon of public administration's MDGs across all the Nigerian tiers.
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He, Wenjun, Royce Sampson, Jihad Obeid, Kyle Hutson, Boyd M. Knosp, Bernard A. LaSalle, Brian Melancon, Kimberly McGhee, Leslie A. Lenert, and Kathleen Brady. "Dissemination and continuous improvement of a CTSA-based software platform, SPARCRequest©, using an open source governance model." Journal of Clinical and Translational Science 3, no. 5 (August 27, 2019): 227–33. http://dx.doi.org/10.1017/cts.2019.403.
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AbstractSPARCRequest© (Services, Pricing, & Application for Research Centers) is a web-based research management system that provides a modular and adaptable “electronic storefront” for research-related services. Developed by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina, it was released as open source (OS) code in 2014. The adoption of SPARCRequest© accelerated in 2016, when, to ensure responsiveness to the needs of partners, its governance also became open. This governance model enables OS partners to suggest and prioritize features for new releases. As a result, the software code has become more modularized and can be easily customized to meet the diverse needs of adopting hubs. This article describes innovative aspects of the OS governance model, including a multi-institutional committee structure to set strategic vision, make operational decisions, and develop technical solutions; a virtual roadmap that ensures transparency and aligns adopters with release-based goals; and a business process model that provides a robust voting mechanism for prioritizing new features while also enabling fast-paced bug fixes. OS software evolves best in open governance environments. OS governance has made SPARCRequest© more responsive to user needs, attracted more adopters, and increased the proportion of code contributed by adopters.
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Finney Rutten, L. J., A. Alexander, P. J. Embi, G. Flores, C. Friedman, I. V. Haller, P. Haug, et al. "Patient-Centered Network of Learning Health Systems: Developing a resource for clinical translational research." Journal of Clinical and Translational Science 1, no. 1 (February 2017): 40–44. http://dx.doi.org/10.1017/cts.2016.11.
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IntroductionThe Learning Health System Network clinical data research network includes academic medical centers, health-care systems, public health departments, and health plans, and is designed to facilitate outcomes research, pragmatic trials, comparative effectiveness research, and evaluation of population health interventions.MethodsThe Learning Health System Network is 1 of 13 clinical data research networks assembled to create, in partnership with 20 patient-powered research networks, a National Patient-Centered Clinical Research Network.Results and ConclusionsHerein, we describe the Learning Health System Network as an emerging resource for translational research, providing details on the governance and organizational structure of the network, the key milestones of the current funding period, and challenges and opportunities for collaborative science leveraging the network.
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Jackson, L., J. Saund, and G. Donnelly. "70 Improving the Documentation of DNACPR Decisions Following the Transition to Electronic Record Keeping." Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.31.
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Abstract Background This quality improvement project was based at The Royal Bolton Hospital across our four Complex Care wards. Introduction We have recently transferred to electronic record keeping. At these points of transition there may be an adverse impact on the quality of patient care and safety. We recognised on our own ward there were inaccuracies between the required paper form and electronic documentation of DNACPR decisions. Consequently, we wanted to review and improve the accuracy of our DNACPR documentation to ensure safe and effective patient care. Methods To gauge the scope of the problem we audited 87 patient’s electronic and paper notes, with no exclusion criteria. We reviewed whether each patient had a formal resuscitation decision, and if a DNACPR decision had been made whether we met our hospital policy by having: 93% of the 87 patient’s had an active decision regarding resuscitation, with a DNACPR decision documented for 50 patients. Of these 50 patients only 11 had all three forms of documentation. More worryingly, there were discrepancies in the documented DNACPR decisions for 11 patients across paper and electronic records. Interventions We escalated our concerns to the Clinical Governance team who sent out a trust wide SBAR highlighting this as an urgent clinical issue. On a directorate level we incorporated DNACPR decision documentation into our afternoon safety huddle and arranged informal teaching for medical, nursing and administrative staff. Results Reassuringly, the subsequent re-audit of 90 patient’s notes showed only one patient to have a discrepancy between paper and electronic documentation. We saw an improvement to 98% having paper forms in the right bedside notes and 100% having a documented electronic DNACPR decision. Conclusion Through local education and trust-wide dissemination of our expected standards we have seen some improvement. We recognise the importance of maintaining this, and importantly that there is still work to be done. The electronic “Resuscitation and treatment escalation plan” is still rarely completed and provides important information on escalation of care and thus will be the focus of a further educational intervention.
