The future of pathology services in the NHS is currently underconsideration. Recent developments in diagnostic technologies and theirpossible impact on pathology testing in the…
Abstract
The future of pathology services in the NHS is currently under consideration. Recent developments in diagnostic technologies and their possible impact on pathology testing in the future are discussed. Trends and patterns of demand for all three main pathology specialties are analysed over the 12‐year period, 1974‐86. The inflation‐adjusted, revenue cost of pathology testing per hospital admission (excluding capital costs) is shown to have fallen in real terms over this period, although it is uncertain whether this would still be the case were capital costs to be included. In the hospital sector, reported increases in demand can be quite simply related to increasing hospital activity by using a linear regression model. However, the very large increases in demand observed in the primary care sector cannot be related reasonably to any routinely reported practice activity indicators. The implications of this highly volatile pattern of demand in general practice are discussed, especially in relation to recent technological advances designed to produce rapid, near‐patient, surgery‐based tests. Although analysis indicates no evidence for historical technology‐induced increases in demand for laboratory services following the introduction of laboratory automation in the 1970s, the possibility of technology‐induced demand in the primary health care sector following the widespread introduction of surgery‐based tests is discussed.
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Ala Szczepura, Carol Davies, Joy Fletcher and Aziz Boussofiane
Describes the exploratory use of a statistical technique called data envelopment analysis (DEA), which has been widely used in other parts of the service sector, to measure the…
Abstract
Describes the exploratory use of a statistical technique called data envelopment analysis (DEA), which has been widely used in other parts of the service sector, to measure the efficiency of 52 general practices in three health districts, serving 378,500 patients (78 per cent of the resident population). DEA identified over half (60 per cent) of the 52 practices as less than 100 per cent efficient, with 25 per cent potentially capable of large increases in activity without higher resource levels. There was no significant relationship between efficiency and whether partnerships were training practices, computerized, holding regular meetings, or the total list size, or age structure of practice populations except that multi‐site practices were found to be significantly more efficient as list size increased. DEA efficiency ratings were compared with a proxy for effectiveness (the ability of practices to reach target levels set in the new GP contract). Practices which were below target levels before the new contract was introduced were far less likely to be able to reach these targets once the contract was in place if they had been classified by DEA as 100 per cent efficient (i.e. judged to be unable to achieve greater outputs without increased resources). More research effort now needs to be devoted to exploring the use of DEA in measuring efficiency in general practice, and to examining the relationship between measures of efficiency and effectiveness in primary care.
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Considers the changes which are being implemented in primary care, and the patterns which are now beginning to emerge. Examines the changing context within which practices now…
Abstract
Considers the changes which are being implemented in primary care, and the patterns which are now beginning to emerge. Examines the changing context within which practices now function (both political and managerial), and considers the power which GPs are beginning to exert, as well as the impact which they may have on the interface between primary and secondary care. Examines the systems being developed for assuring quality in general practice. Predicts an explosion in the need for appropriate information for management and for medical audit in UK primary care, because the context within which general practitioners (GPs) deliver primary care in the NHS is changing rapidly. It is only now becoming evident that this turbulence may well offer major new opportunities to GPs, as well as permanently altering the balance of power in the NHS between primary and secondary care.
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Vassilios P. Aggelidis and Prodromos D. Chatzoglou
It is widely accepted that the use of information and communication technology (ICT) in the healthcare sector offers great potential for improving the quality of services…
Abstract
Purpose
It is widely accepted that the use of information and communication technology (ICT) in the healthcare sector offers great potential for improving the quality of services provided, the efficiency and effectiveness of personnel, and also reducing organizational expenses. This paper seeks to examine various hospital information system (HIS) evaluation methods.
Design/methodology/approach
In this paper a comprehensive search of the literature concerning the evaluation of complex health information systems is conducted and used to generate a synthesis of the literature around evaluation efforts in this field. Three approaches for evaluating hospital information systems are presented – user satisfaction, usage, and economic evaluation.
Findings
The main results are that during the past decade, computers and information systems, as well as their resultant products, have pervaded hospitals worldwide. Unfortunately, methodologies to measure the various impacts of these systems have not evolved at the same pace. To summarize, measurement of users' satisfaction with information systems may be the most effective evaluation method in comparison with the rest of the methods presented.
