Search

Background: The Personalised Residential Supports (PRS) Project provided detailed information about the nature, purposes and outcomes of PRS from the perspectives of key stakeholder groups including people with developmental disabilities, family members and service providers. Although these forms of support have developed over the past two decades, there is a dearth of empirical work that has explored the characteristics of PRS. In contrast, there is a multitude of empirical studies on congregate forms of residential support with a clear trend towards study of the characteristics of relatively small, congregate residential settings. Methods: Personalised Residential Supports was conceived initially in the study as having four key criteria in the support arrangements--a high degree of: individualisation; individual/family influence; informal relationships; and, person-centredness. Four methods of data collection were used to develop a descriptive framework for PRS: a review of empirical and descriptive literature that met inclusion criteria; case studies carried out over 2 years of six adults whose living arrangements met the initial PRS criteria; a focus group of adults with developmental disabilities; and, a series of written surveys of 18 people who were "experts" in their experience and knowledge of PRS-type support arrangements. The latter group included family members, service providers and policymakers. Each dataset was analysed separately and independently by the authors and a third researcher, followed by a process of conciliation and consensus in which the quality framework was developed. Two iterations of the expert group surveys were used to fine tune the framework. Results: Qualitative analysis resulted in a PRS quality framework made up of nine themes containing 28 attributes. Descriptions of each theme and attribute are provided. The nine themes were named as: Assumptions, Leadership, My Home, One Person at a Time, Planning, Control, Support, Thriving and Social Inclusion. Conclusion: This study identified the characteristics of PRS as reported by key stakeholder groups. On face value, the themes expressed in the PRS framework have relevance to all forms of supported accommodation, for many different groups of people. The research is continuing by further development of the framework that will enable its use in the evaluation of existing or planned residential support arrangements.

Background: The Individual Placement and Support (IPS) model aims to achieve open employment for people with mental illness. The Supported Employment Fidelity Scale (SEFS) is a 15-item instrument that evaluates the extent to which a service follows the IPS principles of best practice. This paper describes the IPS model and an evaluation of a specialist employment program for people with mental illness using the SEFS. Methods: The SEFS enabled a quantitative assessment of service provision against the criteria of evidence-based practice principles. Data were collected from multiple sources. In addition, a literature review was conducted, and personnel engaged in implementation of the IPS model at other Australian employment programs were consulted. Results: The program achieved a score of 59 of a possible 75 on the SEFS, which is described as fair supported employment. Discussion: Analysis of the 15-scale items resulted in the identification of strengths, areas for further development, and a set of recommendations. Conclusions: The program was operating substantially in line with evidence-based practice principles and had considerable scope for further development. Issues arising from the evaluation, areas of applicability of the SEFS and the underlying literature, and implications for occupational therapy are highlighted. [ABSTRACT FROM AUTHOR]

Aim To describe actual patient caseload sizes among case managers for long term conditions and explore issues of caseload manageability. Background Department of Health guidance advises that community matron case managers for long term conditions should manage caseloads of 50-80 patients. However, there is currently no evidence to justify these caseload targets. Method In-depth interviews were conducted with 46 case managers for long term conditions, five clinical leads and six programme leads across six Primary Care Trusts. Findings Case managers had caseloads of 10-55 patients each, although numbers fluctuated from week to week. The current caseload target was regarded as difficult to manage. Heavy caseloads were perceived to result in a shift from proactive care towards reactive care, decreased quality of care and increased hospital admissions. Conclusion Case managers for long term conditions are struggling to achieve and maintain caseload targets. Further research is necessary to identify the most appropriate caseload size and provide an evidence base for policy. Implications for nursing management Programme leads and managers need to carefully assess the local situation, the characteristics of the target population and the practicalities of delivering the model of care before identifying appropriate caseload targets. [ABSTRACT FROM AUTHOR]

Aim This paper describes and analyses the role of bed managers within hospitals, and how this can be supported through a development programme. Background and key issues Bed management has increased in importance as access targets have developed, and appreciation of the importance of patient flow has grown. The bed management role is usually performed by nurse managers, and can be particularly stressful and managerially complex. Despite calls for training support, little has been available. In response we have developed and delivered a training programme to over 70 staff in the past 2 years. Evaluation and conclusions The programme evaluation data is used to show that it has had an impact on the knowledge and skills of the bed managers involved, but also on their subsequent behaviours. These changes have translated into results for the organization and the individual, including staff retention, promotion and fewer cancelled operations. We conclude that the programme is an effective way to enhance the knowledge and skills of bed managers, and that the enhanced profile of bed management raises challenges for nurse managers in many areas of the organization. [ABSTRACT FROM AUTHOR]

Purpose – To consider how information and information systems can be used to support improving patient flow in acute hospitals (a key target for the National Health Service in England), and the potential role of the National Programme for Information Technology currently being developed. Design/methodology/approach – The literature plus past and present research, teaching and consulting experience with all levels of the National Health Service is drawn on to consider information provision and requirements. Findings – The National Programme for Information Technology specifies many features designed to support improving patient flows, though timescales for implementation are longer than those for the pledged flow improvements, and operational use of this type of information system has been problematic in the National Health Service. Research limitations/implications – The work is limited to the National Health Service and information systems in use and planned for it. The National Health Service access targets, flow improvement initiatives and the National Programme for Information Technology apply primarily to England. Practical implications – Some bed/flow management information systems currently in use incorporate tools and capabilities in advance of what is outlined in the National Programme for Information Technology, and some rare cases of culture changes in information system use have been achieved. One should learn from these to inform development and implementation of National Programme systems. These existing information systems and approaches may also be useful to hospitals considering systems prior to implementation of the National Programme for Information Technology. Originality/value – There has been very little consideration of the use of operational information and information systems for bed/flow management in the literature. Development and implementation of National Programme for Information Technology systems should build from an understanding of the practice and context of bed/flow management. [ABSTRACT FROM AUTHOR]

