Deidre Wild, Sara Nelson and Ala Szczepura
A three‐year in‐depth study has examined three models to improvecare in residential homes for older people in England. The study showed that each aimed to provide a ‘home for…
Abstract
A three‐year in‐depth study has examined three models to improvecare in residential homes for older people in England. The study showed that each aimed to provide a ‘home for life’ for residents. Using multi‐source data gained from a range of qualitative and quantitative methods involving residential home managers, care staff and extensive review of documentation related to key care functions, inhibitors and enhancers to the achievement of this aim were identified. Inhibitors were lack of available top‐up funding to meet increased care needs, care staff's inadequate knowledge of behaviour‐disordered residents, workload, cross‐sector barriers and environmental problems. Among the enhancers were flexible regulation, up‐skilling of care staff, care staff's achievement in palliative care, perceived avoidance of hospital admission, and sound practice‐led relationships with nurses. The implications for practice are of relevance to policy makers, educators, community health and social care professionals, and older residents, their relatives and representative organisations.
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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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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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Carol Davies, Joy Fletcher, Ala Szczepura and John Wilmot
Since 1990, the changes introduced in UK general practice, such as fund holding and national incentives, have altered the process of care. Audit, defined as “the systematic…
Abstract
Since 1990, the changes introduced in UK general practice, such as fund holding and national incentives, have altered the process of care. Audit, defined as “the systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for patients”, is one method of monitoring change and raising standards. Presents a successful co‐ordinated audit in Warwickshire, 1991‐1993, involving 53 general practices. Highlights the influence of attitudes and communications within practices on the success of audit strategies. Associates aspects of practice culture, such as team working and decision‐making processes, with successful audit. Postulates six descriptive practice types, largely related to cultural factors. Suggests that if cultural factors within practices are identified, external assistance with audit may be more focused and effective.