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At least 307 records · Page 17Linked to original sources
PubMed1998

Between physician and manager: new co-operation models in Dutch hospitals.

Analyses the way hospital organisation models handle the relationship between medical specialists and hospital management. All models that have been developed during the last ten years seek to integrate the medical specialists in the hospital organisation by formally subordinating them to the hospital management. However, recently a new model has come to the fore--the "co-makership"--in which the hospital management and the medical specialists are assigned a position alongside each other.

Cooperative Behavior↗
PubMed2001

Strategic alignment between senior and middle managers in local government and health.

The North West Change Centre at Manchester Business School has been developing collaborative programmes aimed at public sector middle managers. Evaluation recently completed, using follow-up interviews, studied the affect of the programmes on individuals, their organisation and their work intra-organisationally. Reference is made to management theories on strategic alignment and cultural change. The results suggest that middle managers have been highly satisfied resulting in changed attitudes, greater confidence and worked-through project ideas being developed. However, a sense of being "out of alignment" with their organisation remains manifested in poor support for inter-agency working. A model of strategic alignment between middle and senior managers is demonstrated which illustrates the affects of strong and weak alignment and the implications for implementing modernised services. Recommendations are made on contextualising change, how managerial signalling can be improved, how pathways to changed organisational systems can be identified and how barriers to change can be overcome.

Consumer Behavior↗
PubMed2005

Beyond strategy: exploring the brokerage role of facilities manager in hospitals.

PURPOSE: Seeks to explore the brokerage role of facilities manager in hospitals, based on the premise that facilities management (FM) is largely concerned with "strategic brokerage". Strategic brokerage is the term coined by Akhaghi to explain the integration of a wide range of support services to ensure the effective operation of the core business of an organization. DESIGN/METHODOLOGY/APPROACH: The research was conducted in the health service sector using a single case study approach to examine the brokerage potential for FM in a hospital in the Sydney Metropolitan area. A social network analysis technique was used to identify and analyse the communication networks of players in a hospital environment. Two general questions guided the analysis. First, what is the brokerage potential within the FM process? Second, where are the opportunities for brokerage? FINDINGS: The results indicate that identifying relationship linkages between different functional units can create potential brokerage opportunities. ORIGINALITY/VALUE: The proposition is made that viewing FM from a brokerage perspective can add value to the delivery of health-care services.

Cooperative Behavior↗
PubMed2001

The partnership imperative: joint working between social services and health.

This paper explores the partnership between social services and primary care, in one geographical area, in relation to five potential types of obstacle: structural; procedural; financial; professional; and status and legitimacy. It examines the theory of partnership and the Government's attitude towards it. It uses semi-structured interviews with a range of stakeholders to study partnership in practice. Finally, it highlights some of the challenges for the future.

Cooperative Behavior↗
PubMedDate not supplied

An evaluation of the contribution of critical care outreach to the clinical management of the critically ill ward patient in two acute NHS trusts.

This paper reports on an evaluation of the role and contribution of outreach in the management of the critically ill ward patient using Stake's Responsive Model (Stake, 1975) and case study methodology (Simons, 1980). Twenty cases were examined, purposefully sampling all staff involved in the case identified by an initial interview with the outreach nurse. In total, 80 interviews were carried out, 20 with the outreach nurses and 54 with other members of health care teams involved in the cases, and six further targeted in-depth interviews with senior anaesthetic and nursing staff. The outreach contribution which emerged from the data analysis consisted of four core categories: action (getting things done, getting decisions made and following through), focus and vision (concentrating on one patient and having a vision of what action was needed to meet their care needs), orchestration (a communication and co-ordinating role) and expertise (bringing critical care skills and experience to the bedside). These categories were validated and developed in the six in-depth interviews. Three themes emerged from the data describing aspects of the acute care context in which outreach operates. The interviews revealed a battleweary workforce overwhelmed by the complex and increased demands of the critically ill ward patient. The medical and nursing teams at the bedside are inexperienced and often unsupported by senior clinical decision-makers. This is dealt with by 'passing the buck' creating gaps and delays in care management which are the problems addressed by the outreach contribution. Outreach may solve problems for the critically ill ward patient, but the underlying causes remain poorly understood.

