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8. Evaluating lean in healthcare

Author

Burgess, Nicola

Subjects
361, R Medicine (General)
Abstract

The overarching aim of this thesis is to evaluate Lean implementation in the English NHS. Against a background of financial austerity measures and the ostensible widespread adoption of Lean in the UK public sector, and particularly by healthcare organisations, the objective is to understand how Lean is being implemented by NHS hospital Trusts, and whether there is any quantitative evidence that Lean implementation is improving hospital performance. Adopting Pettigrew and Whipp’s (1991) framework of strategic change, this thesis aims to present theoretically sound and practically useful research through an exploration of the context, process and content of Lean implementation by English hospital Trusts. In order to achieve this, the research employs a mixed methods research design incorporating document analysis3, quantitative analysis and case study analysis to afford an insight into the implementation of Lean from multiple viewpoints and facilitate the development of new insights relating to the phenomena of Lean implementation in English hospital Trusts. The research provides a contribution to knowledge in three key areas: firstly through the identification and validation of a typology of approaches to Lean implementation by English hospital Trusts i.e. a characterisation of the method of Lean implementation; secondly through quantitative analysis and discussion of the potential link between Lean implementation and increased performance; and thirdly a set of propositions that provide a narrative and logic to explain the influence of contextual factors upon the process of Lean implementation in English hospitals.

Published
2012

16. Comparison of 6-Month Outcomes of Survivors of COVID-19 versus Non–COVID-19 Critical Illness

Author

Hodgson, Carol L., primary, Higgins, Alisa M., additional, Bailey, Michael J., additional, Mather, Anne M., additional, Beach, Lisa, additional, Bellomo, Rinaldo, additional, Bissett, Bernie, additional, Boden, Ianthe J., additional, Bradley, Scott, additional, Burrell, Aidan, additional, Cooper, D. James, additional, Fulcher, Bentley J., additional, Haines, Kimberley J., additional, Hodgson, Isabelle T., additional, Hopkins, Jack, additional, Jones, Alice Y. M., additional, Lane, Stuart, additional, Lawrence, Drew, additional, van der Lee, Lisa, additional, Liacos, Jennifer, additional, Linke, Natalie J., additional, Gomes, Lonni Marques, additional, Nickels, Marc, additional, Ntoumenopoulos, George, additional, Myles, Paul S., additional, Patman, Shane, additional, Paton, Michelle, additional, Pound, Gemma, additional, Rai, Sumeet, additional, Rix, Alana, additional, Rollinson, Thomas C., additional, Tipping, Claire J., additional, Thomas, Peter, additional, Trapani, Tony, additional, Udy, Andrew A., additional, Whitehead, Christina, additional, Anderson, Shannah, additional, Neto, Ary Serpa, additional, Young, Meredith, additional, Board, Jasmin, additional, McCracken, Phoebe, additional, Martin, Emma-Leah, additional, Burgess, Nicola, additional, Hearn, Kirsty, additional, Brewster, David, additional, Waanders, Alyssa, additional, Simpson, Shannon, additional, de Silva, Yasmin, additional, Barrett, Jonathon, additional, Hanlon, Gabrielle, additional, Lang, Jenna, additional, Burleigh, Sarah, additional, Killer, Elisha, additional, Wang, Michael, additional, O’Connor, Lauren, additional, Thomas, Lauren, additional, Dennis, Lucy, additional, Caruana, Joanna, additional, Al-Bassam, Wisam, additional, Shealy, Morag, additional, Chapman, Marianne, additional, O’Connor, Stephanie, additional, Sheehan, Janne, additional, Alexander, Emily, additional, Sukkar, Amanda, additional, Davis, Liesl, additional, Bass, Francis, additional, Hammond, Naomi, additional, O’Connor, Anne, additional, Yarad, Elizabeth, additional, Totaro, Richard, additional, Buhr, Heidi, additional, Reddy, Nazmeen, additional, Chaseling, Wendy, additional, Ip, Kelvin, additional, Tronstad, Oystein, additional, Mahoney, Alison, additional, Fanning, Cadi, additional, Esterman, Hariette, additional, Kozary, Alexia, additional, and Scott, Bronte, additional