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Shivers, Jennifer, Joseph Amlung, and Theresa Cullen. "An HIT Ecosystem Capability Maturity Model for System-Wide Implementation, Management, and Governance." ACI Open 04, no. 02 (July 2020): e102-e107. http://dx.doi.org/10.1055/s-0040-1715171.
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Abstract Background An effective health system is dependent on the people, processes, and technology required to support its successful use. Technology, including essential health information technology (HIT) components, is not enough to successfully support quality patient care delivery. Without a strong support structure, HIT tools and data alone will fail to meet the desired goal of quality patient care that achieves health equity. Multiple factors, including governance processes, policies, and standards, are critical for the development, implementation, and consistent and effective use of clinical HIT systems and the resulting data. A comprehensive model that provided support for a holistic assessment of the HIT ecosystem could not be identified. The Facility HIT Ecosystem Capability Maturity Model (ECMM) was designed in response to this need. Objectives This project was designed to create and propose a comprehensive framework for self-assessment and support of a maturation pathway for a facility's comprehensive HIT ecosystem, including governance processes, policies, and standards. Methods Iterative methods based on agile and human-centered design practices were used to create and validate the framework and its contents. Results The ECMM and toolkit support a health care facility's clinical or technical leadership, including chief medical officers, chief information officers, and chief medical/health/nursing informatics officers, in identifying and assessing policies, processes, and capabilities surrounding HIT. This framework supports iterative evaluation and step-ladder style progression and goal setting to achieve desired capabilities, both at the local level and at the level of supporting organizations. Reviewer feedback was used to provide iterative tool improvement and refinement. Conclusion The proposed HIT maturity model toolkit showed potential as a tool to help empower health care facilities and their leadership to advance their HIT ecosystem.
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Laporte Uribe, Franziska, Johannes Gräske, Susann Grill, Steffen Heinrich, Susanne Schäfer-Walkmann, Jochen René Thyrian, and Bernhard Holle. "Regional dementia care networks in Germany: changes in caregiver burden at one-year follow-up and associated factors." International Psychogeriatrics 29, no. 6 (March 2, 2017): 991–1004. http://dx.doi.org/10.1017/s1041610217000126.
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ABSTRACTBackground:Recently, regional dementia care networks (DCNs) have been established in Germany to provide timely support for persons with dementia (PwDs) and their families. There is a lack of research in this setting. This study was conducted to describe the burden experienced by informal caregivers over the course of one year when utilizing a DCN and the factors affecting potential changes in caregiver burden during that time.Methods:The study was part of the DemNet-D project, a multi-center observational study of DCNs in Germany. Standardized questionnaires were administered during face-to-face interviews at baseline and at a one-year follow-up with PwDs and their informal caregivers who used a DCN. Based on qualitative data, four DCN governance types were identified and used in a multivariate analysis of burden categories.Results:A total of 389 PwD-informal caregiver dyads completed the follow-up assessment. At follow-up, the dyads reported significantly lower scores for burden in relation to practical care tasks, conflicts of need, and role conflicts. This change was associated with the PwD–caregiver relationship, the caregiver's gender and health status, and the PwD's socio-economic status. The governance structure of the DCNs was associated with change in one of the four burden categories.Conclusions:Our data provide the first indications that different governance structures of DCNs seem to be similarly well suited to support network users and might contribute to reducing caregiver burden. However, further studies set in DCNs examining factors that mediate changes in burden are needed to draw strong conclusions regarding the effectiveness of DCNs. Gender differences and the PwD–caregiver relationship should be considered by DCN stakeholders when developing support structures.
