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Background/Aims: NHS tongue tie service provision throughout the UK has previously been described as a 'post code lottery'. A 2021 survey was conducted, with the aim to provide an update to a 2016 survey of tongue tie services in the UK. Methods: A total of 179 trusts or health boards were approached with similar survey questions to a 2016 survey and achieved a response rate of 72% (n=130). Results: There were similarities to the findings of the previous National Childbirth Trust survey, although there was an overall increase in NHS services provided. There is still variation in terms of the lead professional involved in delivering tongue tie services at the point of contact with the mother and baby, the criteria used for referral, the waiting time for assessment and treatment and the follow-up processes. Evidence supporting most aspects of care is limited, which causes much professional discussion. Conclusions: The provision of NHS tongue tie services is still a 'post code lottery' and inequitable for mothers and babies. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of "upstreamist", health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department. Design/methodology/approach: Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of "upstreamist" system leadership to advance the integration of health care. Findings: Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with "upstreamist" system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED. Research limitations/implications: At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services. Practical implications: This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps. Originality/value: To the best of the authors' knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop "Esther" patient-centred approaches in the design of integrated health and care services. [ABSTRACT FROM AUTHOR]

The wellbeing of care home staff and the need to support them at work was highlighted with devastating clarity by the COVID pandemic. This small study explores what online and at work wellbeing resources were available to frontline care home workers during the first wave of the pandemic. A mixed methods study was undertaken May and July 2020. A multi-disciplinary team undertook a rapid review of online wellbeing information and resources relevant specifically to the care home sector and its non-nurse staff. Qualitative data comprised of digital recordings of semi-structured interviews with six care home managers of five care homes, and an online survey sent to 55 Scottish care homes with a response rate of 18%. Five overarching lessons were identified from the data. The first two ('managing information overload' and 'medium not appropriate for the message') relate to the awareness and use of the online wellbeing resources by frontline care workers. Three others ('visible and supportive leadership', 'building team camaraderie' and 'maintaining a focus on wellbeing beyond a crisis response') highlight the in-house, practice-based issues of supporting the wellbeing of staff. Although small, the findings from this study are of relevance and use by those in the UK and beyond working develop and sustain more effective ways to support and retain of this vital workforce. [ABSTRACT FROM AUTHOR]

One of the main drivers for change towards delivering value-based healthcare is to improve clinical and managerial culture and engagement within organisations. The relationships between clinicians and managers in an organisation are often considered to be either an enabler or disabler towards successful engagement to develop strategies towards better value healthcare. Successful engagement is dependent on effective and transformational leadership that can impact on organisational value in healthcare. The aim of this research was to explore the relationships, behaviours and perceptions between managers and clinicians towards value-based healthcare in the National Health Service in the United Kingdom. A qualitative research methodology of semi-structured in-depth interviewing on a sample consisting of hospital consultants, senior managers and board executives from a diverse group were conducted. A thematic analysis was used to analyse the data using a systematic approach. The study findings identified areas of potential barriers to engagement for clinicians and managers which were related to regulatory burden, financial challenges and workforce shortages. Key recommendations on what will be required to improve clinicians and managers engagement and the leadership approaches towards improving value-based healthcare are discussed. [ABSTRACT FROM AUTHOR]

