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As the UK rebuilds and recovers after the COVID-19 pandemic, tackling socioeconomic inequalities will become increasingly pertinent. The link between health and wealth has been long established, with those at the highest risk of illness also being less likely to access healthcare. The pandemic has highlighted these disparities, with higher morbidity and mortality rates seen in deprived areas, as well as among ethnic minority communities. Leaders and clinicians across the NHS and social care have called for a ‘reset’ in the way healthcare is planned, commissioned and delivered in the UK. There is a growing need for a holistic approach to disease prevention, and it is crucial that government agencies take a strong role in addressing the wider determinants of health.

With the use of telemedicine increasing significantly during the COVID-19 pandemic, this article discusses the implications for healthcare facilities and the extent to which generational gaps affect adoption of new technology.

With home care methods and devices becoming an increasingly important part of healthcare, this article discusses how a human factors approach can ensure a just working culture while also providing optimal patient care.

A substantial amount of literature describes the use of lean methodology in healthcare settings in developed countries, but less is known about its use in developing countries. Studies published between January 2000 and April 2018 describing the use of lean methodology in healthcare settings in developing countries were systematically searched, retrieved and reviewed across eight electronic databases. A total of fourteen studies met the inclusion criteria. The earliest study was published in 2014. Lean was mostly used to improve efficiency (n=10) and eliminate waste in hospitals (n=13). The most common tool used was value stream mapping (n=12). Half of the studies mentioned leadership, but no study reported value from the patients' viewpoints. This review found that lean tools have been used relatively recently in healthcare, mostly in hospitals and with varying emphasis on leadership and the wider lean methodology. Those studies involved staff but not patients, did not report costs and their reported successes were not rigorously evaluated.

This paper examines an aspect of employees' perceptions towards HRM practices and innovation. Approaches towards innovation (open vs. closed) and degree of innovativeness (radical vs. incremental) and organisational climate (structure, performance, knowledge and culture) are central pillars of this paper. The paper considers whether employees in different departments have different perceptions. The data was collected using questionnaires from 129 employees in a telecommunication company in Amman-Jordan which was then analysed using hierarchal multiple regression. The findings noted that HRM practices and specifically in HPWs, motivation and communication demonstrated significant impact on radical innovation and open innovation. However, hygiene factors were significant for open innovation and not significant for radical innovation. Organisational climate (structure, performance, knowledge and culture) imposed a significant impact on both radical innovation and open innovation. The results observed no significant role of departments, and the various HRM practices do not differ based on the departments as a result of the reduced impact of the hierarchical model.

The ongoing changes in UK health policies have aimed to promote competition, provide enhanced performance and deliver improved care to patients. To engage with these ongoing changes, the health service has had to become even more adaptable. This article explores the opportunity to apply distributed leadership across the healthcare environment in order to apply policy changes easily across the health service.

The growing pressure of an ageing population has resulted in an increased focus and interest in home or domiciliary care. This, plus changing lifestyle trends and the COVID-19 pandemic, necessitates a review of care in the UK. The number of domiciliary carers has increased; of the 1.62 million social workers active in 2018, 685 000 were categorised as domiciliary carers. However, this group of carers are not recognised as healthcare professionals. Indeed, there is no formal recognition or definition of the role of the carer in the UK, and there seems to be an overlap between support workers and carers, without adequate explanation of what either of these roles mean in practice. This article highlights the need to pay particular attention to this care sector, particularly in light of both the COVID-19 pandemic and Brexit.

The immense challenges facing mental health services in the UK have become increasingly stark in recent years, with the gap between supply and demand growing even wider as a result of the ageing population. Bryan McIntosh and Jane Peattie discuss the effects of these shortages on care homes and explain how the concept of change management could help healthcare managers to improve patient care and support staff through a joined-up approach to mental health.

Participants in the study were major pharmaceutical companies, it was striking to note that the prevalence of a short sales rather than strategic marketing orientation at senior management and Board level. Symptomatic of this result was the general finding that a businesses's intended overall strategy was rarely translated into expected results. A critical reason emerged – a disconnection between key stakeholders in the communication of strategy. While many businesses had internal communication functions, there was a lack of clarity about organisational fit and role. The findings suggested that businesses should embrace a broader marketing strategy and more specifically apply ‘marketing like activities’ or tried and tested marketing tools to their internal stakeholder market so as to mirror communication to external markets. The recommendations suggest a working model as a basis for a ‘trialogue’ between internal stakeholders, strategic leadership and external markets in the context of a business's strategy.