Published
2022
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20. LuxS: its role in central metabolism and the in vitro synthesis of 4-hydroxy-5-methyl-3(2H)-furanone

Author

Winzer, Klaus, Hardie, Kim R., Burgess, Nicola, Doherty, Neil, Kirke, David, Holden, Matthew T. G., Linforth, Rob, Cornell, Kenneth A., Taylor, Andrew J., Hill, Philip J., and Williams, Paul

Subjects
Microbiological research -- Analysis, Metabolism -- Physiological aspects, Furans -- Physiological aspects, Bacteria -- Growth, Cells -- Genetic aspects, Enzymes -- Physiological aspects, Cysteine -- Physiological aspects, Biological sciences
Abstract

Research has been conducted on bacterial extracellular molecules functioning in cell-to-cell communication. Results suggest that the autoinducer 2 does not act as a signal molecule for different bacteria but is a metabolic pathway by-product secreted during exponential growth and degraded at a later stage.

Published
2002

21. LuxS-dependent quorum sensing in Porphyromonas gingivalis modulates protease and haemagglutinin activities but is not essential for virulence

Author

Burgess, Nicola A., Kirke, David F., Williams, Paul, Winzer, Klaus, Hardie, Kim R., Meyers, Nicholas L., Aduse-Opoku, Joseph, Curtis, Michael A., and Camara, Miguel

Subjects
Microbiological research -- Analysis, Gram-negative bacteria -- Genetic aspects, Virulence (Microbiology) -- Genetic aspects, Periodontal disease -- Causes of, Cysteine proteinases -- Genetic aspects, Biological sciences
Abstract

Research has been conducted on Porphyromonas gingivalis, a Gram-negative bacteria implicated in human periodontal disease aetiology. The role of the quorum sensing in cysteine protease regulation has been investigated via the use of the biosensors capable of detecting quorum-sensing signaling molecules and the results are reported.

Published
2002

24. Organizational Ambidexterity and the Hybrid Middle Manager: The Case of Patient Safety in UK Hospitals.

Author

Burgess, Nicola, Strauss, Karoline, Currie, Graeme, and Wood, Geoffrey

Subjects
INTERVIEWING, RESEARCH methodology, MOTOR ability, PATIENT safety, RESEARCH funding, KNOWLEDGE management, THEMATIC analysis
Abstract

This article focuses on knowledge management in UK hospitals as an area in which organizational ambidexterity ( OA) is a necessary condition. In contrast to much of the literature on OA that looks at senior managers, we focus on the role of 'hybrid' middle managers, professional workers who hold managerial responsibilities, in ensuring that the quality of care delivered is at an optimum 'safe' level for patients. We examine the influence of prevailing tensions and competing agendas characteristic of a professionalized, public-sector context upon knowledge exploitation and exploration at the middle levels of the organization. Our study investigates how these tensions are experienced and reconciled at the individual level. We examine the contextual and personal circumstances that enable hybrid middle managers to forge workable compromises between exploration and exploitation to facilitate OA. We find that this process is contingent on professional legitimacy, social capital, and a holistic professional orientation. This has wider implications for human resource practice to support the discretion and motivation of hybrid middle managers to facilitate OA for enduring performance and advancement of best practice. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Published
2015
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25. HR Practices and Knowledge Brokering by Hybrid Middle Managers in Hospital Settings: The Influence of Professional Hierarchy.

Author

Currie, Graeme, Burgess, Nicola, and Hayton, James C.