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McCoy, A. B., A. Wright, G. Eysenbach, B. A. Malin, E. S. Patterson, H. Xu, and D. F. Sittig. "State of the Art in Clinical Informatics: Evidence and Examples." Yearbook of Medical Informatics 22, no. 01 (August 2013): 13–19. http://dx.doi.org/10.1055/s-0038-1638827.
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Summary Objective: The field of clinical informatics has expanded substantially in the six decades since its inception. Early research focused on simple demonstrations that health information technology (HIT) such as electronic health records (EHRs), computerized provider order entry (CPOE), and clinical decision support (CDS) systems were feasible and potentially beneficial in clinical practice. Methods: In this review, we present recent evidence on clinical informatics in the United States covering three themes: 1) clinical informatics systems and interventions for providers, including EHRs, CPOE, CDS, and health information exchange; 2) consumer health informatics systems, including personal health records and web-based and mobile HIT; and 3) methods and governance for clinical informatics, including EHR usability; data mining, text mining, natural language processing, privacy, and security. Results: Substantial progress has been made in demonstrating that various clinical informatics methodologies and applications improve the structure, process, and outcomes of various facets of the healthcare system. Conclusion: Over the coming years, much more will be expected from the field. As we move past the “early adopters” in Rogers' diffusion of innovations' curve through the “early majority” and into the “late majority,” there will be a crucial need for new research methodologies and clinical applications that have been rigorously demonstrated to work (i.e., to improve health outcomes) in multiple settings with different types of patients and clinicians.
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Bell, Suzanne, Arlene Coulson, Stacey Donnelly, Colette Henderson, Alison Hodgson, and Sandy Rolfe. "A Scottish university prescribing team's experiences and reflections during the COVID-19 pandemic." Journal of Prescribing Practice 4, no. 10 (October 2, 2022): 432–39. http://dx.doi.org/10.12968/jprp.2022.4.10.432.
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The onset of the pandemic and associated restrictions led to the closure of university buildings across Scotland in March 2020. This was immediately followed by the introduction and embedding of online learning, teaching and assessment from previous class or blended delivery modules across all curricula. Academics were required to structure and develop quality student materials from their own homes. In addition, approved programmes of study, such as the prescribing module, had to ensure governance and teaching and learning aligned to Professional Statutory and Regulatory Bodies requirements for students and staff now working and studying at home. There was a recognition that NHS stakeholders and clinical practitioners required support with continuing professional education incorporating robust awareness of critical practice needs and the safety of patients and staff in clinical areas.
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Cannon, Clare, Kenneth Corvo, Fred Buttell, and John Hamel. "Barriers to Advancing Evidence-Based Practice in Domestic Violence Perpetrator Treatment in the United States: Ideology, Public Funding, or Both?" Partner Abuse 12, no. 2 (April 22, 2021): 221–37. http://dx.doi.org/10.1891/pa-2020-0008.
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Though usually framed in the context of ideological and political processes, the failure of domestic violence perpetrator programs to embrace research-supported practice may also be influenced by a widespread unwillingness to use public funds for that purpose. This policy analysis examines the links among federal policy, state implementation, organizational structure, and funding sources of perpetrator service-providing organizations. Those links reveal reciprocal relationships among conservative and ostensibly feminist views of domestic violence within an implied policy framework justifying public underfunding of perpetrator treatment programs. Placed within the current hyper-politicized context of US Federal governance and policy, this analysis identifies advancements in perpetrator treatment in several state governments as harbingers of potential movement toward research-supported practice.