Background: The independent healthcare sector in the UK collects PROMs for several surgical procedures, but implementation has been challenging. We aimed to understand the enablers and barriers to PROMs implementation in the independent healthcare sector in the UK. Method: Between January and May 2021, we remotely conducted semi-structured interviews with hospital consultants, hospital managers and other clinical staff using a topic guide developed from an implementation science framework called the Theoretical Domains Framework (TDF). Results: We interviewed 6 hospital consultants, 5 hospital managers, and 3 other clinical staff (1 nurse and 2 physiotherapists) across 8 hospitals. Common barriers included: the perception that PROMs are predominantly a reporting requirement rather than a quality improvement tool, absence of feedback mechanisms for PROMs data for clinicians, poor awareness of PROMs among healthcare professionals and the public, absence of direction or commitment from leadership, and limited support from hospital consultants. Common enablers included: regular feedback of PROMs data to clinicians, designating roles and responsibilities, formally embedding PROMs collection into patient pathways, and involvement of hospital consultants in developing strategies to improve PROMs uptake. Conclusion: To support PROMs implementation, independent hospitals need to develop long-term organisational strategies that involve sustained leadership commitment, goals or targets, training opportunities to staff, and regular feedback of PROMs data at clinical or governance meetings. The primary purpose of PROMs needs to be reframed to independent healthcare sector stakeholders as a quality improvement tool rather than a reporting requirement. [ABSTRACT FROM AUTHOR]

Dental practice manager Roxanne Barnes on how to run a kids' club. [ABSTRACT FROM AUTHOR]

Background epidemiological data on COVID-19 infection in care homes are scarce. We analysed data from a large provider of long-term care for older people to investigate infection and mortality during the first wave of the pandemic. Methods cohort study of 179 UK care homes with 9,339 residents and 11,604 staff. We used manager-reported daily tallies to estimate the incidence of suspected and confirmed infection and mortality in staff and residents. Individual-level electronic health records from 8,713 residents were used to model risk factors for confirmed infection, mortality and estimate attributable mortality. Results 2,075/9,339 residents developed COVID-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory-confirmed infections. The incidence of confirmed infection was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days in residents and staff, respectively. Sixty-eight percent (121/179) of care homes had at least one COVID-19 infection or COVID-19-related death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection. Out of 607 residents with confirmed infection, 217 died (case fatality rate: 35.7% [31.9%; 39.7%]). Mortality in residents with no direct evidence of infection was twofold higher in care homes with outbreaks versus those without (adjusted hazard ratio: 2.2 [1.8; 2.6]). Conclusions findings suggest many deaths occurred in people who were infected with COVID-19, but not tested. Higher occupancy and lower staffing levels were independently associated with risks of infection. Protecting staff and residents from infection requires regular testing for COVID-19 and fundamental changes to staffing and care home occupancy. [ABSTRACT FROM AUTHOR]

Context: Collecting feedback from patients about their experiences of health care is an important activity. However, improvement based on this feedback rarely materializes. In this study, we focus on answering the question—"what is impeding the use of patient experience feedback?" Methods: We conducted a qualitative study in 2016 across three NHS hospital Trusts in the North of England. Focus groups were undertaken with ward‐based staff, and hospital managers were interviewed in‐depth (50 participants). We conducted a conceptual‐level analysis. Findings: On a macro level, we found that the intense focus on the collection of patient experience feedback has developed into its own self‐perpetuating industry with a significant allocation of resource, effort and time being expended on this task. This is often at the expense of pan‐organizational learning or improvements being made. On a micro level, ward staff struggled to interact with feedback due to its complexity with questions raised about the value, validity and timeliness of data sources. Conclusions: Macro and micro prohibiting factors come together in a perfect storm which provides a substantial impediment to improvements being made. Recommendations for policy change are put forward alongside recognition that high‐level organizational culture/systems are currently too sluggish to allow fruitful learning and action to occur from the feedback that patients give. [ABSTRACT FROM AUTHOR]

