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Article
Publication date: 8 May 2017

Ian Callanan

340

Abstract

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International Journal of Health Care Quality Assurance, vol. 30 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 14 August 2017

Ian Callanan

382

Abstract

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International Journal of Health Care Quality Assurance, vol. 30 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 16 April 2018

Gerard Lambe, Niall Linnane, Ian Callanan and Marcus W. Butler

Ireland’s physicians have a legal and an ethical duty to protect confidential patient information. Most healthcare records in Ireland remain paper based, so the purpose of this…

628

Abstract

Purpose

Ireland’s physicians have a legal and an ethical duty to protect confidential patient information. Most healthcare records in Ireland remain paper based, so the purpose of this paper is to: assess the protection afforded to paper records; log highest risk records; note the variations that occurred during the working week; and observe the varying protection that occurred when staff, students and public members were present.

Design/methodology/approach

A customised audit tool was created using Sphinx software. Data were collected for three months. All wards included in the study were visited once during four discrete time periods across the working week. The medical records trolley’s location was noted and total unattended medical records, total unattended nursing records, total unattended patient lists and when nursing personnel, medical students, public and a ward secretary were visibly present were recorded.

Findings

During 84 occasions when the authors visited wards, unattended medical records were identified on 33 per cent of occasions, 49 per cent were found during weekend visiting hours and just 4 per cent were found during morning rounds. The unattended medical records belonged to patients admitted to a medical specialty in 73 per cent of cases and a surgical specialty in 27 per cent. Medical records were found unattended in the nurses’ station with much greater frequency when the ward secretary was off duty. Unattended nursing records were identified on 67 per cent of occasions the authors visited the ward and were most commonly found unattended in groups of six or more.

Practical implications

This study is a timely reminder that confidential patient information is at risk from inappropriate disclosure in the hospital. There are few context-specific standards for data protection to guide healthcare professionals, particularly paper records. Nursing records are left unattended with twice the frequency of medical records and are found unattended in greater numbers than medical records. Protection is strongest when ward secretaries are on duty. Over-reliance on vigilant ward secretaries could represent a threat to confidential patient information.

Originality/value

While other studies identified data protection as an issue, this study assesses how data security varies inside and outside conventional working hours. It provides a rationale and an impetus for specific changes across the whole working week. By identifying the on-duty ward secretary’s favourable effect on medical record security, it highlights the need for alternative arrangements when the ward secretary is off duty. Data were collected prospectively in real time, giving a more accurate healthcare record security snapshot in each data collection point.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 14 May 2018

Ian Callanan

375

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 20 January 2012

M. Naughton, I. Callanan, A. Guerandel and K. Malone

Medical confidentiality derives from the Hippocratic Oath and has been affirmed in most codes of professional conduct, including the Irish Medical Council's guide to professional…

765

Abstract

Purpose

Medical confidentiality derives from the Hippocratic Oath and has been affirmed in most codes of professional conduct, including the Irish Medical Council's guide to professional conduct and ethics. The Irish Data Protection Act 1988 and Amendment 2003 bring this responsibility into a legal forum. The aim of this audit is to assess how comprehensively medical tutors/consultants instilled knowledge and appreciation of confidentiality and data protection to medical students in a prominent Dublin University Hospital.

Design/methodology/approach

Breaches in data protection legislation by final year medical students were identified by means of a questionnaire. Changes were made to the curriculum (presentations, notices on students' e‐learning interface and induction manual) and to the exams in psychiatry, to increase awareness of data protection legislation. Students at the same point in their education were re‐assessed one year later to see if the interventions were helpful in increasing knowledge and improving adherence to data protection legislation.