First paragraph: Even prior to the conclusion of the European Union (EU) referendum (Brexit), the NHS was showing tremendous signs of strain. Immediately after the outcome was announced, promises of major re-investment of funds saved from payments to the EU were retracted. Since then, hospital closures, cuts and changes to health and social care have been revealed, with regular news broadcasts highlighting the crisis facing the NHS. The uncertainties about post-Brexit relationships, economy, politics and security are likely to further significantly impact the NHS and its sustainability. Higher Education Institutions (HEIs) and the NHS are inextricably linked through research and education of health and social care professionals – changes therefore having implications for both.

In response to a recent report published by the Royal College of Nursing, Bryan McIntosh, Uduak Archibong and Louise Donaghy discuss the impact of motherhood, part-time hours and career breaks on the cultural perceptions and experiences of female healthcare professionals.

The aim of this quality improvement project was to improve patients' knowledge about their vitamin B12 deficiency by developing an information leaflet and engaging nursing staff in providing this educational tool to patients with the condition. Following two ‘plan, do, study, act’ cycles to test and improve implementation of the leaflet, the nursing team met the goal of 100% compliance with providing educational information to patients. An increase in patient knowledge following provision of the leaflet was predicted, and achieved.

T-lymphocytes (T-cell) therapy offers a treatment for cancers. Developing this technology in the future provides the opportunity to revolutionise treatment and to make cancer a chronic condition. T-cells in themselves are a type of lymphocytes (itself a type of white blood cell) that play a central role in cell mediated immunity. They can be distinguished from other lymphocytes, such as B-cells and natural killer cells (NK cells), by the presence of a T-cell receptor (TCR) on the cell surface. T-cells have the capacity to destroy diseased cells, but tumours present a considerable challenge that reduces their impact. As cancer cells are frequently ‘invisible’ to the immune system, and they create an environment that suppresses T-cell activity., genetic engineering of T-cells can be used therapeutically to overcome these challenges. T-cells can be taken from the blood of cancer patients and then modified to recognise and destroy cancer-specific antigens.

Background/Aims Previous research indicated that BAME staff are disproportionately represented in NHS disciplinary proceedings. Methods To review the findings from part one of this two-part series and give appropriate recommendations. Results Six factors explaining this disproportionality emerged: closed culture and climate; subjective attitudes and behaviour; inconclusive disciplinary data; unfair decision making; poor disciplinary support and disciplinary policy misapplication. Conclusions Disciplinary policy needs streamlining, and greater clarity needs to be achieved regarding the difference between disciplinary, capability and performance issues. This article makes several recommendations to help reach equality in disciplinary hearings.

Purpose The purpose of this paper is to summarize studies that have examined patient safety culture in maternity units and describe the different purposes, study designs and tools reported in these studies while highlighting gaps in the literature. Design/methodology/approach Peer-reviewed studies, published in English during 1961–2016 across eight electronic databases, were subjected to a narrative literature review. Findings Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: assessing intervention effects on PSC (n=17), and assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Interventions varied from a single action lasting five weeks to a more comprehensive four year package. The time between baseline and follow-up assessment varied from 6 to 24 months. No study reported measurement or intervention costs, and none incorporated the patient’s voice in assessing PSC. Practical implications Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs and find ways to incorporate the patient’s voice. Originality/value This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.

Background/Aims This article investigates the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings. Methods The study involved an in-depth knowledge review and analysis of literature on the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings from 2008 to 2017, as well as semi-structured interviews with 15 key stakeholders. Participants were stakeholders from both primary and secondary care and included equality and diversity leads, human resource professionals, NHS service managers, representatives of trade unions and health professional regulatory council representatives. Findings The knowledge review indicates that to date, black, Asian and minority ethnic staff are disproportionately represented in NHS disciplinary proceedings. Evidence gathered demonstrates the continuation of inappropriate individual disciplinary action and failure to address organisational shortcomings against black, Asian and minority ethnic members of staff. Conclusions Overall, six factors were identified as underpinning the disproportionate representation of black minority ethnic staff in disciplinaries: closed culture and climate; subjective attitudes and behaviour; inconclusive disciplinary data; unfair decision making; poor disciplinary support; and disciplinary policy misapplication.