Practical implications
The methodologies, taxonomies and concepts presented in this paper could benefit researchers and practitioners in the evaluation of HISs.
Originality/value
This review points out the need for more thorough evaluations of HISs that look at a wide range of factors that can affect the relative success or failure of these systems.
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Marcello Bertotti, Ifeoma Elizabeth Dan-Ogosi and Mala Rao
Workplace well-being is key to improving health and therefore productivity. Although the Chinese population and their influence on business in the UK are growing rapidly, little…
Abstract
Purpose
Workplace well-being is key to improving health and therefore productivity. Although the Chinese population and their influence on business in the UK are growing rapidly, little is known about the attitudes of Chinese employers and employees towards workplace well-being. The paper aims to discuss this issue.
Design/methodology/approach
The authors conducted a qualitative study to explore the views of Chinese employees and employers in London and interviewed occupational health and workplace well-being experts.
Findings
Employers’ understanding of workplace well-being was limited, their approach was reactive rather than proactive. Contextual factors hampered most efforts towards workplace well-being. Employees reported that working conditions were generally poor with likely implications for employees’ physical and mental health. Generational and migratory changes further complicate the scenario but potentially usher in positive change.
Research limitations/implications
This study was conducted in a London area with a high density of Chinese businesses. The study nevertheless covered only a limited selection of business sectors. Caution may therefore be necessary in assuming the transferability of these findings to other parts of the UK.
Practical implications
Chinese businesses are agreeable to being informed about and considering the business case for workplace well-being. Chinese workers need better working conditions, easier access to health services preferably delivered through Chinese-based networks of community and business associations which are trusted by both employers and employees.
Originality/value
This study offers novel evidence on the attitude of Chinese employers and employees towards workplace well-being by comparing views from both groups. Chinese people face considerable health and mental health problems through their work environment, in contrast with conclusions from the Health Survey for England and Labour Force Survey.
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Joanne Crawford, Farah Ahmad, Dorcas E. Beaton and Arlene S. Bierman
The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South Asian…
Abstract
Purpose
The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South Asian (SA) immigrants.
Design/methodology/approach
Six focus groups conducted in English, Punjabi, and Urdu were held with 42 SA immigrants, 50-74 years old and at average risk for CRC, from November 2012 to May 2013. All focus group discussions were audio-taped and transcribed verbatim. Data analysis used an inductive and systematic approach employing constant comparison techniques.
Findings
Three dominant themes emerged. Beliefs and attitudes towards cancer and screening represented SA immigrant’s perceptions that early detection was beneficial; screening was not necessary in the absence of symptoms; cancer was scary; and the loss of previously established bowel practices upon immigration as potential risks for CRC. Knowledge and awareness focused on unscreened participants’ cancer stories; screened participants’ knowledge of CRC, risk factors, and screening; experiential learning from focus groups; and screened participants’ strategies to promote screening. Support and accessibility concentrated on physician support and responsibility to provide information, explanation, and recommend screening to facilitate access.
Originality/value
Findings provide novel insights on socio-cultural context, beliefs, and barriers to CRC screening among SA immigrants. Culturally appropriate community-based strategies included story-telling, the use of social networks, and greater physician engagement. Enhancing collaborative partnerships with physicians and public health may minimize structural barriers and reduce health disparities. Future research could explore effectiveness of outreach strategies including these collaborations.
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Deidre Wild, Ala Szczepura, Clive Bowman, Angela Kydd and Richard Wallis
– The purpose of this paper is to place the future development of technology within the existing reality of the diversity of care homes.
Abstract
Purpose
The purpose of this paper is to place the future development of technology within the existing reality of the diversity of care homes.
Design/methodology/approach
Using the findings from a learning exercise, the paper illustrates “diversity” in terms of the meaning staff, relatives, and residents attach to the words “care home”. This tri-partite approach provides a basis for exploring types of technology that could, if appropriately introduced, prove to be of benefit to the different users and staff.
Findings
Technology is more likely to be “fit for purpose” when it has been developed jointly with those who work, live in, and who visit care homes. Costs and benefits will be issues to be taken into account.
Research limitations/implications
A lack of research evidence on the role of technology in care homes was a key limitation. In future, research should adopt a co-production approach to technology development.