Aim and objectives This study explored the experiences and perspectives of community psychiatric nurses, day centre managers and social workers about supporting clients living with and without dementia attending a generic day care service. The purpose of the study was to elucidate approaches that enable clients living with dementia to access and derive benefit from the service. Background In the light of international ageing demographics and strategy towards social inclusion, it is anticipated that demand for generic day care services for clients living with and without dementia will increase. Design and methods A descriptive qualitative design utilised three focus groups for data collection. Community psychiatric nurses ( n = 4), day centre mangers ( n = 4) and social workers ( n = 12) participated in the study. Data analysis informed a narrative description of the approaches that support adults living with dementia in day care. Findings An exhaustive description is encapsulated in five key themes. These are ' easing the transition to day care,' 'proactively managing supervision and complexity of need,' 'sustaining the person and family carer,' making the best of what we have' and 'encountering a need for change,' The data conveyed a sensitivity to the life story and needs of clients with dementia. Whilst the data revealed deficits in the physical environment of the centres, there were indications of the generation of a positive social environment. Conclusions A generic day care service that provides an integrated blend of care and treatment and social and recreational support to older adults, irrespective of whether they have or have not dementia, is realistic and manageable. The routine of day centre attendance may have value in sustaining clients with dementia and family care-giving relationships. Implications for practice Approaches to support the attendance of clients with dementia at day care include home visits, life story work, proactive supervision and careful planning of social groupings and recreational activities. [ABSTRACT FROM AUTHOR]

Societies throughout the world are ageing and the proportion of people over 85 years of age is increasingly rapidly. In many countries a significant number of frail older people live in nursing care homes and will develop palliative care needs as they approach the end of their lives. In the United Kingdom around one fifth of those who die each year do so in a care home. Many of these will be cared for by generalist nurses and doctors without specific skills and knowledge in end-of-life care. Following a one-year pilot of the introduction of a nursing home facilitator post to introduce the principles of a palliative care approach into three nursing care homes for older people, the number of residents dying in hospital reduced by 25%. [ABSTRACT FROM AUTHOR]

The Sign up to Safety (SutS) programme was launched in June 2014 by health secretary Jeremy Hunt. It focuses on listening to patients, carers and staff, learning from what they say when things go wrong, and then taking action to improve patient safety. The programme aims to make the NHS the safest healthcare system in the world by creating a culture devoted to continuous learning and improvement (NHS England 2014). Musgrove Park Hospital, part of Taunton and Somerset NHS Foundation Trust, was one of 12 NHS organisations that signed up to the SutS programme, making public its commitment to the national pledges to be ‘open and transparent’ and to develop a safety improvement plan. This paper describes the development of the strategy. [ABSTRACT FROM AUTHOR]

How is medical labor power, that being the capacity to assemble, adjust, or arrange medical subjects, converted into medical practice? Drawing on three qualitative case studies in the United States, Canada, and the United Kingdom, we argue that this conversion is shaped by pressures channeled through the relations that medical workers enter into with patients "from below" and managers "from above." We demonstrate this by examining a common empirical object: ambulance labor. In addition to providing a unique window into the varieties of medical work, paramedicine offers a strategic venue for examining the kinds of productive relations that medical laborers enter into. Our research shows how the labor process is shaped by patient requests that can either conform or contradict workers' shared sense of vocation. We also detail how this same process is simultaneously pressured by managers who are generally focused on increasing both the flexibility and the visibility of their workers. Many of these pressures, we argue, can be linked to common forces of neoliberalism across our three nations. Our analysis of the medical labor process inspires some practical recommendations to reform ambulance-based care. However, our primary aim is to advance a labor-centric approach to studying medicine. • Examines medicine as a labor process through three case studies of ambulance work. • Unique pressures shape the conversion of medical labor power into medical practice. • Ambulance workers in U.S., Canada, and UK are pressured by patients "from below.". • Those same workers are also pressured by managers "from above.". • These pressures are linked to common forces of neoliberalism across our cases. [ABSTRACT FROM AUTHOR]

Health-care systems need strong leadership if they are to be sustainable and responsive to the health needs of the future. There is little empirical and theoretical literature about how medical managers conceptualize management or undertake management roles. There is widespread support in the literature for the establishment of clinician management structures. In the UK, there is considerable interest in doctors becoming more involved in management of the National Health Service (NHS). The aim of the study was to explore the experiences, competencies, and development needs of doctor managers in the UK. Data were collected using a multi-method approach: qualitative interviews and a survey with doctor managers in the NHS. The template method was used for qualitative data analysis while appropriate statistical tests in SPSS were used for quantitative data analysis. The findings of the study add to the knowledge on experiences of doctor managers: motivations for a management role and difficulties encountered. Ways of addressing some of the difficulties are proposed. In addition, the study provides data on doctors' leadership and managerial competencies, training, and development needs as well as their preferred learning styles. [ABSTRACT FROM AUTHOR]

