Biomedical subjects
Alistair Hewison
Publications and source records attributed to Alistair Hewison.
Evidence-based management in the NHS: is it possible?
The rise of evidence-based medicine and more recently evidence-based policy reflect the increasing importance of evidence as a basis for the organisation and delivery of health care. Evidence-based practice is central to the "modernisation" of health care in current UK policy. The latest manifestation of this process is the emergence of evidence-based management in health care. This paper examines the development of evidence-based approaches in health care and questions the appropriateness of such an approach to management. The problems inherent in applying the principles of EBP to management are explored and alternative apporoach based on the notion of craft is suggested as more practical and realistic.
Leadership development in health care: a word of caution.
Leadership development is seen as central to the modernisation agenda of the NHS. It has been identified in key policy documents and a range of leadership development programmes have been developed to meet this need This paper reviews the evidence concerning leadership development in nursing. The conclusion reached is that leadership is only one element in the changes that need to occur in health care. Too much emphasis on leadership without an equal concern for transforming the organisations nurses and other health personnel work in may result in leadership being added to the list of transient management "fads" which have characterised health care in recent years.
Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches.
BACKGROUND: A huge range of patient classification systems/tools are used in critical care units to inform workforce planning, however, they are not always applied appropriately. Many of these systems/tools were not originally developed for the purposes of workforce planning and so their use in determining the nurse:patient ratio required in critical care settings raises a number of issues for the organisation and management of these services. AIM: The aim of this paper is to review the three main assessment systems that are commonly used in critical care settings in the UK and evaluate their effectiveness in accurately determining nurse : patient ratios. If the application of these systems/tools is to enhance care, a thorough understanding of their origins and purpose is necessary. If this is lacking, then decisions relating to workload planning, particularly when calculating nurse : patient ratios, may be flawed. CONCLUSIONS: Patient dependency/classification systems and patient dependency scoring systems for severity of illness are robust measures for predicting morbidity and mortality. However, they are not accurate if used to calculate nurse : patient ratios because they are not designed to measure nursing input. Nursing intensity measures provide a useful framework for calculating the cost of providing a nursing service in critical care and can serve as a measure of nursing input, albeit a fairly basic one. However, many components of the nursing role are not "accounted" for in these measures. IMPLICATIONS: The implications of these findings for the organization and management of critical care services are discussed. Careful consideration of these areas is vital if a cost efficient and cost-effective critical care service is to be delivered.
From conflict to collaboration? Contrasts and convergence in the development of nursing and management theory (2).
AIM: This paper examines the development of theory in the occupation of management, in order to determine how this process is similar to that which has occurred in nursing. BACKGROUND: The need for the Health Service to be effectively managed was a prominent feature of UK health policy in the 1980s and early 1990s and accounts of the introduction of 'management methods' into health care tend to focus on the conflict between management and nursing. More recently, however, the policy emphasis has shifted towards collaborative and co-operative approaches to the provision of health care. METHOD: An examination of the development of nursing was conducted in a previous paper and serves as a point of reference in identifying areas of contrast and convergence in the development of nursing and management ideologies. This paper focuses on the development of theory in the occupation of management. CONCLUSION: A consideration of the nature of nursing and management is beneficial because it provides insights which can help practitioners in their transition from nurse to manager. In the past the relationship between nursing and management has been presented somewhat simplistically and this paper demonstrates that the situation is much more complex. If this complexity is recognized it can be taken into account and serve as a basis for removing barriers between these two key groups of personnel. Ultimately, this may lead to the collaboration and co-operation necessary to deliver the responsive services identified as targets in recent policy pronouncements.
Modernizing the British National Health Service (NHS) -- some ideological and policy considerations: a commentary and application.