Business schools have great prestige and charge large amounts of money for their courses. But how good is the science on which they base their prescriptions for action? To find out we examined the published output from the only three British business schools with the highest (5*) research assessment ranking at the time the articles were published. We conclude that theory development and model construction are often elegant. However, the methods used to obtain primary empirical information to confirm or refute the theories or populate models are poor, at least from a positivist or pragmatic ontological perspective. Large scale comparative studies made up only a small proportion of research output from the business schools. Literature reviews were not systematic. The sampling frame and rationale for selection of cases for study are inadequately described. The methods of data collection were frequently not given in sufficient detail to enable the study to be replicated and the conclusions tended to go far beyond what the data by themselves could support. However, this does not have to be the case—there are excellent examples of research in social sciences. We conclude, therefore, that top-rated British business research is a scantily clad emperor. [ABSTRACT FROM AUTHOR]

This paper outlines the development of a method of planning for Computer-Integrated Manufacture (CIM) in a company manufacturing complex engineering products at a number of sites in Europe. The method described relies heavily on a model (i.e. a diagrammatic representation) of CIM as the for planning. A selection of different models is given alone with a critique of their usefulness in CIM planning, and a method by which such models can be classified. Some guidelines for developing a model of CIM are given along with the experiences of the company in planning for CIM. The main findings of the research indicate that the development of a CIM model is beneficial not only for planning; the process of evolution of the model can greatly increase understanding of CIM. Furthermore it helps to focus on functions and business objectives rather than being constrained by departmental boundaries, bringing a new dimension to strategic planning. [ABSTRACT FROM AUTHOR]

To date, relatively little has been written about computer-integrated manufacture (CIM), but what has emerged from such writings is a profusion of definitions and interpretations. This article reports on an attempt to categorise the various definitions of CIM. The findings of this analysis reveal that the most common definitions regard CIM as something which affects the whole organisation, by computerising the major organisational functions, or viewing the organisation as part of a total business unit. The other main definitions of CIM view it as an ‘integrated CAD/CAM system’, or a system which uses the most advanced manufacturing technology. Both these definitions, however, take a narrow view of CIM and do not take external influences into account. It is the authors' view that the most important part of CIM is integration, and this must encompass all areas of the business. [ABSTRACT FROM AUTHOR]

Abstract Background Significant changes in provision of clinical care within the English National Health Service (NHS) have been discussed in recent years, with proposals to concentrate specialist services in fewer centres. Stroke is a major public health issue, accounting for over 10% of deaths in England and Wales, and much disability among survivors. Variations have been highlighted in stroke care, with many patients not receiving evidence-based care. To address these concerns, stroke services in London and Greater Manchester were reorganised, although different models were implemented. This study will analyse processes involved in making significant changes to stroke care services over a short time period, and the factors influencing these processes. We will examine whether the changes have delivered improvements in quality of care and patient outcomes; and, in light of this, whether the significant extra financial investment represented good value for money. Methods/design This study brings together quantitative data on ‘what works and at what cost?’ with qualitative data on ‘understanding implementation and sustainability’ to understand major system change in two large conurbations in England. Data on processes of care and their outcomes (e.g. morbidity, mortality, and cost) will be analysed to evidence services’ performance before and after reconfiguration. The evaluation draws on theories related to the dissemination and sustainability of innovations and the ‘social matrix’ underlying processes of innovation. We will conduct a series of case studies based on stakeholder interviews and documentary analysis. These will identify drivers for change, how the reconfigurations were governed, developed, and implemented, and how they influenced service quality. Discussion The research faces challenges due to: the different timings of the reconfigurations; the retrospective nature of the evaluation; and the current organisational turbulence in the English NHS. However, these issues reflect the realities of major systems change and its evaluation. The methods applied in the study have been selected to account for and learn from these complexities, and will provide useful lessons for future reconfigurations, both in stroke care and other specialties.

Abstract Background In response to policy recommendations, nine National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were established in England in 2008, aiming to create closer working between the health service and higher education and narrow the gap between research and its implementation in practice. The Greater Manchester (GM) CLAHRC is a partnership between the University of Manchester and twenty National Health Service (NHS) trusts, with a five-year mission to improve healthcare and reduce health inequalities for people with cardiovascular conditions. This paper outlines the GM CLAHRC approach to designing and evaluating a large-scale, evidence- and theory-informed, context-sensitive implementation programme. Discussion The paper makes a case for embedding evaluation within the design of the implementation strategy. Empirical, theoretical, and experiential evidence relating to implementation science and methods has been synthesised to formulate eight core principles of the GM CLAHRC implementation strategy, recognising the multi-faceted nature of evidence, the complexity of the implementation process, and the corresponding need to apply approaches that are situationally relevant, responsive, flexible, and collaborative. In turn, these core principles inform the selection of four interrelated building blocks upon which the GM CLAHRC approach to implementation is founded. These determine the organizational processes, structures, and roles utilised by specific GM CLAHRC implementation projects, as well as the approach to researching implementation, and comprise: the Promoting Action on Research Implementation in Health Services (PARIHS) framework; a modified version of the Model for Improvement; multiprofessional teams with designated roles to lead, facilitate, and support the implementation process; and embedded evaluation and learning. Summary Designing and evaluating a large-scale implementation strategy that can cope with and respond to the local complexities of implementing research evidence into practice is itself complex and challenging. We present an argument for adopting an integrative, co-production approach to planning and evaluating the implementation of research into practice, drawing on an eclectic range of evidence sources.