Objective: This article aims to outline the historical development of medical leadership in the United Kingdom (UK), present recent advances, and discuss professional development and future prospects.Conclusions: With increasing involvement of medical professionals in top managerial roles in the UK over the last 30 years, leadership development initiatives have been growing steadily and there is increasing recognition of the need for leadership and management skills for doctors. Such skills can help to greatly improve patient care as well as enhance organisational effectiveness and productivity. The central involvement of professional bodies such as the UK Faculty of Medical Leadership and Management, and the establishment of medical fellowship schemes, have provided a solid foundation for a new generation of aspiring medical leaders but there is still a long way to go to achieve a higher degree of professionalism for clinical leadership in the UK. The evidence base is weak such that integrated efforts by clinicians and management academics have much to offer in achieving the vision of socially responsible, clinically relevant and research informed medical leadership training. [ABSTRACT FROM AUTHOR]

Whilst child welfare systems in the United Kingdom, Australia and the United States may share a number of common goals, they are not designed to identify families with multiple problems. Where system output measures have been utilised as proxy measures to detect such families they indicate the presence of families in the population served by child and family social work. In interviews with practitioners and managers working within contrasting welfare systems, we explore how families with multiple problems are identiifed, what repsonses they currently recieve and how their needs might be better met. [ABSTRACT FROM AUTHOR]

In the first of two articles, Alison Smith reports on a survey of modern matrons that has resulted in a complete review of their role, from recruitment to continuing professional development. [ABSTRACT FROM AUTHOR]

The article presents information on various practical and theoretical issues concerning small-scale research in government regulatory agencies. It is stated that small-scale research projects can make a positive and valuable contribution to the academic literature. Information on several small-scale research conducted in the British Health and Safety Executive (HSE) is provided. According to the findings of a research, 98% HSE inspectors saw health and safety law as criminal matter. The article also highlights some of the key challenges faced in conducting such research project.

This paper considers some of the implications for Nursing Managers arising from a recent systematic review of practice development carried out in the UK by McCormack et al. (2007a, b) . The paper begins by offering some background to practice development (PD). It then summarizes the methodology and method of the systematic review before moving on to discuss, what it is suggested, are the main implications Nursing Managers need to focus on. Finally, 10 points or key messages from the review, relevant for Nursing Managers, are offered. This paper is relevant not only to managers in older people's services but to all services. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to report on research into human resource management within an operations management environment; specifically, operational team-work amongst health care workers in a hospital. Design/methodology/approach - Eight operational teams within a UK National Health Service hospital took part and the research and a combination of survey and group discussions. Findings - The results show the construct of the team had little operational definition. Key factors identified as contributing to effective team-working include: leadership; frequency of team meetings; a climate of trust and openness. There was limited evidence of truly multi-disciplinary teams and of organisational support for team-working. Research limitations/implications - The methodology applied was appropriate, generating data to facilitate discussion and draw specific conclusions therefrom, A perceived limitation is the single case approach; however, Remenyi et al. argue this can be enough to add to the body of knowledge. In terms of implications this paper demonstrates that team-working is no panacea; as part of a bundle of good operations management practices it is associated with efficiency, effectiveness, and in this case improved patient care. Practical implications - The paper suggests a new input, process, output model of effective team-working and identifies issues to be faced in adopting a strategy of developing an operational team-based organisation. Originality/value - The value of this paper is the conclusion that the importance of operational team-working is as a paradigm for assessing how effectively individuals and groups work together, rather than as a specific organisational form with an optimal size. [ABSTRACT FROM AUTHOR]

The article provides an overview regarding the author's role as radiation protection supervisor for the Special Care Dental Service in Bromly Primary Care Trust (PCT), in Great Britain. According to the author, her role in the PCT is to assist their acting head in ensuring that their department complies with the Ionizing Radiation Regulations 2000 (IRR). She outlines the general duties of the radiation protection supervisor which include applying local rules and other radiation safety training.

