This study from Manbinder Sidhu and Jack Pollard investigated: what specifically has led to hospitals and GP practices being run by the same organisation; how it is done; the expectations of the GPs and NHS managers who made it happen; whether those expectations are being fulfilled; and whether there are any other consequences.
To do this, they have interviewed GPs, NHS managers and other staff, 52 people in all, at two locations in England and one in Wales. They have also observed management meetings and reviewed documents referred to by interviewees.
They found that the dominant re
The dataset included interviews and focus groups with 121 participants from primary care (33 patients, 55 GPs, 11 other clinicians, nine managers, four support staff, four national policymakers, five technology industry).
The results found, with few exceptions, video consultations were either never adopted or soon abandoned in general practice despite a strong policy push, short-term removal of regulatory and financial barriers, and advances in functionality, dependability, and usability of video technologies (though some products remained ‘fiddly’ and unreliable). The relative advantage
In this article, Wu et al. argue that the enduring sociological concepts of the informal organisation and formal organisation offer analytical purchase in understanding the causes of such problems and how they can be addressed.
Their analysis emphasises the interdependence of the formal and informal organisation. The formal organisation describes codified and formalised elements of structures, procedures and processes for the exercise of voice, but participants often found it frustrating, ambiguous, and poorly designed. The informal organisation—the informal practices, social connections,
The research team interviewed 40 mental health clinicians and managers from a variety of healthcare systems who were participating in a burnout intervention. The team determined results of those interviews could be broken down into three themes around how organisations might reduce burnout.
A work culture that prioritizes person-centered care over productivity and other performance metrics.
Management skills and practices to overcome bureaucracy.
Opportunities for employee professional development and self care.
"Clinicians told us that they chose this line of work be
This framework highlights the following five dimensions, which the authors believe should be included in any safety and monitoring approach in order to give a comprehensive and rounded picture of an organisation’s safety:
Past harm: this encompasses both psychological and physical measures
Reliability: this is defined as ‘failure free operation over time’ and applies to measures of behaviour, processes and systems
Sensitivity to operations: the information and capacity to monitor safety on an hourly or daily basis
Anticipation and preparedness: the ability to anticipate
Here, Dr Sara Ryan questions whether inquiries or investigations are an effective way of holding stakeholders to account and discusses the need for more qualitative research to better understand bereaved family experiences of inquiries and investigations.
Political Quarterly (1).pdf
There are calls for greater use of ‘soft’ intelligence around quality and safety.
Little research examines the challenges and opportunities soft data present.
This study in the English NHS found clinicians and managers saw utility in soft data.
Dominant approaches to interpretation risked obscuring their greatest value.
Soft data might better be used to disrupt understanding and challenge consensus.
The authors conducted a qualitative interview study with 22 accident investigators from different domains in Sweden. They found a wide range of factors that led investigations away from the ideal, most which more resembled factors involved in organisational accidents, rather than reflecting flawed thinking.
One particular limitation of investigation was that many investigations stop the analysis at the level of “preventable causes”, the level where remedies that were currently practical to implement could be found. This could potentially limit the usefulness of using investigations to get
WHO's definition of an After Action Review and resources
Guidance for After Action Review
After Action Review infographic
3 minute video explaining the AAR practice as promoted by WHO, including the definition, the different methodologies and available resources.
After Action Reviews and simulation exercises