Acute Disease↗
PubMedDate not supplied

The nursing role in ICU outreach: an international exploratory study.

It is widely acknowledged that many critically ill patients are managed outside of designated critical care units. One strategy adopted in Australia and England to assess and manage risk in these patients is the intensive care unit (ICU) outreach or liaison nurse service. This article examines how ICU outreach/liaison roles in Australia and England operate in the context of Manley's theoretical framework for advanced nursing practice. Descriptive case study design using semi-structured interviews and job descriptions as sources of evidence. Findings of interviews with six Australian ICU Liaison nurses are already published; this study replicated the Australian study with four ICU Consultant Nurses in England and mapped interview and job description data from both countries onto Manley's conceptual framework for advanced practice/consultant nurse. Four themes emerged from the English data: patient interventions, support for ward staff, liaison between ward and ICU staff and hospital-wide impact. The first three of these comprised the core service common to the roles in both countries. Manley's four subroles (expert practitioner, consultant, educator and researcher) were present across both countries. However, the interview and job description data demonstrated that there were lower expectations in Australia that the roles would lead to staff development and build capacity across the hospital system. Similarly, formal education for ward staff such as ALERT and CRiSP courses were more developed in UK. Our data demonstrate that the role undertaken in England and Australia is sufficiently comparable to use as a research intervention in international studies across the two countries. However, the macro service level differs. Job descriptions across both countries emphasized the need to influence hospital policy; however, the ICU consultant nurses in England might be considered better placed to achieve this through role title and access to the hospital executive. In both countries, the roles would benefit from systematic evaluation of the impact on outcomes. This is particularly important for longer-term integration of the role in the health services in both countries.

Aftercare↗
PubMedDate not supplied

Schools in the welfare network.

This paper examines the place of schools within the welfare network for children and young people, and notes potentially disfunctional elements of the social division of welfare. The stratification between welfare professions and the relationship between normal and crisis care is discussed. Three levels of school based welfare systems are identified, working alongside school attached and community based professions, each with its own characteristics. Trends are identified which reflect the development of more effective multi-professional cooperative care.

Communication↗
PubMed2006

Nurses', midwives' and health visitors' involvement in cross-boundary working within child health services.

BACKGROUND: Cross-boundary working is a key policy objective. Cross-boundary working provides the foundation for high quality provision across child health services and is imperative for an effective child protection system and the support of children and young people with health needs. METHODS: Two participative conferences were attended by 113 stakeholders utilizing the World Café focus group method. Most (87%) of the sample were nurses, midwives or health visitors. RESULTS: Many examples of cross-boundary working were identified across the different areas of practice. Remarkably few transdisciplinary examples were identified in contrast to the number of inter-agency examples. Intra-organizational boundaries across the health service were also noted. CONCLUSIONS: Considerable cross-boundary working was reported but transdisciplinary working is not yet well established across all areas of child health provision.

Child↗
PubMed2004

Guidelines on the role of the specialist nurse in supporting patients with lung cancer.

Recently, there has been a significant increase in the number of nurse specialist posts working with patients with lung cancer in the UK. This has been in response to a recognized need to improve lung cancer services. However, there is concern that these posts have been developed quickly with little strategic planning or evaluation. This paper is a collaborative project by the members of The London and South East Lung Cancer Forum for Nurses and aims to offer guidelines to managers and practitioners on areas where improvements may be made in the care of patients with lung cancer. Recommendations are based on Government guidelines, evidence from recent research studies and the experience of the members of the Forum.

Communication↗
PubMed2007

Evaluating partnership working: lessons for palliative care.