Findings

Significant breaches of the data protection legislation at baseline and follow up were identified. Examples include: “Data shall be kept for one or more specified, explicit and legitimate purposes” – when asked if they would inform patients that assessments were for submission of a case report, 44 per cent at baseline and 56 per cent at follow‐up said yes. “Appropriate security measures shall be taken against unauthorised access” – 52 per cent password‐protected their computer at baseline and 59 per cent did at follow‐up. Of those that had no password protection at baseline, 70 per cent of their computers were used by others, with little change in this at follow‐up (68 per cent). At baseline 52 per cent kept a copy of reports on USB devices compared to 46 per cent at follow‐up. 26 per cent admitted to losing a USB device in the past. “Data should not be kept longer than is necessary for that purpose” – 63 per cent admitting keeping electronic copies of case reports on their computers following submission at baseline and 64 per cent at follow‐up. “Data should be made anonymous” – 96 per cent at baseline and 100 per cent at follow‐up used initials when submitting case reports to make the data anonymous.

Practical implications

What was disappointing was that, while knowledge and awareness of obligations under data protection legislation improved following intervention, breaches in compliance still remained.

Originality/value

This is the first such audit in Ireland on the provision of educational training in the area of data protection legislation to medical students. It is likely that that such breaches by medical students reflect the tip of the iceberg in relation to probable breaches amongst registered healthcare professionals. The challenge now facing the medical profession and healthcare services is to effect behavioural change to improve compliance with data protection legislation.

Details

Clinical Governance: An International Journal, vol. 17 no. 1
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 16 April 2018

Patrick John Harnett

Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care…

1076

Abstract

Purpose

Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care.

Design/methodology/approach

This study is based on an integrative literature review on systemic improvement in healthcare.

Findings

A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics.

Practical implications

Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process.

Originality/value

Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 31 August 2012

Chris O'Riordan and Aoife McDermott

The purpose of this paper is to explore the nature and value of the clinical management role undertaken by primary care doctors in Ireland. To date, a majority of research has…

595

Abstract

Purpose

The purpose of this paper is to explore the nature and value of the clinical management role undertaken by primary care doctors in Ireland. To date, a majority of research has focused on clinical management roles in the acute sector.

Design/methodology/approach

The paper presents a sub‐set of data from a mixed methods study. In total, 14 semi‐structured interviews are drawn upon to identify the nature and value of the clinical management role in primary care.

Findings

Comparison with acute sector research identifies considerable differences in the nature of the clinical management role across sectors – and in the associated value proposition. Structural and role‐related contingencies affecting the potential value of clinical management roles in Irish primary care are discussed. Structural influences include the private ownership structure, low complexity and limited requirement for cross‐professional coordination. Role‐related influences include the primacy of the clinical identity, time constraints and lack of managerial training.

Research limitations/implications

The findings provide a limited basis for generalisation, premised on 14 interviews in one national context. However, given the international shift towards the provision of health services in primary care, they provide a research agenda for an important healthcare context.

Practical implications

The findings draw attention to the need for policy consideration of the value of the clinical manager role in primary care; how policy can support effective primary care management; and the need for specialised management training, which takes account of the small‐firm context.

Originality/value

The paper identifies that primary‐care clinical‐management roles focus on operational management and oversight and discusses the structural and role‐related factors which affect their efficacy.

Details

Journal of Health Organization and Management, vol. 26 no. 5
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 22 June 2010

Vincent Russell, Laura A. Wyness, Eilish McAuliffe and Martin Fellenz

This paper aims to explore hospital consultants' social identification, in terms of perceptions of their position in society, the salient targets for their social identification…

897

Abstract

Purpose

This paper aims to explore hospital consultants' social identification, in terms of perceptions of their position in society, the salient targets for their social identification and how this appears to influence their perceptions of management activities and change.

Design/methodology/approach

A purposeful sample of 15 hospital consultants from a wide range of specialities and work locations in Ireland were recruited. Semi‐structured, in‐depth interviews were undertaken and thematic analysis was used to interpret the interview data.

Findings

The paper finds that all interviewees perceived public attitudes towards hospital consultants, as a group, to be negative. Twelve interviewees derived most sense of belonging from group membership within their immediate work area. These groups seemed to represent sources of validation and esteem and enabled consultants to exercise control over their work. Many consultants, however, described a sense of detachment from their employing health boards. Management, as a salient target for social group identification, was perceived as associated with powerlessness and lack of respect. Interviewees generally viewed involvement in management with little enthusiasm and considerable caution.