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Delva, Jorge, Adam Paberzs, Patricia Piechowski, Karen Calhoun, Diane Carr, Meghan Spiroff, Ayse Buyuktur, and Kevin Weatherwax. "2543." Journal of Clinical and Translational Science 1, S1 (September 2017): 54. http://dx.doi.org/10.1017/cts.2017.193.
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OBJECTIVES/SPECIFIC AIMS: To describe how Michigan Institute for Clinical & Health Research (MICHR) has engaged communities in its leadership and governance structure. This presentation will describe these practices, how they are being evaluated, and future plans for institute-wide engagement of communities in translational research. METHODS/STUDY POPULATION: Engaged partners from various communities across Michigan in various ways within MICHR’s Community Engagement Program. RESULTS/ANTICIPATED RESULTS: MICHR has utilized participatory practices in the development of the CAB to strengthen existing relationships and build new ones with potential partners. DISCUSSION/SIGNIFICANCE OF IMPACT: MICHR-wide Community Advisory Board (CAB) will ensure community voices are heard and utilized in leadership and strategic decisions for CTSA activities.
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BEVAN, GWYN, and JOCELYN CORNWELL. "Structure and logic of regulation and governance of quality of health care: was OFSTED a model for the Commission for Health Improvement?" Health Economics, Policy and Law 1, no. 4 (October 2006): 343–70. http://dx.doi.org/10.1017/s1744133106005020.
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The Labour Government elected in 1997 faced similar problems in health care to those faced by the Conservative Government in schools in the early 1990s. And the policies developed for health care in the late 1990s echoed those that had been implemented for schools. This paper considers one of those common policies, namely the creation of new central inspectorates required to visit all organizations over a four-year period: the Office for Standards in Education (OFSTED) to inspect the quality of teaching in schools, and the Commission for Health Improvement (CHI) to review the implementation of the systems and processes of clinical governance in every organization in the National Health Service (NHS). At its creation, CHI was described as an OFSTED for the NHS. This paper compares these two inspectorates; describes origins of policies and institutions; considers their rhetoric and practices; describes the processes the two organizations used and considers their impacts. It argues that structural differences meant that CHI could never have been an OFSTED for the NHS; relational distance is a key aspect of inspection/regulation; and that the key to effective regulation in the case of the NHS was the relational proximity between CHI and the NHS, with the added weight of a strong performance management regime.
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Steele, Rachel, and Paul A. Tiffin. "‘Personalised evidence’ for personalised healthcare: integration of a clinical librarian into mental health services – a feasibility study." Psychiatric Bulletin 38, no. 1 (February 2014): 29–35. http://dx.doi.org/10.1192/pb.bp.112.042382.
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Aims and methodTo evaluate the feasibility of integrating a clinical librarian (CL) within four mental health teams. A CL was attached to three clinical teams and the Trustwide Psychology Research and Clinical Governance Structure for 12 months. Requests for evidence syntheses were recorded. The perceived impact of individual evidence summaries on staff activities was evaluated using a brief online questionnaire.ResultsOverall, 82 requests for evidence summaries were received: 50% related to evidence for individual patient care, 23% to generic clinical issues and 27% were on management/corporate topics. In the questionnaires 105 participants indicated that the most common impact on their practice was advice given to colleagues (51 respondents), closely followed by the evidence summaries stimulating new ideas for patient care or treatment (50 respondents).Clinical implicationsThe integration of a CL into clinical and corporate teams is feasible and perceived as having an impact on staff activities. A CL may be able to collate ‘personalised evidence’ which may enhance individualised healthcare. In some cases the usual concept of a hierarchy of evidence may not easily apply, with case reports providing guidance which may be more applicable than population-based studies.
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Kannan, Vaishnavi, Mujeeb A. Basit, Puneet Bajaj, Angela R. Carrington, Irma B. Donahue, Emily L. Flahaven, Richard Medford, et al. "User stories as lightweight requirements for agile clinical decision support development." Journal of the American Medical Informatics Association 26, no. 11 (September 12, 2019): 1344–54. http://dx.doi.org/10.1093/jamia/ocz123.