Partnership working in palliative care is being increasingly promoted as the solution to poorly coordinated health and social care services. A key example is the UK National Institute for Clinical Excellence (NICE) guidance on supportive and palliative care. However, partnerships have costs in negotiating, developing and maintaining working relationships and translating these into successful outcomes, so may not always be the best or most effective method of service improvement. This article explores structural, procedural, financial, professional and legitimacy barriers to partnership working. We conclude that these five barriers could be sufficient to destroy emerging partnerships. Nowhere in the NICE guidance on supportive and palliative care are such barriers acknowledged. We suggest that current and projected palliative care partnerships should be critically evaluated against both process and outcome success criteria. Such evaluations must be integral to partnerships, to learn about what makes an effective palliative care partnership, and what affects partnerships have on patient care and outcomes. Partnerships may not be the panacea for issues of fragmentation, and should not be the only solution considered. Lessons should be learnt from the UK's promulgation of partnerships to ensure that these are used appropriately and only where patient benefit can be anticipated.

Delivery of Health Care↗
PubMed1992

An interpersonal-epistemological curriculum model for nurse education.

This paper proposes a curriculum model for nurse education which holds forms of knowledge and interpersonal relationships as key issues if nurse education is to develop autonomous, reflective, critical practitioners. By adopting areas of cognitive interest, principles of andragogy and the concept of reflection-in-action, the model provides a heuristic tool which attempts to enable the provision of a nurse education which is devoted to adult learning processes and relevant to the development of education in the practice setting. The technical, practical and emancipatory areas of cognitive interest provide an understanding of learning domains which require different knowledge bases, methods of learning and forms of assessment to each other. The pedagogy/andragogy dichotomy is presented to reflect two teaching paradigms. The former approach is derived from the activity of teaching children and provides for passive dependence. The latter is more appropriate to adult learning and student self-direction. The model attempts to promote the transitional dynamic which moves the student nurse toward a state of greater self-direction. Finally, the concept of reflection-in-action is discussed in an attempt to ensure that the areas of cognitive interest and the learning strategies are inextricably linked to the practice component of a professional nurse education. All three dimensions are combined to show how each should develop in unison as the professional education of the nurse proceeds along a chronological dimension.

Clinical Competence↗
PubMed1994

An evaluation of communication strategies during the process of incorporating a college of health studies into a university.

This paper reports on an evaluation of communication strategies employed by management during the incorporation of a college of health care studies as a new faculty of a university. Mindful of the stress and anxiety that organizational change can evoke, from the earliest stages of the projected incorporation senior managers at the college and the university employed a wide variety of methods to communicate to staff in the college the changes that were in progress and at the same time to set up mechanisms for evaluating the effectiveness of the communication. The method of inquiry was a questionnaire to all the staff of the college in March and June of the year preceding incorporation. This was supported by interviews with a 10% sample of the college to explore in greater depth issues identified in the questionnaires. The findings indicated that in general communication had been perceived as effective; and that of the various methods used the two most valued by staff were: (a) a regular newsletter; and (b) an advisory and consultative committee of staff drawn from all areas of the work of the college up to and including senior lecturer.

Administrative Personnel↗
PubMed2006

Conflict within nursing work environments: concept analysis.

AIM: The aim of this paper is to examine the concept of conflict in nursing work environments using the evolutionary approach to concept analysis. BACKGROUND: In nursing work environments, conflict among nurses is becoming a significant issue resulting in job dissatisfaction, absenteeism, and turnover. Although discussed frequently in the nursing literature, nursing research has focused predominantly on conflict management without first understanding the elements, causes and effects of conflict. METHODS: A literature search was conducted using CINAHL, Proquest, PsychINFO, Social Sciences Index and MEDLINE databases and the keywords conflict and work environment. Articles over the last 25 years from each of these databases were examined to identify major themes, areas of agreement and disagreement across disciplines, changes in the concept over time, and emerging trends. FINDINGS: Conflict is a multidimensional construct with both detrimental and beneficial effects. Most definitions agree that conflict is a process involving two or more people, where a person perceives the opposition of the other. Antecedents stem from individual characteristics, interpersonal factors, and organizational factors. Individual effects, interpersonal relationships, and organizational effects are the main consequences of conflict. A theoretical model of the antecedents and consequences is presented, with implications for further development. CONCLUSIONS: A more thorough understanding of the sources and outcomes of conflict within nursing work environments would enable the prevention of conflict. If properly understood and managed, conflict can also lead to positive outcomes for nurses and healthcare organizations.

