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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Roger Paxton, Paula Whitty, Ali Zaatar, Andrew Fairbairn and Jane Lothian
The purpose of this article is to clarify the distinction between research and audit, and propose appropriate regulatory arrangements for audit and related activities.
Abstract
Purpose
The purpose of this article is to clarify the distinction between research and audit, and propose appropriate regulatory arrangements for audit and related activities.
Design/methodology/approach
The methods used were literature reviews and conceptual analysis.
Findings
Research and audit overlap in various ways, but differ in terms of their purposes and the risks likely to be encountered and distinguished, along with a third related category of activities called quality improvement.
Practical implications
Appropriate regulatory arrangements are proposed for audit and quality improvement activities. Using these should ensure appropriate ethical standards and risk management, while avoiding the time‐consuming over‐regulation that occurs when projects are unnecessarily submitted to the ethical scrutiny appropriate for research projects.
Originality/value
Gives suggestions and information that could be of great value in spreading service improvement.
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Paula Whitty, Ruth Thomas and Jeremy Grimshaw
Discusses the feasibility of disseminating and implementing guidelines in routine practice, informed by discussions with senior actors in the field of guidelines implementation…
Abstract
Discusses the feasibility of disseminating and implementing guidelines in routine practice, informed by discussions with senior actors in the field of guidelines implementation. Comments about the lack of protected budgets to support guideline dissemination and implementation strategies and common strategies of using “soft money” or resources for specific initiatives to support such activities. The “opportunity costs” of strategies need to be considered. In addition there are implications for the implementation of the NHS information strategy. For clinical governance as a whole, not only is it likely that widespread cultural change is required, but also the capacity of the system still needs considerable expansion if sufficient educational activities are to become routine.
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David J. Hunter, Jonathan Erskine, Adrian Small, Tom McGovern, Chris Hicks, Paula Whitty and Edward Lugsden
The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a…
Abstract
Purpose
The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended.
Design/methodology/approach
The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.’s “receptive contexts for change” and four of the eight factors stood out as especially important and form the basis of the paper.
Findings
The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very same pressures. Yet, despite having an enormous influence on health policy, the political context is frequently avoided in research or not regarded as instrumental in determining the outcomes in respect of transformational change.
Research limitations/implications
The chief limitation is the credibility and authenticity of the interviews captured at particular points in time. These formed the datebase for subsequent analysis. The authors sought to guard against possible bias by supplementing interviews with observational studies and focus groups as well as running two dissemination events at which emerging findings from the study were subjected to independent external scrutiny and comment. These events provided a form of validation for the key study findings.
Practical implications
The research findings demonstrate the importance of context for the likely outcome and success of complex transformational change initiatives. These require time to become embedded and demonstrate results especially when focused on changing culture and behaviour. But, in practice, allowing sufficient time during which the organisation may remain sufficiently stable to allow the change intervention to run its course and become embedded and sustainable is highly problematic. The consequence is that bold and ambitious efforts like the NETS are not given the space and stability to prove themselves. Too often, politics and external environmental pressures intrude in ways that may prove dysfunctional and negative.
Social implications
Unless a different approach to transformational change and its leadership and management is adopted, then changing the NHS to enable it to appear more responsive to changing health care needs and expectations will remain a cause for concern. Ultimately the public will be the losers if the NHS remains insensitive to changing needs and expectations. The patient experience was at the centre of the NETS programme.
Originality/value
The study is original insofar as no other has sought to evaluate the NETS independently and over a reasonable time period. The research design, based on a mixed-methods approach, is unusual in evaluations of this nature. The study’s conclusions are not so original but their value lies in largely confirming and reinforcing the findings from other studies. It perhaps goes further in stressing the impact of politics on health policy and the negative consequences of constant organisational change on attempts to achieve deep change in the way the NHS is organised and led.