Biomedical subjects
Publications and source records attributed to P Spurgeon.
A survey of all 47 trusts in the West Midlands found that clinical governance had not been advanced beyond the production of strategies, establishing committees and appointing leads. There is little evidence of the cultural change clinical governance requires. Clinical governance has yet to make a real difference at the clinical workface.
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The role of the chief executive in a transformed organisation is an extremely challenging one. The development of vision, building a commitment to it and communicating it constantly are key skills for a chief executive. However, the need to build and empower the stakeholders within and outside the organisation to support the changes required to deliver the vision requires leaders who can connect with a wide range of people and build alliances and partnerships to secure organisational success. A passion for understanding human intervention and behaviour is needed to encourage, cajole and drive teams and individuals to own and commit to change and a new direction. This requires leaders who have imagination and creativity--who seek connections and thread them together to create order out of incoherence. These skills are not taught in schools or textbooks, but are probably innate. They are what separate leaders from the rest. These skills need to be developed. A movement towards encouraging experimentation, career transfers and more individuality is needed if capable leaders of the future are to appear.
The development of NHS trusts has been a major part of the NHS reforms in the United Kingdom. The creation of trust boards has coincided with significant pressures from the combined forces for change and consolidation within publicly financed health care in the UK. The development of a long term strategic vision for trusts to ensure long-term survival is imperative. Considers evidence from international researchers and translates this into the context of NHS trusts. Discusses how they define and identify vision and ensure that vision building can be communicated and understood by key stakeholders within and outside the organization. Offers several practical suggestions on how their vision can be monitored and evaluated within the organization.
AIMS/BACKGROUND: Geographical variations in health care are common. There is, however, no simple explanation for why they arise. Variations in rates of ophthalmic surgery in the population aged 65 and over were investigated, with the aim of determining their cause. METHODS: Routine data sources were used to obtain the 1991-2 age and sex standardised rates for English health districts with an ophthalmic unit. Weighted least squares regression was used to study the relation between these rates and various factors describing the population and the provision of care. RESULTS: Surgery rates varied more than threefold. High rates of surgery were associated with high throughput and bed numbers (both p < 0.001), high proportions of day case surgery (p < 0.001), long waiting lists (p < 0.001), and a high number of theatre sessions (p = 0.002). Conversely, a high percentage of emergency admissions was associated with lower rates of surgery (p = 0.004). These six variables accounted for 58% of the variation. CONCLUSION: Geographical variations were found to exist, less than two thirds being explained by differences in the provision of care. The remaining variation may partly be attributed to private practice and the lack of consensus for many ophthalmic procedures (the 'surgical signature'), including a lowering of the threshold for surgery. These findings have implications for the planning of ophthalmic services.
This study investigated a wide range of job-related characteristics which had the potential of acting as stressors for General Practitioners (GPs). Three hundred and four GPs completed a detailed questionnaire which sought audit information including practice workload factors, coping approaches and attitudinal information including sources of stress and the value of management training. Ten independent factors were identified as underpinning GP stress and using multi-variate analysis, it was shown that each of these factors is predicted by a separate and distinct set of variables. This finding suggests that it is inappropriate to simply talk about GP stress since it is a multi-dimensional concept. This finding has important implications for identifying potentially successful mechanisms of coping and support.
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As Hales (1986) has observed, the problem of much of the managerial research to date has been the reluctance to ask why managers behave in the way they do. The behaviour of general managers in tackling organisational change in the NHS needs to be viewed not only with respect to what is done but also with respect to how personal and organisational objectives are construed. In other words, the implementation of organisational change ultimately rests on how general managers perceive the nature of this change and their role in structuring their own personal and organisational objectives into appropriate activities. Examining the compatibility of managerial activities and the underlying values and intentions which support them is of critical importance in any cognitively-based approach. These intentions provide an important link between perceptions (i.e. how the organisation is construed) and behaviour (i.e. what activities managers choose to perform). Understanding the conceptual frameworks which underpin managerial activities could have profound implications for assessing the performance of general managers.
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A commercially available closed dialysis system and a new peritoneal cannula with potential advantages for infants have been developed. The dialysis set includes three dialysate bags that may be connected to the filling burette; the warming coil of the set is placed in a thermostatically controlled water bath. The peritoneal catheter comprises a flexible tube with side holes and a sharp short bevelled needle with obturator. Advantages of the new equipment over previously available equipment are that the cannula is easier to insert; there is less risk of contaminating the dialysate since the tubing set is unbroken from supply to cannula; the mix of the dialysate may be changed easily without interrupting dialysis; and the equipment may be assembled easily by unskilled staff.
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During 1971-5, 72 episodes of acute renal failure were treated in 70 children aged up to 16 years. The commonest causes were renal hypoperfusion (31 cases), haemolytic-uraemic syndrome (12), glomerulonephritis (9), septicaemia (5), and congenital abnormalities (6). Though referral from other hospitals was generally prompt, 10 out of 51 patients had been observed for up to seven days before transfer. Dailysis was used in 44 cases, the most common complications of which were peritonitis in those treated with peritoneal dialysis and acute changes in fluid balance in those treated with haemodialysis. Altogether 37 patients fully recovered, 10 were discharged with chronically impaired renal function, 17 died, and six entered the dialysis and transplantation programme. The mortality fell from 33% in 1972 to 20% in later years, which was due solely to maintenance dialysis being available. Though all patients with irrevocable kidney failure who were suitable entered the dialysis and transplantation programme, with current financial restrictions we doubt whether we shall be able to find places for all such patients in the future.
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