Subjects
GERIATRIC nursing, HEALTH facility employees, LABOR incentives, INTERPROFESSIONAL relations, INTERVIEWING, RESEARCH methodology, MEDICAL cooperation, NATIONAL health services, MOTIVATION (Psychology), NURSING services administration, PATIENT safety, PERSONNEL management, PROFESSIONS, RESEARCH, RESEARCH funding, PEER relations
Abstract

Drawing upon the ability-motivation-opportunity ( AMO) framework, our study extends understanding of the interaction between human resource ( HR) practices and the brokering of knowledge by hybrid middle managers. Examining health care delivered to older people in a hospital setting, our study highlights that hybrid nurse middle managers broker knowledge downward through professional hierarchy to their peer group, but find it difficult to broker knowledge upward. Meanwhile, because they lack legitimacy with doctors, they lack the opportunity to broker knowledge interprofessionally. Hybrid medical middle managers are potentially more able to broker knowledge within their peer group. However, some of lower status intraprofessionally, like nurses, may lack legitimacy and opportunity to do so. Meanwhile, higher-status medical middle managers may lack motivation to engage in knowledge brokering with peers outside their specialism. We suggest that inter- and intraprofessional power and status has important implications for HR practices to support knowledge brokering by hybrid middle managers. Should HR practices fail to support ability, motivation, and opportunity for knowledge brokering across and within professions, then a 'broken' rather than 'broker' chain may result. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Published
2015
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26. PSYCHOLOGICAL CONTRACTING: MAKING OBLIGATIONS EXPLICIT TO SUPPORT A TRANSFORMATIVE CHANGE PARTNERSHIP.

Author

BURGESS, NICOLA, RICHMOND, JOHN, and KIEFER, TINA

Abstract

We examine the creation and maintenance of an explicit psychological contract (PC) designed to facilitate a new relationship between five hospitals and their regulator. Our study illustrates how an explicit PC facilitates transition from a command and control relationship to one that fosters partnership working. Drawing on Rousseau's (2018) dynamic phase model of the PC, we describe the process of PC creation and maintenance over time. Drawing upon over four years of data we illustrate the critical role of PC 'breach' in triggering sensemaking and sensegiving activity, reinforcing the status quo, and maintaining the explicit PC. [ABSTRACT FROM AUTHOR]

Published
2020
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28. Temporal pacing of outcomes for improving patient flow: Design science research in a National Health Service hospital.

Author

Johnson, Mark, Burgess, Nicola, and Sethi, Simon

Subjects
NATIONAL health services, DESIGN science, DESIGN research, PUBLIC health research, RESEARCH
Abstract

Improving patient flow in hospitals is a contemporary challenge in the UK National Health Service (NHS). When patients remain in a hospital bed for longer than clinically necessary, hospital performance is dramatically impacted, quality of care is reduced, and elective surgeries are cancelled at great cost to both hospital and patient. This research explains how one UK hospital employed design science research to improve patient flow after other process improvement techniques had failed. The work focused on improving patient flow through the creation of a set of interconnected, temporally paced routines that successfully engaged doctors and nurses in new, outcome‐specific ways of working. These routines were both independent and interdependent, were relationally coordinated through time, and systematically and unambiguously engaged all levels of staff at specific temporal junctures. We discover that the successful adoption of these routines was cumulative rather than iterative and was aligned with ongoing efforts supporting the social aspects of change. Through this work, our case hospital saw performance improvements that moved them from being below average to the best in the country, combining improvements in patient care with savings of over £3 million in the first 12 months. The contribution of this research is twofold; first, we explain how the development of outcome‐specific routines can facilitate process improvement, and second, we illustrate how design science research can successfully bridge theory and practice to promote swift and even flow in healthcare. [ABSTRACT FROM AUTHOR]

Published
2020
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29. The (un)desirability of hybrid managers as ‘controlled’ professionals : comparative cases of tax and healthcare professionals