Introduction: This paper demonstrates the practical application of process mapping principles as a model for evaluating NHS improvement. The NHS improvement in question was the merger of three crisis resolution teams within an NHS trust in 2012. The aims were to improve overall operational efficiency and enhance multidisciplinary working to meet operational targets. This paper examined changes following the merger to capture the effects of service improvement and the reality of the patient journey. Methods: A pooled cross-sectional approach, using six years of aggregated hospital data, was taken. To achieve operational efficiency, a process map of referrals, readmissions, length of stay and waiting times for crisis resolution team assessments was examined. Prevalence of clinical referral rates and disease classification before and after the merger were compared. Conclusion: Between 1 April 2009 and 30 March 2015, length of stay and readmissions for patients to crisis resolution team rates reduced. Operational sustainability and capacity was enhanced through the redistribution of clinical human resources. Multidisciplinary skill mix (e.g. through improved team composition) also improved.

This article has been withdrawn from publication.

First paragraph: On the 8th of June 2017 the United Kingdom will go the polls. The NHS will be central to the campaign. This will not just be a campaign concerned about NHS funding it never really is, there are always so many other issues. However, it will be either be consciously or subconsciously about the nature of the NHS in the immediate foreseeable future.

Whistleblowing is in part defined by the protection that it offers and does not offer to those who speak. Why some organisations find it almost impossible to protect whistblowers depends more on the properties of the organisation than the act of the individual whistleblower. These properties are, to a greater or lesser degree, present in all organisations but they are particularly present in nursing with its longstanding culture of deference to authority. Not all organisations protect whistleblowers that, unfortunately, are perceived to represent a threat to the organisation and the individual for challenging the underpinning norms of the organisation.

Corporations in the 21st century play a decisive role in the future of society. Their power and influence in world affairs often seems devoid of ethics and seems to exceed the reach and the means of many nations. As a result, the strategic positions they take towards value, creation and ethics affects every individual on the planet. This paper explores strategic routes that organisations could apply to facilitate economic growth while ensuring their ecological integrity and ensuring social enhancements generates benefits to a wider scope of organisational stakeholders. By conducting a critical analysis and clarifying common misconceptions between corporate social responsibility (CSR), creating shared value (CSV) and sustainability, it is possible to determine how these interrelated strategic approaches have evolved. This article argues the importance of transforming the purpose of organisations to encapsulate stakeholder value creation as the main reason for their existence.

This commentary explores the Government's apprenticeship reform programme

After heart disease, cancer is the most common cause of death in many developed countries. In this article, we discuss the relationship between economic growth and cancer incidence. The purposes of the article are to describe and measure the influence of an increasing real per capita income on the overall incidence of cancer. Using cross-sectional data for 162 countries, regression results with crude and age-standardised rates allow us to measure the elasticity of cancer incidence with respect to per capita income, and to decompose the elasticity coefficient into two components: age-effect and lifestyle-effect.

Understanding the distribution and determinants of cancerous diseases in specified populations attempts to prevent and control cancer-related public health issues. These insights are used to inform prevention and cancer control public health strategies Quantifying cancer occurrences in a given population is therefore an essential step in epidemiological studies. During economic growth, however, every society undergoes several substantial structural changes in healthcare demand and supply. In this paper, we discuss the relationship between economic growth and cancer incidences. The purposes of the paper are to describe and measure the influence of an increasing per capita income on the overall incidence of cancer. By using worldwide cross-sectional data from 162 countries, regression results with crude and age-standardised rates, allows us to measure the elasticity of cancer incidences with respect to per capita income and to decompose the elasticity coefficient into two components: age-effect and lifestyle-effect. Understanding how cancer incidence evolves during economic growth is increasingly useful for forecasting the economic impact of cancerous diseases and for governing the process of resource allocation in planning health services. In this article we sketch a macroeconomic theory of cancer incidence. We introduce some basic hypotheses about how demand-side economic structural changes may affect the evolution of cancer incidence. Finally, we try to develop a basic framework in order to explain how economic structural changes on the demand-side can affect the evolution of cancer incidence.