Attitude of Health Personnel↗
PubMed2005

Bridging the information gap between hospitals and home care services: experience with a patient admission and discharge form.

Hospital care and ambulatory care are institutionally and financially so deeply separated in Germany that discontinuity of individual treatment and, hence, losses in both the quality and efficiency of care are all too often the consequences of this widely deplored systemic defect. In order to improve the communication between home care services and hospitals during admission or discharge of patients in need of long-term nursing care, the research project 'aski' has developed an innovative instrument and procedure for the reciprocal transfer of information between these institutions. After successful testing, the Patient Accompanying Form was offered for public use. Two years later, a written and telephone survey was conducted among the somewhat disappointingly small number of its users. Based on their experience, issues surrounding the implementation of such instruments in the health care system are discussed as well as the chances of enhancing integrative care by promoting coordinated communication between the providers.

Aftercare↗
PubMed2007

Enabling student placement through strategic partnerships between a health-care organization and tertiary institutions.

Nursing management needs to demonstrate its commitment to clinical education for undergraduate nursing students. The vision for the nursing leadership and management team at Princess Alexandra Hospital is to guide and support the development of hospital clinicians, at all levels in the organization, to effectively facilitate undergraduate students' learning during their clinical practical experiences. This paper examines the evolution of the meaning, commitment and practices that have been intrinsic to the development of strategic partnerships between the health-care organization and tertiary institutions to ensure that hospital staff who consistently facilitate student learning in the clinical context are well supported. The partnerships are based on open channels of communication between the health-care organization and the tertiary institutions whereby each party identifies its needs and priorities. This has resulted in increased hospital staff satisfaction through greater involvement by them in the placements of students, and enhanced understanding of clinicians of the student placement process that has contributed to improved satisfaction and outcomes for the students.

Attitude of Health Personnel↗
PubMed2004

Process for improving the integration of care across the primary and acute care settings in rural South Australia: asthma as a case study.

OBJECTIVE: To develop a process for improving the integration of care across the rural acute and primary care settings using asthma as a case study. METHODS: Development of the process on the analysis of case note audit, survey, interviews and a workshop. SETTING: A rural region of South Australia. RESULTS: A work plan for improving general practitioner (GP)-hospital integration was developed that resulted from analysis of the defined problem, GPs and stakeholder involvement, communication between all stakeholders, provision of an incentive to bring all the stakeholders together, and identification of evidence-based solutions. CONCLUSIONS: Managing chronic disease in a community requires the integration of care across the primary and acute care setting. To be successful, GP-hospital integration initiatives require stakeholder involvement, locally developed solutions, engagement of GPs, communication and a well-developed plan. This project provides a process for achieving this.

Acute Disease↗
PubMed2006

Interagency collaborative research projects: illustrating potential problems, and finding solutions in the nursing literature.

Collaborative research activities are increasingly being used across health-care settings and are viewed as a positive way to achieve mutual outcomes. However, interagency or intersectoral research programmes are not without problems. They are, at best, challenging and complex activities that require enormous commitment of resources, expertise and insight from all stakeholders. This paper uses the example of an actual collaborative research project to illustrate factors that can impair collaboration and in turn negatively impact on intersectoral research outcomes. It is anticipated that an honest description of those events and issues that adversely affected the programme presented here, and examination of the associated literature, will serve as a guide to others embarking on similar collaborative endeavours. This paper does not attempt to provide a full review of the comprehensive range of literature about collaboration and collaborative research; rather, it presents some key themes identified as having the potential to impact on the success of collaborative research projects. Key themes acknowledged by the authors as influencing the progress of the research project highlighted here are communication, environment, politics and power, and organizational culture.

Attitude of Health Personnel↗