Author

Currie, Graeme, Burgess, Nicola, and Tuck, Penelope

Subjects
ComputingMilieux_THECOMPUTINGPROFESSION
Abstract

In this review, focusing upon comparative cases of tax inspectors and nurses, we address debate about whether development of hybrid manager roles represents controlled professionalism or organizing professionalism. We evaluate whether the activities of hybrid managers are desirable in broader terms, whether the actions of hybrid managers transcend executive managers’ or policy-makers’ interests to serve a broader societal interest, thereby retaining a hallmark of professionalism. We argue that tax inspectors enact the hybrid role in a way characteristic of controlled professionalism. Meanwhile hybrid nurse managers enact their role characteristic of controlled professionalism in a poor performing organization, but more characteristic of organizing professionalism in a high performing organization. Despite our mixed analysis of how this plays out on the ground, we remain optimistic that managerial practice of hybrids can be managed from within professional ranks, and in a way that meets organizational and public interest simultaneously.\ud \ud

Published
2016

32. Facilitated modelling with discrete-event simulation: Reality or myth?

Author

Robinson, Stewart, Worthington, Claire H, Burgess, Nicola, Radnor, Zoe J, Robinson, Stewart, Worthington, Claire H, Burgess, Nicola, and Radnor, Zoe J

Abstract

Is it possible for discrete-event simulation to be used in a facilitated workshop environment? Over the last decade there have been various attempts to use simulation in this way, but we argue here that none have been successful in achieving a fully facilitated mode where the model is both developed and used in the workshop. We attempt to use a discrete-event simulation in a facilitated mode as part of a lean improvement workshop in a hospital setting. The model was successfully developed and used within the 3 day period of the workshop. Although the intervention was successful, we still had to build the model in the ‘back-office’, meaning that a fully facilitated mode was not achieved. The paper concludes by discussing how fully facilitated modelling with discrete-event simulation might be made possible; the answer is more about changing mind-sets than about technological challenge.

Published
2013

33. SimLean Healthcare Handbook

Author

Burgess, Nicola, Worthington, Claire H, Radnor, Zoe, Robinson, Stewart, Cooke, Matthew, Burgess, Nicola, Worthington, Claire H, Radnor, Zoe, Robinson, Stewart, and Cooke, Matthew

Abstract

The SimLean Handbook provides guidance on how to run SimLean during an improvement event. The handbook is intended for training purposes, to illustrate through the use of simulation and step by step analysis, the principles of Lean. We use the term 'facilitator' throughout the handbook in reference to the person who is delivering the training and the term 'participants' is used in reference to the receivers of the training. In addition the document is also useful for independent study and reference.

Published
2011

38. Evaluating Lean in healthcare.

Author

Burgess, Nicola and Radnor, Zoe

Abstract

Purpose – The purpose of this paper is to present findings relating to how Lean is implemented in English hospitals. Design/methodology/approach – Lean implementation snapshots in English hospitals were conducted by content analysing all annual reports and web sites over two time periods, giving a thorough analysis of Lean's status in English healthcare. Findings – The article identifies divergent approaches to Lean implementation in English hospitals. These approaches are classified into a typology to facilitate an evaluation of how Lean is implemented. The findings suggest that implementation tends to be isolated rather than system-wide. A second dataset conveys Lean implementation trajectory across the time period. These data signal Lean's increasing use by English hospitals and shows progression towards an increasingly systemic approach. Practical implications – Data were collected using content analysis methods, which relies on how “Lean” methods were articulated within the annual report and/or on the organisation's web site, which indicates approaches taken by hospital staff implementing Lean. Originality/value – This research is the first to examine more closely “how” Lean is implemented in English hospitals. The emergent typology could prove relevant to other public sector organizations and service organisations more generally. The research also presents a first step to understanding Lean thinking in the English NHS. This article empirically analyses Lean implementation in English hospitals. It identifies divergent approaches that allow inferences about how far Lean is implemented in an organisation. Data represent a baseline for further analysis so that Lean implementation can be tracked. [ABSTRACT FROM AUTHOR]

Published
2014
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39. The applicability of the Viable Systems Model as a diagnostic for small to medium sized enterprises.

