Care pathways have been widely used in physical healthcare since the 1980s. Their use provides a range of benefits including more efficient treatment planning, increased use of research evidence, clinical audit, multi-professional teamwork and cost-effectiveness. Their introduction and use in mental health has been less widespread, due to the perceived lack of predictability often associated with mental disorders. However, a number of local, national and international initiatives have promoted their use, integrating either disorder (predictive) or process (benchmark) oriented approaches. Evidence from these indicates that contemporary and future mental health developments can benefit from the wider adoption of care pathways. The involvement of patients, relatives and carers, in addition to a range of emerging technologies and enhanced therapeutics, provides many opportunities to place pathways at the heart of mental health strategies. This paper describes an overview of the approach, highlights a number of models of intervention, and provides an example from the author’s own area of practice. These models relate to an implementation framework for clinicians and managers to use as a guide to challenging stereotypical or outdated organisational behaviours.
Drivers and enablers of change in healthcare: How professions matter. Ellen Kuhlmann.
Governments around the world are under pressure to make services more cost-effective and at the same time improve public safety and the quality of care. Policy makers are pursuing strategies of marketisation and managerialism coupled with consumer involvement. These policies attempt tighter control over care providers by taking away their power. This paper argues for a more dynamic approach regarding the role of the professional in changing healthcare systems. With a focus on the medical profession as the dominant player in healthcare, modernisation processes in the German health system serve as a case study to explore how professional groups matter in the changing governance of healthcare. The case study also highlights the overlapping interests of professionals and institutions. The approach described in this paper moves beyond performance and managerial regimes and brings into view a broader range of driving forces and ‘enabling players’. The paper argues that a greater variety of professional groups may create more sustainable ‘motion’ in power structures than the new managerialist regimes.
Patient choice: Friend or foe? Steve Bojakowski.
The introduction of choice into the NHS has been a major feature of the UK Government’s health policy of the past few years. This paper discusses the limits of choice, emphasising the need for clarity between the NHS and independent sector in making treatment available to those patients who choose to pay for it. The financial limit placed on the NHS, however, is one limit to choice that cannot be overcome. This will be more constrained in the future, due to the slowdown in increases in government spending on the NHS. This slowdown signals a policy shift away from individual choice to a more personal type of care through the introduction of ‘collective’ patient engagement mechanisms, introducing a patient’s ‘voice’ into the development of quality local health services. The paper concludes that how the NHS — and private providers — responds to these challenges will determine whether choice will prove to be a friend or foe.
The global economic pressures that create dissatisfaction among healthcare providers may be the same forces that will unite physicians, nurses and hospital leaders, and help them work more interdependently. All parties feel squeezed by rising consumer expectations despite stagnant or decreasing reimbursement, rising expenses and staffing shortages. Collaboration, although difficult because of differences in background, outlook and training, can help all parties survive and thrive in the future as it fosters improved care for communities.
The role of the independent sector in the provision of clinical services on behalf of the NHS in England is often misunderstood and is perceived by some stakeholders as offering the NHS little more than marginal additional capacity. Indeed, some NHS organisations have been accused of ‘obstructive, disruptive and protectionist behaviours’ towards non-traditional ‘NHS family’ service providers. This paper outlines the development of the independent sector’s role in the provision of clinical healthcare services over recent years. The first part of the paper considers the historical context, including the impact of both the changing role of the state over the past 50 years and the change of government at the end of the last century. Consideration is then given as to the position today, and the impact of current policy drivers for the use of the independent sector in the provision of NHS clinical services. The final part of the paper uses the specialty of orthopaedics, for the purposes of illustration, in order to explore the contribution of the independent sector to the delivery of the last remaining major access target, 18 weeks referral to treatment, and the development of a range of responsive services in the community.
This paper presents information from studies that found a patient-centric focus in the implementation of information communications and technology (ICT) in Europe, the Middle East and Africa. Integrating systems in a multi-vendor environment, implementing an electronic medical record (EMR) and/or its components, and replacing/upgrading/implementing inpatient clinical systems were most frequently identified as top ICT priorities for healthcare organisations. Clinical data repositories, clinical information systems and EMRs were also identified as priorities for the near future. With such a substantial focus on clinical applications, it is critical for clinicians to be involved in the ICT decision-making, implementation and governance processes. Clinicians are most likely to be involved in participating in ICT systems evaluations, exploring innovative ways to use ICT and developing/implementing clinical training programmes. While there is no shortage of applications and technologies to help make patient care safer, more effective and of better quality, there are numerous barriers to the implementation of such technology. The lack of a strategic ICT plan is most likely to be identified as such a barrier. Other barriers include vendors’ inability to deliver products in a timely fashion and lack of staffing resources. As healthcare organisations move forward, it is important that they remember that ICT is a tool to support overall business objectives, and that individuals from all areas of the organisation, particularly senior leadership and clinicians, must be involved throughout the process.
This paper considers the implementation of the Corporate Manslaughter and Corporate Homicide Act 2007 (‘the Act’) and its implications specifically for healthcare providers. The paper will describe the main provisions of the Act and provide examples of how the Act may be used by a prosecuting authority. The paper considers the effect that the Act will have upon existing health and safety legislation and concludes that no further obligations have been introduced in addition to those which already exist under health and safety legislation. Healthcare providers should concentrate on their health and safety obligations to which they should already be accustomed rather than being concerned about the consequences of the Act.
Healthcare marketing has five ‘P’s. Steven J. Gray.
This paper will explore the traditional foundation of marketing plans (McCarthy’s four ‘P’s and postulate that healthcare marketing requires an expansion of this foundation to include principles as a fundamental tenet of every healthcare business.
UK policy review. Jonathan Anscombe.
This regular column reviews the upcoming policy trends for 2008/09. After a brief review of developments in 2007, the paper explains that the ‘architectural’ reforms of the last seven years are now largely complete, and the focus of the next year will be on making these reforms work. The Next Stage Review by Lord Darzi will put the focus clearly on the clinical agenda, focusing particularly on long-term conditions and primary and community care. Opportunities for the independent sector are likely to be with strategic health authorities, primary care and hospital trusts rather than a central programme, and should focus on delivering clinical, evidence-based improvements in these areas and advisory services for the implementation of pathways and improving commissioning.
[...] news letters wrote an interesting post today onHere’s a quick excerptTheir introduction and use in mental health has been less widespread, due to the perceived lack of predictability often associated with mental disorders. However, a number of local, national and international initiatives have promoted … [...]
By: » Journal of Management & Marketing in Healthcare 1 (3) on May 27, 2008
at 5:27 pm