Aim(s): This study is concerned with understanding the work of non-registered nurses (health care assistants) in a UK hospital setting.Background There are increasing numbers of health care assistants employed by the National Health Service in the UK to support registered nurses providing nursing care. However, little is known about the make-up of the health care assistant workforce and the changing nature of their role. This study addresses some of these gaps in the research-based literature.Methods: A single case study design using mixed methods (survey, interviews, participant observations, focus groups and documents) was used to generate an in-depth account of health care assistants' work in one organization. The study is built upon what health care assistants say they do, compared with what they actually do in practice. It explores how and whether the work of health care assistants is adequately supervised, tensions between the work of health care assistants and registered nurses and the subsequent effects on teamwork and patient care.Findings: There are policy expectations associated with the work of health care assistants. However, this study reveals significant deviations from these goals. The workplace arena and the negotiations between health care assistants and registered nurses that take place within it, actively shape the health care assistants' work. Findings suggest dynamic patterns of use, misuse and non-use of the health care assistants as a resource to patient care.Discussion and implications for practice: The changing roles of registered nurses have direct implications for the roles of health care assistants: as registered nurses take on extra duties and responsibilities they are conceding some of their role to health care assistants. This has implications for nurse managers. The competence of health care assistants to carry out nursing work needs to be reassessed and there also needs to be ongoing monitoring and supervision of their work to maximize, and further develop, their contribution to patient care and to ensure quality standards. Managers also need to be aware of the importance of workplace negotiations in the interpretation of formal policies and the subsequent shaping of health care assistants' work at the level of service delivery. [ABSTRACT FROM AUTHOR]

Describes the Five Gear Model, a tool in helping care managers in personal centered planning decide how much intervention is necessary in Great Britain. Gathering of information; Designing of service; Development of service; Problem solving.

Looks at how nurse administrators manage mistakes and challenges in a healthcare workplace in Great Britain. Major areas of accountabilities considered for nurse managers; Impact of media coverage on both workers and managers; Comments of some managers on the effectiveness of applying rules and procedures when handling mistakes.

One of the key objectives of the community care reforms of 1990 in the United Kingdom was the development of a flourishing independent sector alongside good quality public services. The aims of the reforms were to increase the available range of options, widen consumer choice and promote independence. The purpose of the study reported here was to examine — from the perspective of older service users, their carers and care managers — experiences at the operational level of arranging, delivering and receiving care services. The findings are based on data gathered in seven local authorities including reviews of case files, policy documents and face-to-face, in-depth interviews with 55 users, 37 carers and 28 care managers. There is evidence of a pronounced emphasis on procedure-based systems of care management. Potentially this has two significant consequences. First, the fostering of personal relationships may be subordinated to the organisation of short-term tasks and thereby may threaten patterns of trust and accountability. Second, the associated fragmentation of the assessment and care management process which in turn can lead to discontinuities of care for users and their carets. The paper concludes that there is still some way to go before care managers as micro-commissioners have sufficient and reliable information or available service capacity to match providers' capabilities with users' and carers' needs. [ABSTRACT FROM AUTHOR]

AIM: It is the intention of this paper to highlight the problems associated with the organizational implications of the role NHS Service Managers (SMs) played in the quality process of the mid-1990s. BACKGROUND: To provide quality care all staff must be committed and involved, in this study it appeared that few SMs played a part in the process. METHODS: Semistructured taped interviews were conducted with 33 SMs and three Chief Executives in seven Trusts. As part of a study they were asked the role SMs played in quality in their clinical directorate. The data was transcribed and analysed in a content-analysis approach. FINDINGS: Quality of care was not the SMs' primary objective. The role played by SMs was dependent on their background, experience and the organization in which they worked. Most Trusts' quality-control strategy was not standardized, co-ordinated or integrated, nor was the audit process regulated. For most, quality was seen as synonymous with professions, managers from a non-professional background found the monitoring of the quality of performance inherently difficult. Only one Trust (the most successful) appeared to undertake organizational learning, influenced by the philosophy of the Chief Executive. [ABSTRACT FROM AUTHOR]