Practical implications
The authors take a pragmatic stance that if due care is taken in preparations for and the introduction of technology, this would increase uptake of technology to meet different needs.
Social implications
The paper makes the points that: older people can learn new technological skills; the concept of care homes as user-led is in accord with increased opportunity to engage residents in new technology. Technology in care homes while posing challenges also could prove to be a major lucrative market.
Originality/value
By triangulating the perspectives of residents, relatives, and staff the authors hope to have presented a realistic and evidence-based overview of the potential for technology advancement in care homes.
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Chih Sin, Ayesha Janjua, Annie Hedges, Chloe Cook and Joanna Sloman
The National Health Service Breast Screening Programme set up 20 years ago in the UK has to evolve continuously to meet changing needs as a result of fundamental transformations…
Abstract
The National Health Service Breast Screening Programme set up 20 years ago in the UK has to evolve continuously to meet changing needs as a result of fundamental transformations in the age and ethnic profile of the population. This article draws on evidence generated as part of the Healthcare Commission's national study aimed at identifying issues that may contribute to different groups not having equal access to, experience of, or outcomes from services relating to breast screening and breast cancer treatment. Findings indicate that ethnicity has an effect on the awareness of services and of breast cancer. Access to screening and the experience of screening and treatment are influenced by the interaction of ethnicity with age. Younger women from certain black and minority ethnic groups face particular barriers. There can be additional barriers experienced by those from linguistic minorities. Equality of access, experience and outcomes does not mean treating everyone the same way.
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Chantal Baril, Viviane Gascon, Liette St-Pierre and Denis Lagacé
– The purpose of this paper is to study a medication distribution technology's (MDT) impact on medication errors reported in public nursing homes in Québec Province.
Abstract
Purpose
The purpose of this paper is to study a medication distribution technology's (MDT) impact on medication errors reported in public nursing homes in Québec Province.
Design/methodology/approach
The work was carried out in six nursing homes (800 patients). Medication error data were collected from nursing staff through a voluntary reporting process before and after MDT was implemented. The errors were analysed using: totals errors; medication error type; severity and patient consequences. A statistical analysis verified whether there was a significant difference between the variables before and after introducing MDT.
Findings
The results show that the MDT detected medication errors. The authors' analysis also indicates that errors are detected more rapidly resulting in less severe consequences for patients.
Practical implications
MDT is a step towards safer and more efficient medication processes. Our findings should convince healthcare administrators to implement technology such as electronic prescriber or bar code medication administration systems to improve medication processes and to provide better healthcare to patients.
Originality/value
Few studies have been carried out in long-term healthcare facilities such as nursing homes. The authors' study extends what is known about MDT's impact on medication errors in nursing homes.
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Benjamin Sunday Uzochukwu, Chinyere Cecilia Okeke, Joyce Ogwezi, Benedict Emunemu, Felicia Onibon, Bassey Ebenso, Tolib Mirzoev and Ghazala Mir
The importance of social exclusion and the disadvantage experienced by many minority ethnic and religious populations are rooted in SDG 10. To address this exclusion effectively…
Abstract
Purpose
The importance of social exclusion and the disadvantage experienced by many minority ethnic and religious populations are rooted in SDG 10. To address this exclusion effectively it is important to understand their key drivers. This paper aimed to establish the key drivers of exclusion and their outcomes in Nigeria.
Design/methodology/approach
The methods involved a scoping review of literature and stakeholder workshops that focused on drivers of social exclusion of religious and ethnic minorities in public institutions.
Findings
At the macro level, the drivers include ineffective centralized federal State, competition for resources and power among groups, geographic developmental divide and socio-cultural/religious issues. At the meso-level are institutional rules and competition for resources, stereotypes and misconceptions, barriers to access and service provision. At the micro-level are socio-economic status and health-seeking behaviour. The perceived impact of social exclusion included increasing illiteracy, lack of employment, deteriorating health care services, increased social vices, communal clashes and insurgencies and vulnerability to exploitation and humiliation. These drivers must be taken into consideration in the development of interventions for preventing or reducing social exclusion of ethnic and religious minorities from public services.
Originality/value
This is a case of co-production by all the stakeholders and a novel way for the identification of drivers of social exclusion in public services in Nigeria. It is the first step towards solving the problem of exclusion and has implications for the achievement of SDG 10 in Nigeria.