Julie Ashford, Martin Eccles, Senga Bond, Jesley Ann Hall and John Bond
The drive towards clinical effectiveness and cost‐effective care within the NHS is becoming increasingly apparent. Consequently, there is a need to change clinical practice, and a…
Abstract
The drive towards clinical effectiveness and cost‐effective care within the NHS is becoming increasingly apparent. Consequently, there is a need to change clinical practice, and a set of activities with which to implement the necessary and desirable changes is required. Resistance to accepting change at an individual and organisational level is common and it is postulated that the solution lies in adopting an eclectic approach where the range of factors affecting the implementation of change is considered. A possible framework for identifying suitable behaviour change strategies is proposed. Factors included are the context of change, the relevant theoretical and empirical literature and the implementation and maintenance of change. With practical application in mind, the framework is intended as a tool to assist health care professionals analyse the change process in a structured manner and develop potential strategies for achieving desirable behaviour changes within their own and others’ practice.
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Lynne Corner, Richard Curless, Stuart Parker, Martin Eccles, Barbara Gregson, John Bond and Oliver James
Clinical guidelines have been identified as key components of improving clinical effectiveness. Local development of national guidelines is advocated to ensure that…
Abstract
Clinical guidelines have been identified as key components of improving clinical effectiveness. Local development of national guidelines is advocated to ensure that recommendations are relevant to local needs and context. This paper discusses the methods used in adapting national guidelines for geriatric day hospitals for use in the Northern and Yorkshire Region, and highlights differences between guidelines developed at national and regional levels.
The transition from comprehensive school to either an academic or a vocational track and from academic track to tertiary education are the key educational transitions during…
Abstract
The transition from comprehensive school to either an academic or a vocational track and from academic track to tertiary education are the key educational transitions during adolescence and young adulthood in many European educational systems. The present chapter approaches engagement and disengagement during these key educational transitions in the context of the 4-C (channelling, choice, co-regulation, compensation) life-span model of motivation and phase-adequate engagement model. In accordance with the life-span model of motivation and the phase-adequate engagement model, school transitions are triggers that channel the engagement and disengagement processes. The former process reflects school-related engagement, whereas disengagement is a key element of the school-burnout process. Engagement in the school context is defined as a positive, fulfilling work-related state of mind characterized by vigor and energy, dedication, and absorption. School burnout comprises three dimensions in terms of exhaustion due to school demands: a cynical and detached attitude toward the school, feelings of inadequacy as a student, and disengagement. Cynicism is manifest in an indifferent or distal attitude toward school work in general, a loss of interest in it, and not seeing it as meaningful. Inadequacy refers to a diminished sense of competence, achievement, and accomplishment as a student.
This paper describes the implementation of a clinical guideline across three acute Trusts. A Clinical Effectiveness Steering Group identified prevention of venous thromboembolism…
Abstract
This paper describes the implementation of a clinical guideline across three acute Trusts. A Clinical Effectiveness Steering Group identified prevention of venous thromboembolism as a health priority. A local guideline development group adapted the recommendations of an existing review and produced a local guideline. Then, a multidisciplinary implementation group developed the practical aspects of implementing guidelines into routine daily practice. They identified appropriate staff to carry out risk assessment and to administer appropriate prophylaxis, as necessary. They also produced a “guideline pack” containing a training resource manual and implementation aids. Following this a multiple strategy implementation programme was used to introduce the guidelines, and an evaluation was carried out eight to ten months after the introduction of the guidelines. The evaluation identified a number of areas for improving current practice. Guideline implementation is a complex, time‐consuming process.
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This paper describes the implementation of a clinical guideline across three acute Trusts. A Clinical Effectiveness Steering Group identified prevention of venous thromboembolism…
Abstract
This paper describes the implementation of a clinical guideline across three acute Trusts. A Clinical Effectiveness Steering Group identified prevention of venous thromboembolism as a health priority. A local guideline development group adapted the recommendations of an existing review and produced a local guideline. Then, a multidisciplinary implementation group developed the practical aspects of implementing guidelines into routine daily practice. They identified appropriate staff to carry out risk assessment and to administer appropriate prophylaxis, as necessary. They also produced a “guideline pack” containing a training resource manual and implementation aids. Following this a multiple strategy implementation programme was used to introduce the guidelines, and an evaluation was carried out eight to ten months after the introduction of the guidelines. The evaluation identified a number of areas for improving current practice. Guideline implementation is a complex, time‐consuming process.
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John H. Parr, Colin Bradshaw, Wendy Broderick, Harold Courtenay, Martin Eccles, Eileen Murray, Joan Royle and Paula Whitty
Following a high‐profile publicity campaign across South Tyneside aimed at professionals and patients, 52.4 per cent of all patients admitted with suspected myocardial infarction…
Abstract
Following a high‐profile publicity campaign across South Tyneside aimed at professionals and patients, 52.4 per cent of all patients admitted with suspected myocardial infarction during a six‐month period received 300mg of aspirin. Twelve months later GPs’ performance had improved from 25 per cent to 52.9 per cent of patients directly admitted by GPs being prescribed aspirin when first seen. Following a definite myocardial infarction 78.4 per cent of patients were discharged taking 75mg of aspirin, with no valid reason for omission in 6.6 per cent of patients. Six months after discharge 71.8 per cent of patients were still taking aspirin. Twelve months later 90 per cent of discharged patients were taking aspirin. GP PACT data showed a marked increase in prescribing 75mg aspirin during the period. The use of a publicity campaign to disseminate the message to both professionals and patients has resulted in a beneficial increase in aspirin prescribing for myocardial infarction across the district.
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John Newton, Martin Eccles and Jennifer Soutter
Presents the results of a literature review on general practice partnerships. The objective was to find out what has been written and by whom. The results of the review indicate…
Abstract
Presents the results of a literature review on general practice partnerships. The objective was to find out what has been written and by whom. The results of the review indicate that very little empirical work has been carried out and most of the publications are by doctors addressing the practical problems of working in partnerships. Given this paucity of material, goes on to discuss relevant literature from social science disciplines and presents five perspectives on partnerships. Each perspective yields questions worthy of further investigation particularly at a time when primary care is experiencing rapid change and development.