Announces the appointment of Ian Wylie as the Chief Executive of the British Dental Association (BDA). Wylie's experiences as the Director of Corporate Affairs of King's Fund; Work experiences in primary healthcare in Hackney, East London; Wylie's vision for BDA.

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This paper presents the findings of deconstructing a short extract from a report written by a National Health Service Trust chief executive. Changes in National Health Service management since the early 1980s are briefly discussed. This is followed by a theoretical discussion of deconstruction and metaphorization. The text is analysed focusing on the 'binary opposites' reason and emotion. It is argued that reason is given hierarchical pre-eminence and that emotion is hidden or marginalized but that both concepts are central in order to arrive at an understanding of the text. The chief executive appears to constitute his role in ways which might be characterized as engineering (reason) and as traditional fatherhood (emotion). Metaphors in the text are used in order to provide evidence to support these characterizations. One implication which is particularly highlighted is that management in this text is seen as a distinctively masculine practice – perhaps surprisingly within what is presumed to be the caring and supportive environment of a health care organization. The paper ends with some reflexive reflections on the analysis. [ABSTRACT FROM AUTHOR]

Investigates the role of clinical directors with reference to the strategic contribution they can make to health service organizations in Great Britain. Overview of the clinical director program; Ways of enhancing strategic capabilities; Use of planned managerial learning and development to promote capabilities.

In September 1983 the government introduced a first package of performance indicators for all District and Regional Health Authorities. These indicators were claimed to 'enable health service managers to compare their local performance with other health districts and with the country as a whole'. This paper examines the origins of this major initiative, and goes on to analyse its main technical, organisational and political characteristics. Questions are raised concerning the usefulness of the present indicators, and the presence of the necessary organisational and political conditions for the exercise to succeed. The independence of the medical profession is argued to be one crucial factor, the lack of adequate integration with streams of decision-making on key policy and resource issues another. The paper concludes with an appraisal of the scope for further development of performance indicators within the National Health Service. [ABSTRACT FROM AUTHOR]

The creation of the internal market has merely been the latest progression in the change processes confronting the NHS over recent years as the UK Government searches for new ways of expanding patient output while concurrently restricting provision of additional financial resources. To assist in the implementation of change, acute sector providers have introduced managerial concepts from the private sector such as strategic planning. It is not clear, however, whether these techniques are appropriate or effective in the management of health-care services. A survey was undertaken to gain the perspectives of middle managers in acute units on the degree to which senior management involves them in determining performance goals and strategic plans. Results indicate that in most units, the orientation of senior management is to retain control over key issues associated with strategic planning and to minimize the degree to which the workforce is involved in any decision-making processes. Reviewing these results relative to the service-sector management theories concerning the options of industrializing or employee empowerment strategies indicates that senior management in the acute sector is operating a production-line service output philosophy. Although this orientation may meet the immediate needs of the UK Government, a review of how this strategic philosophy has severely weakened Western firms' position in world markets provides a basis for examining whether greater economic advantages might accrue to Britain by redirecting the management of change in the NHS towards a strategic philosophy based on employee empowerment. [ABSTRACT FROM AUTHOR]

Reviews the role of the clinical director in the NHS, based on data collected in a qualitative research study. Utilizes role theory to invite insight into a relatively new but important managerial role. Suggests that effectiveness in the role may be measured by the extent to which managers are able to meet the expectations of their role set, and also that the overall effectiveness of the clinical direction may be the extent to which he or she is able to influence, adapt, modify or change these role expectations. [ABSTRACT FROM AUTHOR]

