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Biomedical subjects

Martin N Marshall

Publications and source records attributed to Martin N Marshall.

7 recordsLinked to original sources
PubMed2004

How do we maximize the impact of the public reporting of quality of care?

BACKGROUND: Many developed countries are beginning to see the public reporting of comparative information about the quality of health care as an important way of improving accountability, stimulating quality improvement and empowering members of the public. The production and dissemination of quality reports is particularly high on the policy agenda in the US and the UK, and there is now a considerable amount of experience and evidence from these countries to guide the process. Over the last decade there has been a lively debate about the balance between the advantages and problems of public reporting, but most commentators now believe it is time to cease asking whether we should disseminate information and start asking how it can be done most effectively. PURPOSE: To recommend ways of helping policy makers and practitioners to maximize the impact of quality reports and minimize the unintended consequences. Recommended strategies. We make recommendations about the importance of understanding the macro- and micro--environment within which public reporting takes place, of actively addressing the unintended consequences of public reporting, of incentivizing the response to the data and of engaging the public and media. The effectiveness of the different strategies, on their own or in combination, is likely to be determined by the environment within which reporting takes place. CONCLUSIONS: It is not desirable to look for a common 'fix' applicable to all organizations or transferable across all international boundaries. However, in this paper we describe lessons that we think are common to all countries attempting to produce and disseminate health care quality reports.

Information Dissemination↗
PubMed2003

Managing change in the culture of general practice: qualitative case studies in primary care trusts.

OBJECTIVES: To explore the potential tension between the need for managers to produce measurable change and the skills required to produce cultural change, and to investigate how managers of primary care trusts are attempting to deal with this tension. DESIGN: Qualitative case studies using data derived from semistructured interviews and a review of published documents. An established cultural framework was to used to help interpret the findings. SETTING: Six primary care trusts in England purposefully sampled to represent a range of cultural, structural, geographical, and demographic characteristics. PARTICIPANTS: 42 interviews with 39 different senior and middle primary care trust managers conducted over an 18 month period. RESULTS: We found two distinct and polarised styles of management. One group of managers adopts a directive style and challenges the prevailing norms and values of clinicians, an approach characteristically seen in organisations with hierarchical cultures. This group is made up mostly of senior managers who are driven principally by the imperative to deliver a political agenda. Managers in the second group are more inclined to work with the prevailing cultures found in general practice, attempting to facilitate change from within rather than forcing change from outside. This management style is characteristically seen in organisations with a clan-type culture. The approach was manifest mostly by middle managers, who seem to act as buffers between the demands of senior managers and their own perception of the ability and willingness of health professionals to cope with change. The different management approaches can lead to tension and dysfunction between tiers of management. CONCLUSIONS: The development of primary care depends on high quality managers who are able to draw on a range of different management skills and styles. Managers are most likely to be effective if they appreciate the merits and drawbacks of their different styles and are willing to work in partnership.

Administrative Personnel↗
PubMed2003

Implementing culture change in health care: theory and practice.

OBJECTIVES: To review some of the key debates relating to the nature of organizational culture and culture change care organizations and systems. METHODS: A literature review was conducted that covered both theoretical contributions and published studies of the processes and outcomes of culture change programmes across a range of health and non-health care settings. RESULTS: There is little consensus among scholars over the precise meaning of organizational culture. Competing claims exist concerning whether organizational cultures are capable of being shaped by external manipulation to beneficial effect. A range of culture change models has been developed. A number of underlying factors that commonly attenuate culture change programmes can be identified. Key factors that appear to impede culture change across a range of sectors include: inadequate or inappropriate leadership; constraints imposed by external stakeholders and professional allegiances; perceived lack of ownership; and subcultural diversity within health care organizations and systems. CONCLUSIONS: Managing organizational culture is increasingly viewed as an essential part of health system reform. To transform the culture of a whole health system such as the UK National Health Service would be a complex, multi-level, and uncertain process, comprising a range of interlocking strategies and supporting tactics unfolding over a period of years.

Health Care Reform↗
PubMed2002

Attitudes to the public release of comparative information on the quality of general practice care: qualitative study.

OBJECTIVES: To examine the attitudes of service users, general practitioners, and clinical governance leads based in primary care trusts to the public dissemination of comparative reports on quality of care in general practice, to guide the policy and practice of public disclosure of information in primary care. DESIGN: Qualitative focus group study using mock quality report cards as prompts for discussion. SETTING: 12 focus groups held in an urban area in north west England and a semirural area in the south of England. PARTICIPANTS: 35 service users, 24 general practitioners, and 18 clinical governance leads. RESULTS: There was general support for the principle of publishing comparative information, but all three stakeholder groups expressed concerns about the practical implications. Attitudes were strongly influenced by experience of comparative reports from other sectors-for example, school league tables. Service users distrusted what they saw as the political motivation driving the initiative, expressed a desire to "protect" their practices from political and managerial interference, and were uneasy about practices being encouraged to compete against each other. General practitioners focused on the unfairness of drawing comparisons from current data and the risks of "gaming" the results. Clinical governance leads thought that public disclosure would damage their developmental approach to implementing clinical governance. The initial negative response to the quality reports seemed to diminish on reflection. CONCLUSIONS: Despite support for the principle of greater openness, the planned publication of information about quality of care in general practice is likely to face considerable opposition, not only from professional groups but also from the public. A greater understanding of the practical implications of public reporting is required before the potential benefits can be realised.

Access to Information↗
PubMedDate not supplied

Public reporting on quality in the United States and the United Kingdom.

The public reporting of comparative information about health care quality is becoming an accepted way of improving accountability and quality. Quality report cards have been prominent in the United States for more than a decade and are a central feature of British health system reform. In this paper we examine the common challenges and differences in implementation of the policy in the two countries. We use this information to explore some key questions relating to the content, target audience, and use of published information. We end by making specific recommendations for maximizing the effectiveness of public reporting.

Community Participation↗