Practical implications

This paper shows that management approaches to hospital consultants could benefit from awareness that their social identity may already be under threat. Assaults on core professional values in the communication surrounding change are likely to provoke resistance. Existing work groups, with which consultants identify, could serve as a less threatening means to engage them with issues of cost and quality than externally imposed structures.

Originality/value

This paper informs ways in which hospital consultants could be more successfully involved in health service management.

Details

Journal of Health Organization and Management, vol. 24 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 19 June 2017

Kittipong Suweero, Wutthipong Moungnoi and Chotchai Charoenngam

Building operation and maintenance (BOM) services are important activities for highly competitive businesses. In addition, outsourcing decision factors are key to the…

1152

Abstract

Purpose

Building operation and maintenance (BOM) services are important activities for highly competitive businesses. In addition, outsourcing decision factors are key to the effectiveness of BOM. Hence, the purpose of this paper is to identify and prioritize the decision factors that affect outsourcing decision factors for BOM services, to elicit the different perceptions of each managerial group (shopping centers, hotels, and hospitals), and to categorize the important outsourced BOM decision factors.

Design/methodology/approach

On the basis of the literature review, the authors observed that there are 56 outsourcing decision factors in six groups. The survey included 105 of the largest and most competitive companies in Bangkok, Thailand. The statistical methods applied were the relative importance index (RII), t-test, one-way analysis of variance (ANOVA), and factor analysis (FA).

Findings

The findings show that the three participant groups are different in some respects, as shown by their RII values. After ranking the RII values, the top 15 factors for each participant group were used to compare the participant groups using the t-test and one-way ANOVA, which confirmed their respective similarities and differences. Through an FA, the top reasons that each business outsourced BOM services were grouped into major categories.

Originality/value

The results of this research will not only facilitate an understanding of the related decision factors used by each particular business in the commercial sector but will also assist outsourcing companies in identifying and improving support services for businesses.

Details

Property Management, vol. 35 no. 3
Type: Research Article
ISSN: 0263-7472

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Article
Publication date: 31 August 2012

Liz Fulop

In many countries leadership theories and leadership development programs in healthcare have been dominated by individualistic and heroic approaches that focus on developing the…

3543

Abstract

Purpose

In many countries leadership theories and leadership development programs in healthcare have been dominated by individualistic and heroic approaches that focus on developing the skills and competencies of health professionals. Alternative approaches have been proffered but mainly in the form of post‐heroic and distributed forms of leadership. The notion of “hybridity” has emerged to challenge the assumptions of distributed leadership. The paper seeks to explore how the concept of hybridity can be used to re‐theorize leadership in healthcare as it relates to clinician managers (or hybrid‐professional managers).

Design/methodology/approach

The theoretical developments are explored and empirical material is presented from research in Australian public hospitals to support the case for the existence of hybridized forms of leadership in healthcare. The paper discusses whether hybridity needs re‐theorizing to adequately account for clinician leadership. It contributes to debates surrounding the role of clinician leadership in healthcare reform particularly in relation to those doctors who occupy management positions at the division or unit levels as distinct to CEOs. The study uses qualitative research, i.e. interactive interviews to present accounts of how healthcare professionals describe leadership. It undertakes both deductive and inductive theme analysis of the interview material.

Findings

There is support for hybridized configurations of leadership in interview materials of healthcare professionals but other aspects were also noted that cannot be explained by this approach alone.

Originality/value

The paper is the first to examine the concept of hybridity in the context of clinician leadership. Many approaches to leadership in healthcare fail to address the complexity of leadership within the ranks of clinician managers and thus are unable to deal adequately with the role of leadership in healthcare reform and change.

Details

Journal of Health Organization and Management, vol. 26 no. 5
Type: Research Article
ISSN: 1477-7266

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