The very existence of the health service Review created a potential for change among health service managers which is giving the recent White Paper a boost But self-governing hospitals and budgets for general practitioners are not the key to the reforms. There is a danger that the real managerial benefits will be lost in the political battles which are being fought over these two issues. INSET: White Paper's Proposals. [ABSTRACT FROM AUTHOR]

In the UK, the National Health Service (NHS) has undergone a period of dramatic structural change, leaving many managers fulfilling roles that they have not been specifically trained to undertake. Inadequacies in the financial skills of NHS managers, in a quasi-competitive environment, can have serious functional repercussions, many of which have been reported in the press. This paper addresses the measurement of the level of financial literacy of NHS managers drawn from two district health authorities. The method of measurement of financial skills and the choice of sampling method pose significant problems for researchers in this area. This study indicates that the general level of financial awareness of managers is relatively low. The potential consequences of these shortcomings are discussed together with the opportunities of redressing the situation in the short- and medium-term. [ABSTRACT FROM AUTHOR]

Examines managerial effectiveness in the public sector in Great Britain. Effectiveness of clinical directors in the National Health Service; Four categories of criteria for effectiveness; Unit business plan.

The article examines the performance indicators in the National Health Service (NHS) in Great Britain using the criteria set by the Financial Accounting Standards Board for evaluating the operational value of a piece of information. These criteria include reliability and relevance. The performance indicator package appears to offer benefits in the form of increased quality and availability of information. The packages has been aimed primarily at NHS managers and clinicians. The package can be used by local authorities to control their management.

The article looks at the efforts of English pathologist Ronald Ross to eliminate malaria from the British Empire. According to Ross, the various guilty species of mosquito could be easily identified by feeding them experimentally on cases of malaria, and then, when researchers had studied their habits by the usual means, researchers should be able to control them and the disease carried by them wherever researchers wished to incur the comparatively small expense required. Ross was determined to stamp malaria out of every city and large town possessing Health Officers and Sanitary Departments in British possessions. The proper thing for a competent Government to have done in 1899 was to have formed at once a strong interdepartmental committee to deal with the new method of malaria prevention throughout the Empire, and to have employed Ross and other experienced sanitary officers to carry out the work; and he have no doubt that if this had been done an immense saving of life would have been effected.

As advanced technology begins to play an increasingly important part in patient administration, the boundaries between administrators and clinicians will inevitably overlap. Robert Keys explores how administrative skills can be used to support good clinical practice and patient care by looking at two contrasting models. [ABSTRACT FROM AUTHOR]

Background: The collaborative care model with a care manager has previously generated beneficial results for patients with depression in terms of decreased burden of depression symptoms. A care manager function has been tested in Sweden in the PRIM-CARE RCT with successful results. The aim of the present study was to evaluate the process of implementing care managers in collaborative care for patients with depression in Swedish primary health care in the PRIM-CARE RCT. Methods: The study followed UK Medical Research Council guidance for process evaluation. Field notes from the implementation of the PRIM - CARE RCT were used, as well as data collected from five focus group discussions with General Practitioners (n = 29) and three focus group discussions with care managers (n = 11). Data were analysed with content analysis. Results: Training sessions, careful preparation and extensive initial support to the care manager and staff at the Primary Care Centres were important ingredients in the implementation. The close access to facilitators, the recurrent peer support meetings, and the weekly newsletter strengthened the care manager function. Conclusions: A complex intervention adapted to the Swedish primary care context focusing on a care manager function for patients with depression could be performed through a stepwise implementation process. Financial support from the health care regions included in the study helped to reduce the impact of identified barriers. This process evaluation has revealed new and important knowledge for primary care development concerning infrastructure and organization building, knowledge sharing, and facilitating factors and barriers. Trial registration: NCT02378272 Care Manager – Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM – CARE). Registered March 4 2015. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Tributes have been paid to nurse Tony Bell, former chief executive of Alder Hey Children's Hospital in Liverpool, who has died. [ABSTRACT FROM AUTHOR]