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AbstractObjectiveWe sought to demonstrate applicability of user stories, progressively elaborated by testable acceptance criteria, as lightweight requirements for agile development of clinical decision support (CDS).Materials and MethodsUser stories employed the template: As a [type of user], I want [some goal] so that [some reason]. From the “so that” section, CDS benefit measures were derived. Detailed acceptance criteria were elaborated through ensuing conversations. We estimated user story size with “story points,” and depicted multiple user stories with a use case diagram or feature breakdown structure. Large user stories were split to fit into 2-week iterations.ResultsOne example user story was: As a rheumatologist, I want to be advised if my patient with rheumatoid arthritis is not on a disease-modifying anti-rheumatic drug (DMARD), so that they receive optimal therapy and can experience symptom improvement. This yielded a process measure (DMARD use), and an outcome measure (Clinical Disease Activity Index). Following implementation, the DMARD nonuse rate decreased from 3.7% to 1.4%. Patients with a high Clinical Disease Activity Index improved from 13.7% to 7%. For a thromboembolism prevention CDS project, diagrams organized multiple user stories.DiscussionUser stories written in the clinician’s voice aid CDS governance and lead naturally to measures of CDS effectiveness. Estimation of relative story size helps plan CDS delivery dates. User stories prove to be practical even on larger projects.ConclusionsUser stories concisely communicate the who, what, and why of a CDS request, and serve as lightweight requirements for agile development to meet the demand for increasingly diverse CDS.
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White, Clare, Simon Noble, Max Watson, Flavia Swan, Annmarie Nelson, and Miriam J. Johnson. "Optimised clinical study recruitment in palliative care: success strategies and lessons learned." BMJ Supportive & Palliative Care 10, no. 2 (July 13, 2019): 216–20. http://dx.doi.org/10.1136/bmjspcare-2019-001820.
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Recruitment challenges to clinical research studies in palliative care settings, particularly in hospices, are well documented. However, a recent study (Hospice Inpatient Deep vein thrombosis Detection (HIDDen) study) performed across five hospices in the UK recruited above target and on time. We describe strategies that aided successful recruitment in this study, and the lessons learnt for improving future studies. A recent review suggested that the ‘Social Marketing Mix Framework’ (SMMF) could help researchers with recruitment strategies in palliative care. We describe the recruiting strategies employed through the Social Marketing Mix lens and consider if it would be a useful framework for future researchers to use at the planning stage. Successful recruitment strategies employed in HIDDen study included: (i) addressing particular study-related factors, (ii) ensuring all patients were screened and offered participation if eligible, (iii) reducing impact on the clinical team through dedicated research nurses at sites, (iv) addressing research team issues with cross-cover between sites, where geographically possible, and (v) regular video conferencing meetings for support and collaborative solving of challenges. Limited pre-existing research infrastructure at most of the recruiting hospices created particular challenges. The SMMF provides a potential structure to help researchers to plan recruitment. However, to fully streamline trial set up and in order for hospice involvement in research to be realised systematically, a centralised approach to governance, organisational culture change whereby hospices embrace research as a legitimate purpose and consistent access to research staff are identified as key strategic elements promoting recruitment to studies in hospices.
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Shaw, Geraldine. "National clinical programmes in the Republic of Ireland: a qualitative study of acute hospitals." Journal of Research in Nursing 25, no. 5 (August 2020): 421–40. http://dx.doi.org/10.1177/1744987119893014.
