Physicians in leadership: the association between medical director involvement and staff-to-patient ratios

In a hospital environment that demands a careful balance between commercial and clinical interests, the extent to which physicians are involved in hospital leadership varies greatly. This paper assesses the influence of the extent of this involvement on staff-to-patient ratios. Using data gathered from 604 hospitals across Germany, this study evidences the positive relationship between a full-time medical director (MD) or heavily involved part-time MD and a higher staff-to-patient ratio. The data allows us to control for a range of confounding variables, such as size, rural/urban location, ownership structure, and case-mix. The results contribute to the sparse body of empirical research on the effect of clinical leadership on organizational outcomes.

Evidence-informed development of engineering practical work: Effecting change through staff and student engagement

This paper discusses innovations in curriculum development in the Department of Engineering at the University of Cambridge as a participant in the Teaching for Learning Network (TFLN), a teaching and learning development initiative funded by the Cambridge-MIT Institute a pedagogic collaboration and brokerage network. A year-long research and development project investigated the practical experiences through which students traditionally explore engineering disciplines, apply and extend the knowledge gained in lectures and other settings, and begin to develop their professional expertise. The research project evaluated current practice in these sessions and developed an evidence-base to identify requirements for new activities, student support and staff development. The evidence collected included a novel student 'practice-value' survey highlighting effective practice and areas of concern, classroom observation of practicals, semi-structured interviews with staff, a student focus group and informal discussions with staff. Analysis of the data identified three potentially 'high-leverage' strategies for improvement: development of a more integrated teaching framework, within which practical work could be contextualised in relation to other learning; a more transparent and integrated conceptual framework where theory and practice were more closely linked; development of practical work more reflective of the complex problems facing professional engineers. This paper sets out key elements of the evidence collected and the changes that have been informed by this evidence and analysis, leading to the creation of a suite of integrated practical sessions carefully linked to other course elements and reinforcing central concepts in engineering, accompanied by a training and support programme for teaching staff.

Guidewire retention following central venous catheterisation: a human factors and safe design investigation.

BACKGROUND: Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. OBJECTIVE: The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. METHODS: Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. RESULTS: The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. CONCLUSIONS: Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.