Purpose – The purpose of this paper is to explore theoretical connections between the cognitive consequences of power on self-perception and the behaviours of leaders. Design/methodology/approach – A systematic literature review was carried out to investigate the psychological consequences of power in terms of self-perception, perspective taking abilities, emotions and behaviours. The literature reviewed is further integrated in a theoretical model, and a series of propositions suggesting a relation between power, perspective taking, self-construal and leadership are introduced. Findings – This paper argues that power creates both temporary and enduring cognitive changes that transform the way individuals assimilate and differentiate their self from others. This transforms the way individuals in power behave as leaders, as well as followers. Individuals’ self-construal and perspective taking seem to play a mediating role in determining the behaviours of powerful and powerless individuals. This relation is moderated by organizational culture and structure, as well as personality traits. Research limitations/implications – Further research is needed to test these propositions, including the existence of cross-cultural differences in the power – self-construal relation, and the consequences of holding different types of power on an individual's self-construal. For employees and consultants working in organizational development and organizational change, understanding the potential consequences of power in terms of self-perception will improve the understanding of promoting individuals to higher positions. The present research also bears implications for scholars interested in understanding cross-cultural and gender differences in leadership. Originality/value – This conceptualization of self-construal as an interface between power and leadership reconcile the individual dynamics of trait theories of leadership and the environmental positions of situational theories of leadership. The paper discusses elements considered critical for design of leadership programs in the workplace, professional development and programs to shape the design of leadership.

The NHS must increase productivity by 6% per annum if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. Given that staff costs are 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforces will need to be changed to meet these targets. Healthcare management will be greatly affected by these changes. We argue that skill maximisation (e.g. increasing the responsibilities of healthcare practitioners) is the key to increasing productivity and care quality. We argue that to increase output (represented by volumes of cases treated) and quality of care is not just necessary, but essential. We therefore argue that the key to addressing the future of healthcare is the maximisation of the use of human resource.

This article looks at the relationship between stress, nursing integrity and patient care. It has been argued that the professional integrity of nurses has been eroded and consequently they have become more susceptible to anxiety, stress and exhaustion, potentially affecting care delivery. The authors suggest that the goal of providing high professional standards is threatened by increased service demands, and there is therefore a need for nurses to develop effective coping strategies to manage stress resulting from competing tensions in the workplace.

Corporate social responsibility has been seen by corporations as a practice to adopt as an act of philanthropy. There have been attempts to expand the role of social responsibility to business problems however there has never been an attempt to consider the strategic alignment of social outcomes to strategy. This article analyses the role of strategy by providing a review of strategy using Whittington's generic strategies model and expanding the same model to incorporate a social strategy model that supports the anecdotal idea that social responsibility can be potentially strategic. The paper centres its argument within the Indian context.

This commentary explores the role of evidence-based management for evidence based decision making legitimacy in mental health nursing

First paragraph: Within the UK there is a growing demand for clinical imaging and scanning. This demand is attributable to both a rapid advance in clinical (diagnostic) imaging technology over the last 30 years, and imaging being at the forefront of prediction, prevention, diagnosis and monitoring disease pathways.

Despite its rapid growth in recent literature, risks in project management have received limited critical attention when compared to Lean principles and total quality management. The aim of this article is to examine the ongoing dialogue within health services funders and providers concerning the relationship between project management and its relationship to hard and soft environmental risk factors. The failure of high profile projects and cost to the taxpayer is on the increase. This article argues that the lack of understanding in relation to a holistic assessment of project success factors contributes to increased risk of failure. It argues that greater emphasis is needed on placing risk relative to both operational and cultural factors, as opposed to the frequent use of prescriptive mechanistic methodologies. These changes have the potential not merely to improve the success rates of healthcare management projects, but health outcomes too.