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Background The national clinical programmes (NCPs) were established in 2010 to achieve three objectives, namely: improve quality, access and cost effectiveness. Limited research exists on their implementation in the Republic of Ireland (ROI). This qualitative study identified key stakeholders’ perceptions on (a) implementation thus far, and (b) conditions perceived necessary for implementation in acute hospitals. Aims The overall aim of this research was to undertake an in-depth study to explore from the perspectives of key stakeholders, their perceptions on implementation of the national clinical programmes, thus far, in relation to three overarching objectives (to improve quality, access, cost effectiveness) and what are the conditions necessary for their implementation in the Republic of Ireland's acute hospitals. Methods Twenty participants were interviewed using face-to-face audio-recorded semi-structured interviews. Transcribed data were coded and analysed, and a number of themes emerged from the dataset relating to the study aims. Results Implementation was perceived as being inconsistent. Outcomes were identified as: best practice guidelines, models of care, protocols, pathways; education & training; new services; improved discharges; improved patient outcomes; reduced length of stay; timely access; reduced waiting lists; cost effectiveness and other intangible outcomes. Sixteen conditions, under four themes, were perceived necessary for implementation, namely: Governance – structure, audit & monitoring, senior management support, accountability, and clear objectives and expectations; Communication – visible face-to-face engagement, internal awareness, and external awareness; Leadership – programme level, national level, hospital level, and professional level; Resources – budget, staff, information technology, training, skills, and competency. Conclusions This study adds to the existing limited body of knowledge on implementation of the NCPs in the acute hospitals in the ROI while contributing to the wider international literature in this area. The study provides hitherto unreported knowledge on the conditions that are perceived necessary for implementation. Novel in the ROI context is the perceived necessity to condense the number of NCPs, placing greater emphasis on (a) the need to structurally integrate the NCPs across the continuum of care, and (b) the importance of communication through visible face-to-face engagement. This study concludes that significant progress has been made by the NCPs towards meeting the objectives, albeit to varying degrees. There is a strong perception that the NCPs should remain, and that addressing the conditions perceived necessary for implementation in the areas of governance, communications, leadership and resources by both top-down senior health officials and bottom-up front-line hospital staff would significantly enhance the ability of the NCPs to meet objectives and implementation. It provides the ROI health services with valuable information to inform future reform, strategic planning and NCP implementation.
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Miranda Montoya, María Consuelo, Jackeline Bravo Chamorro, Luz Marina Leegstra, Deyanira Duque Ortiz, and Lauren Maxwell. "A blank check or a global public good? A qualitative study of how ethics review committee members in Colombia weigh the risks and benefits of broad consent for data and sample sharing during a pandemic." PLOS Global Public Health 2, no. 6 (June 6, 2022): e0000364. http://dx.doi.org/10.1371/journal.pgph.0000364.
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Broad consent for future use facilitates the reuse of participant-level data and samples, which can conserve limited resources by confirming research findings and facilitate the development and evaluation of public health and clinical advances. Ethics review committees (ERCs) have to balance different stakeholder concerns when evaluating the risks and benefits associated with broad consent for future use. In this qualitative study, we evaluated ERC members’ concerns about different aspects of broad consent, including appropriate governance, community engagement, evaluation of risks and benefits, and communication of broad consent for future use in Colombia, which does not currently have national guidance related to broad consent for future use. We conducted semi-structured, in-depth interviews with 24 ERC members from nine Colombian ERCs. We used thematic analysis to explore ERC members’ concerns related to broad consent for future use. Most ERC members expressed concern about the idea of not specifying the purposes for which data would be used and by whom and suggested that pre-specifying governance procedures and structure would address some of their concerns about broad consent. ERC members emphasized the need for engaging communities and ensuring research participants understood broad consent for future use-related language in informed consent forms. Researchers and research institutions are under increasing pressure to share public health-related data. ERC members play a central role in balancing the priorities of different stakeholders and maintaining their community’s trust in public health research. Further work is needed on guidelines for developing language around broad consent, evaluating community preferences related to data sharing, and developing standards for describing governance for data or sample sharing in the research protocol to address ERC members’ concerns around broad consent for future use.
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Pearce, Claire, and Leanne Pagett. "Advanced allied health assistants: an emerging workforce." Australian Health Review 39, no. 3 (2015): 260. http://dx.doi.org/10.1071/ah14253.