Author

Burgess, Nicola and Wake, Nicholas

Subjects
SYSTEMS theory, SMALL business, BUSINESS performance measurement, BUSINESS development, BIG business
Abstract

Purpose – This paper presents research into the use of the Viable Systems Model (VSM) in small to medium sized enterprises (SMEs). Research on the VSM has been focussed on large organisations. The purpose of this paper is to explore the usefulness of the VSM in diagnosing issues of viability in SMEs. Design/methodology/approach – Case study research was undertaken in which semi structured diagnostic interviews took place with SMEs using the VSM as a diagnostic tool. The aim was to investigate whether the VSM would assist in diagnosing problems with viability and whether it could then prescribe and facilitate improvements in operations. Qualitative case study evidence is presented that shows the results of these interventions. Findings – The paper reports some examples of operational problems that were exposed through the intervention process and shows some general conclusions to support the use of VSM for analysing operations and supporting small business viability. A number of "threats to viability" themes were apparent and these are discussed. Practical implications – The semi-structured interview protocol created for the research could be used to diagnose viability issues in other SMEs and thus is of practical relevance to other organisations. Originality/value – The VSM originates from the theory of cybernetics which can be broadly defined as "the science of effective organisation". Previous use of the model has focused upon the viability of large organisations; the applicability of the VSM in a small business operational context has received little attention. The paper demonstrates the benefits of the using the VSM to pinpoint problems that threaten SME viability. [ABSTRACT FROM AUTHOR]

Published
2013
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40. NIV@Home: a pilot randomized controlled trial of in-home noninvasive ventilation initiation compared to a single-day admission model.

Author

Sheers, Nicole L., Hannan, Liam M., Rautela, Linda, Graco, Marnie, Jones, Jennifer, Retica, Sarah, Saravanan, Krisha, Burgess, Nicola, McGaw, Rebekah, Donovan, Ashleigh, Clohessy, Talia, Chao, Caroline, Charles, Cameron, Howard, Mark E., and Berlowitz, David J.

Subjects
*AMYOTROPHIC lateral sclerosis, *BURDEN of care, *NEUROMUSCULAR diseases, *RESPIRATORY insufficiency, *NONINVASIVE ventilation
Abstract

AbstractObjective: Noninvasive ventilation (NIV) is the primary treatment for respiratory insufficiency in neuromuscular disease. NIV implementation is usually conducted within hospitals; however, in-home implementation with intensive follow-up is an effective alternative. This pilot study aimed to assess model feasibility, acceptability, and NIV usage at 12-weeks after a single visit in-home implementation of NIV with remote monitoring follow-up (NIV@Home) compared to an in-hospital day admission NIV initiation plus planned polysomnography (Usual care). Methods: A single-blinded randomized controlled trial (www.anzctr.org.au ACTRN12620000682943) of adults with neuromuscular disease referred for NIV implementation. Participants were stratified by disease (MND or Other diagnoses) and bulbar symptoms before randomization to NIV@Home or Usual care, with follow-up at 12-weeks. The primary outcome was NIV usage. Secondary outcomes included feasibility, health-related quality of life, symptoms, carer burden, and NIV experience (semi-structured qualitative interviews). Results: Twenty-three participants (MND bulbar = 9, MND non-bulbar = 11, Other = 3) were randomized (NIV@Home = 9). No statistical differences were observed in the percentage of MND participants using NIV for >4 hours/day (NIV@Home = 33% vs. Usual care = 60%, p = 0.370), average use (NIV@Home = 2.4 [1.5–9.3] vs. 5.3 [1.8–7.0] hours/day, p = 0.568), or secondary outcomes. In-home NIV implementation was feasible and safe but took more therapist time (NIV@Home = 278 [270–305] vs. 172 [130–200] minutes, p < 0.001). Participants in the NIV@Home group reported substantial advantages to receiving care in home. Conclusion: In-home NIV implementation is feasible and acceptable to people with MND but requires more therapist time. Larger studies are required to determine whether there are clinically important differences between this model of NIV initiation and a traditional hospital-based model. [ABSTRACT FROM AUTHOR]

Published
2024
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42. The Death of a Bundle of Organizational Routines.