The modernization of the British National Health Service, discussed by Peter Bradshaw in his paper, is having profound effects on nursing and patient care. The aim of this paper is to engage with the debate he has initiated in order to demonstrate its importance to nursing. The focus will be on key elements of the policy process not addressed by Peter Bradshaw as his emphasis was mainly on ideological concerns, but which nonetheless warrant consideration. These include the increasingly important role of evidence in policy making, and the role of nurses in the policy process. To this end four main themes are explored. First, specific comment is made on some of the points raised by Peter Bradshaw, in the context of the available evidence; secondly the role of evidence in the formulation and evaluation of policy is discussed; thirdly the policy process and nursing is examined; finally some tentative suggestions are made concerning the actions nurses and nurse managers can take to become more active in the health policy arena. The intention is to use Peter Bradshaw's work as a point of departure in examining further, some of the issues he highlights and to contribute to the debate.
Qualitative management research in the NHS. A classic case of counting to one?
This paper examines research that has been undertaken to investigate management in health care and argues that there is no firm "evidence base" to demonstrate its effectiveness. However there is an emerging tradition of qualitative work, which has developed in response to the pace of organisational and structural change in health care, which reveals that the prevalent "ideal type" of rational management is inaccurate. One of the avowed strengths of qualitative research is that it uncovers what the nature of a particular phenomenon is, in essence it aims to "count to one". This need to understand and define health care management, forms the rationale for the studies reviewed and has influenced the research agenda in this area. Evidence is being demanded to demonstrate the efficacy of all clinical procedures, yet in researching managerial practice we are still counting to one.
Implementing audit in palliative care: an action research approach.
AIM: To investigate the factors that influence the successful implementation of audit in a palliative care setting. BACKGROUND: Quality assurance is a necessary component of contemporary health care. In the past, palliative care has not generally been subject to systems of audit and quality management. However in recent years the need for all health care organizations to have clear policies and procedures for maintaining quality has become more pressing. METHOD: An action research project was conducted to investigate the implementation of audit in a palliative care setting, which involved the application and modification of the Support Team Assessment Scale (STAS). FINDINGS: A collaborative approach was adopted and this facilitated the identification of factors vital to successful introduction of the audit methodology into the unit. These included effective teamwork, the input of an external facilitator, good relationships with management and prompt and relevant feedback on progress. The use of STAS was fully integrated into the work of the unit and a robust programme of audit has been established. CONCLUSIONS: Combining the cyclical nature of action research methodology and the audit process with Lewin's change theory provided a clear conceptual framework for the research. This approach would be applicable in a range of health care settings to bring about improvements in quality management.
From conflict to collaboration? Contrasts and convergence in the development of nursing and management theory.
AIM: This is the first of two papers which examine the development of theory in the occupations of management and nursing, in order to determine where the similarities and differences lie. BACKGROUND: The need for the Health Service to be effectively managed was a prominent feature of UK health policy in the 1980s and early 1990s and accounts of the introduction of 'management methods' into health care tend to focus on the conflict between management and nursing. More recently, however, the policy emphasis has shifted towards collaborative and co-operative approaches to the provision of health care. METHOD: An examination of the development of nursing is conducted as the first step in identifying areas of contrast and convergence in the development of nursing and managerial ideologies. In the second paper a similar approach is taken to the history of management. CONCLUSION: Nursing has been subject to a succession of ideologies aimed at advancing practice, however, many of these approaches have been accepted in an uncritical way. In the second paper the similarities in the development of management thought are examined and the implications this has for nursing management explored.
Role overlap between occupational therapy and physiotherapy during in-patient stroke rehabilitation: an exploratory study.
The concept of role overlap between occupational therapy and physiotherapy has been the subject of debate for at least three decades. Stroke rehabilitation is an area where role overlap between occupational therapists and physiotherapists occurs. This article reports an exploratory study carried out with nine physiotherapists and nine occupational therapists working in a variety of in-patient stroke rehabilitation settings. Analysis of qualitative data collected through semi-structured interviews revealed that the majority of the participants recognised the existence of role overlap as inevitable within collaborative health care and felt it was of benefit to patients. However, it appeared that the concept was also perceived as a challenge to role security by many when considered from a professional perspective. Acceptance of role overlap depended upon the extent to which it occurred in the particular setting. Generic therapy was seen as an extreme form of overlap and regarded as an undesirable progression by most participants. The main strategy used to challenge this development was to emphasise professional uniqueness through role delineation. However, this strategy was found to be weak in the context of increasing demands for collaboration at a policy level.