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Objective Nationally and internationally there is work underway to continue to advance the scope of practice of allied health assistants (AHA). The advanced role requires additional training and competency development, as well as significant clinical experience. To build on the evidence relating to advanced scope AHAs, ACT Health undertook a project to explore the potential for the development of the local AHA workforce. This paper provides an overview of the project. Methods The potential for advanced AHAs in the Australian Capital Territory (ACT) was assessed using literature reviews, consultation with other services working with advanced AHAs and interviews with local allied health managers and assistants. Results A role for advanced AHAs within the ACT workforce was recommended, along with the need to further develop the AHA governance structure and AHA training packages and to undertake more research into the AHA workforce. Conclusion AHAs make a positive contribution to the delivery of effective, responsive, consumer-focused healthcare. The advanced AHA role provides further opportunities to enhance the flexibility of allied health services while also providing a career structure for this growing workforce.
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Olawepo, John Olajide, Echezona Edozie Ezeanolue, Adanma Ekenna, Olabanjo O. Ogunsola, Ijeoma Uchenna Itanyi, Elima Jedy-Agba, Emmanuel Egbo, et al. "Building a national framework for multicentre research and clinical trials: experience from the Nigeria Implementation Science Alliance." BMJ Global Health 7, no. 4 (April 2022): e008241. http://dx.doi.org/10.1136/bmjgh-2021-008241.
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There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement sessions, and established a governance structure. Additionally, we selected and trained a core research team, developed criteria for site selection, assessed site readiness for research and obtained ethical approval from a single national institutional review board. We used the Exploration, Preparation, Implementation, Sustainment framework to guide our reporting of the process in the development of this network. The NISA-MIRCs will provide a nationally representative infrastructure to initiate new studies, support collaborative research, inform policy decisions and thereby fill a significant research infrastructure gap in Africa’s most populous country.
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Chen, Yinghong. "Valuation of voting scheme changes the cases of Electrolux AB and SKF AB." Corporate Ownership and Control 1, no. 4 (2004): 131–43. http://dx.doi.org/10.22495/cocv1i4p11.
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This paper studies the effects of the change of voting scheme on the market prices of Electrolux and SKF AB using standard event study methodology and a clinical approach. The economic effect of the voting scheme change is assessed using the market model. We investigate the loss of control due to the change of the voting scheme. The degree of the change of power is calculated using Shapley power index (SPI) and Banzhaf power index. There is a wealth transfer from the high vote shareholders to low vote shareholders in the process since in both cases the high power shareholders required no compensation. We expect that share price to have a positive response to such an announcement due to the reduced power discount and corporate governance improvement. The magnitude of the response on the event day depends also on the information structure of the period leading to the announcement.
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Ayede, Adejumoke Idowu, Oluwakemi Oluwafunmi Ashubu, Kayode Raphael Fowobaje, Samira Aboubaker, Yasir Bin Nisar, Shamim Ahmad Qazi, Rajiv Bahl, and Adegoke Gbadegesin Falade. "Management of possible serious bacterial infection in young infants where referral is not possible in the context of existing health system structure in Ibadan, South-west Nigeria." PLOS ONE 16, no. 3 (March 30, 2021): e0248720. http://dx.doi.org/10.1371/journal.pone.0248720.