Author

Aristidou, Angela and Burgess, Nicola Jane

Abstract

Much has been written about why organizations die. Some research focuses on how the process of organizational death unfolds (e.g. Sutton, 1987). In contrast little research or conceptual work focuses on how organizational processes die. Organizational routines are acknowledged as key organizational processes. Our qualitative field study of the death of a bundle of entangled organizational routines is used to develop a process model to explain the death of organizational routines. This model adds to existing organizational literature by focusing specifically on the death of an organizational process rather than birth or growth. Additionally, it expands our understanding of the dynamics of bundles of routines and addresses the unexplored theoretical puzzle of how entangled routines are held together despite actors in one routine being ignorant of actions in interrelated routines. [ABSTRACT FROM AUTHOR]

Published
2019
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43. Evaluating lean in healthcare

Author

Burgess, Nicola

Subjects
R1
Abstract

The overarching aim of this thesis is to evaluate Lean implementation in the\ud English NHS. Against a background of financial austerity measures and the\ud ostensible widespread adoption of Lean in the UK public sector, and particularly\ud by healthcare organisations, the objective is to understand how Lean is being\ud implemented by NHS hospital Trusts, and whether there is any quantitative\ud evidence that Lean implementation is improving hospital performance. Adopting\ud Pettigrew and Whipp’s (1991) framework of strategic change, this thesis aims to\ud present theoretically sound and practically useful research through an exploration\ud of the context, process and content of Lean implementation by English hospital\ud Trusts. In order to achieve this, the research employs a mixed methods research\ud design incorporating document analysis3, quantitative analysis and case study\ud analysis to afford an insight into the implementation of Lean from multiple\ud viewpoints and facilitate the development of new insights relating to the\ud phenomena of Lean implementation in English hospital Trusts.\ud The research provides a contribution to knowledge in three key areas: firstly\ud through the identification and validation of a typology of approaches to Lean\ud implementation by English hospital Trusts i.e. a characterisation of the method of\ud Lean implementation; secondly through quantitative analysis and discussion of\ud the potential link between Lean implementation and increased performance; and\ud thirdly a set of propositions that provide a narrative and logic to explain the\ud influence of contextual factors upon the process of Lean implementation in\ud English hospitals.

44. A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care

Author

Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., Waring, Justin, Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., and Waring, Justin

Abstract

Background: Brokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people. Objectives: Generate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs. Design: We utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups. Setting: NHS East and NHS West Midlands. Participants: One hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK. Main outcome measures: Which H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care? Results: Health-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement. Conclusions: Clinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs

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45. A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care

Author

Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., Waring, Justin, Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., and Waring, Justin

Abstract

Background: Brokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people. Objectives: Generate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs. Design: We utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups. Setting: NHS East and NHS West Midlands. Participants: One hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK. Main outcome measures: Which H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care? Results: Health-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement. Conclusions: Clinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs

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46. A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care

Author

Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., Waring, Justin, Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., and Waring, Justin

Abstract

Background: Brokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people. Objectives: Generate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs. Design: We utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups. Setting: NHS East and NHS West Midlands. Participants: One hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK. Main outcome measures: Which H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care? Results: Health-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement. Conclusions: Clinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs

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View/download PDF

47. A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care

Author

Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., Waring, Justin, Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., and Waring, Justin

Abstract

Background: Brokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people. Objectives: Generate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs. Design: We utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups. Setting: NHS East and NHS West Midlands. Participants: One hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK. Main outcome measures: Which H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care? Results: Health-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement. Conclusions: Clinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs

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48. A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care

Author

Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., Waring, Justin, Currie, Graeme, Burgess, Nicola, White, Leroy, Lockett, Andy, Gladman, John R.F., and Waring, Justin

Abstract

Background: Brokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people. Objectives: Generate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs. Design: We utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups. Setting: NHS East and NHS West Midlands. Participants: One hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK. Main outcome measures: Which H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care? Results: Health-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement. Conclusions: Clinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs

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