The NHS must increase productivity by 6% every year if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. We know staff costs make up 60% of the NHS budget, so it is likely that both the number and composition of the 1.7 million-strong workforces will need to change in order to meet these targets. We argue that while substituting registered nurses with healthcare assistants (HCAs) is desirable in terms of financial benefits, there is not enough research evidence to identify the impact of changes or maximisation in skill mix upon efficiency (represented by the number of NHS cases treated) and the quality of care experienced by service users.

PurposeAfter many years of equal opportunities legislation, motherhood still limits womens' career progress even in a feminized occupation such as nursing. While the effect of motherhood, working hours, career breaks and school aged children upon career progression has been discussed widely, its actual scale and magnitude has received less research attention. The purpose of this paper is to examine the impact of these factors individually and cumulatively.Design/methodology/approachThis paper considers the impact of the above through a longitudinal analysis of a demographically unique national database, comprising the 46,565 registered nursing workforces in NHS Scotland from 2000‐2008. The variables examined include gender, employment grades, number and length of career breaks, lengths of service, age, working patterns, the number and age of dependent children.FindingsThe results indicate: motherhood has a regressively detrimental effect on women's career progression. However, this is a simplistic term which covers a more complex process related to the age of dependent children, working hours and career breaks. The degree of women's restricted career progression is directly related to the school age of the dependent children: the younger the child the greater the detrimental impact. Women who take a career break of greater than two years see their careers depressed and restricted. The results confirm that whilst gender has a relatively positive effect on male career progression; a women's career progression is reduced incrementally as she has more children, and part‐time workers have reduced career progression regardless of maternal or paternal circumstances.Originality/valueThis paper is the only example internationally, of a national workforce being examined on this scale and therefore its findings are significant. For the first time the impact of motherhood upon a women's career progression and the related factors – dependent children, career breaks and part‐time working are quantified. These findings are relevant across many areas of employment and they are significant in relation to broadening the debate around equal opportunities for women.

Using data for every elective procedure in 2007 in the English National Health Service, we found evidence of socioeconomic inequality in the probability of having a procedure cancelled after admission while controlling for a range of patient and provider characteristics. Whether this disparity is inequitable is inconclusive. © 2012 John Wiley & Sons, Ltd.

The article traces the history of the Poly Implant Prosthesis (PIP) scandal from an ethical perspective and explores the underpinning moral dilemmas inherent in the act of ‘whistleblowing.’ It goes on to consider the consequential stakeholder and broader societal reaction to whistleblowing which is discussed through deontological and teleological perspectives of ethically driven motives to act. It draws on the duty of care responsibility of healthcare professionals and the dilemma of personal consequence by the act of whistleblowing, whereby the objective of that act is the maintenance or improvement of patient standards and care. It argues that a cultural shift in organisational behaviour is urgently required to abrogate the needs for whistleblowing by means of internal systems and processes. Whistleblowing would thus become a supererogatory act of moral courage rather than carrying negative consequences in the interests of short-term saving face.

Objectives To model the frequency of ‘last minute’ cancellations of planned elective procedures in the English NHS with respect to the patient and provider factors that led to these cancellations. Methods A dataset of 5,288,604 elective patients spell in the English NHS from January 1st, 2007 to December 31st, 2007 was extracted from the Hospital Episode Statistics. A binary dependent variable indicating whether or not a patient had a Health Resource Group coded as S22 - ‘Planned elective procedure not carried out’ - was modeled using a probit regession estimated via maximum likelihood including patient, case and hospital level covariates. Results Longer waiting times and being admitted on a Monday were associated with a greater rate of cancelled procedures. Male patients, patients from lower socioeconomic groups and older patients had higher rates of cancelled procedures. There was significant variation in cancellation rates between hospitals; Foundation Trusts and private facilities had the lowest cancellation rates. Conclusions Further research is needed on why Foundation Trusts exhibit lower cancellation rates. Hospitals with relatively high cancellation rates should be encouraged to tackle this problem. Further evidence is needed on whether hospitals are more likely to cancel operations where the procedure tariff is lower than the S22 tariff as this creates a perverse incentive to cancel. Understanding the underlying causes of why male, older and patients from lower socioeconomic groups are more likely to have their operations cancelled is important to inform the appropriate policy response. This research suggests that interventions designed to reduce cancellation rates should be targeted to high-cancellation groups.