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Introduction Neonatal infections contribute substantially to infant mortality in Nigeria and globally. Management requires hospitalization, which is not accessible to many in low resource settings. World Health Organization developed a guideline to manage possible serious bacterial infection (PSBI) in young infants up to two months of age when a referral is not feasible. We evaluated the feasibility of implementing this guideline to achieve high coverage of treatment. Methods This implementation research was conducted in out-patient settings of eight primary health care centres (PHC) in Lagelu Local Government Area (LGA) of Ibadan, Oyo State, Nigeria. We conducted policy dialogue with the Federal and State officials to adopt the WHO guideline within the existing programme setting and held orientation and sensitization meetings with communities. We established a Technical Support Unit (TSU), built the capacity of health care providers, supervised and mentored them, monitored the quality of services and collected data for management and outcomes of sick young infants with PSBI signs. The Primary Health Care Directorate of the state ministry and the local government led the implementation and provided technical support. The enablers and barriers to implementation were documented. Results From 1 April 2016 to 31 July 2017 we identified 5278 live births and of these, 1214 had a sign of PSBI. Assuming 30% of births were missed due to temporary migration to maternal homes for delivery care and approximately 45% cases came from outside the catchment area due to free availability of medicines, the treatment coverage was 97.3% (668 cases/6861 expected births) with an expected 10% PSBI prevalence within the first 2 months of life. Of 1214 infants with PSBI, 392 (32%) infants 7–59 days had only fast breathing (pneumonia), 338 (27.8%) infants 0–6 days had only fast breathing (severe pneumonia), 462 (38%) presented with signs of clinical severe infection (CSI) and 22 (1.8%) with signs of critical illness. All but two, 7–59 days old infants with pneumonia were treated with oral amoxicillin without a referral; 80% (312/390) adhered to full treatment; 97.7% (381/390) were cured, and no deaths were reported. Referral to the hospital was not accepted by 87.7% (721/822) families of infants presenting with signs of PSBI needing hospitalization (critical illness 5/22; clinical severe infection; 399/462 and severe pneumonia 317/338). They were treated on an outpatient basis with two days of injectable gentamicin and seven days of oral amoxicillin. Among these 81% (584/721) completed treatment; 97% (700/721) were cured, and three deaths were reported (two with critical illness and one with clinical severe infection). We identified health system gaps including lack of staff motivation and work strikes, medicines stockouts, sub-optimal home visits that affected implementation. Conclusions When a referral is not feasible, outpatient treatment for young infants with signs of PSBI is possible within existing programme structures in Nigeria with high coverage and low case fatality. To scale up this intervention successfully, government commitment is needed to strengthen the health system, motivate and train health workers, provide necessary commodities, establish technical support for implementation and strengthen linkages with communities. Registration Trial is registered on Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001373369.
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Ogink, Helena, Anna-Karin Ringqvist, Liselotte Bergqvist, Tobias Nordin, Anita Nordenson, and Ann-Charlotte Mårdby. "A strategic tool to improve long-term health outcomes in clinical practice: SHOR driver and association diagram." International Journal for Quality in Health Care 32, no. 1 (November 18, 2019): 20–27. http://dx.doi.org/10.1093/intqhc/mzz100.
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Abstract Quality problem or issue An over-arching principle of healthcare governance in Sweden is to achieve as much health for as many patients as possible given the available resources. With high life expectancy and increased years lived with non-communicable diseases, more effective interventions in prevention and control of non-communicable diseases are needed in order to ensure high-quality healthcare. Initial assessment Few publications have described a generic and resource-effective method of implementing the perspective of health outcomes in relation to costs in a clinical Swedish university hospital context. To fill this gap, a generic method was developed at Sahlgrenska University hospital in Gothenburg, Sweden. Choice of solution A System-based driver and association diagram of Health Outcomes in relation to available Resources (SHOR) was developed. The SHOR driver and association diagram comprised different perspectives: health, patient, process, research and cost perspectives. It enabled the translation from long-term health outcomes to applications in clinical practice. Implementation Three patient groups exemplify the use and implementation of the method of SHOR association and driver diagram; bipolar disorder (psychiatry), primiparous women with spontaneous onset of labour, (obstetric care) and chronic obstructive pulmonary disease (somatic care). Evaluation The SHOR driver and association diagram enabled a structure to monitor and support quality development towards maximised health outcomes in relation to available resources and associated total costs for a specific patient group. Lessons learned This method has connected clinical practice, management and research and has been used for both strategic and operational purposes.