The public health role of community pharmacies

This article describes the experience of developing an enhanced public health role for a community pharmacy in the Castle Vale estate in Birmingham. It shows that the neighbourhood-based regeneration context of Castle Vale has created a stimulating setting for an ambitious and innovative pharmacy company to demonstrate what might be possible on a much wider scale in the UK. A core ethos of the Castle Vale regeneration initiative has been public-private partnership and this project reveals some 'critical success factors' for on-the-ground achievement.

Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams:a mixed-methods approach

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

A comparative assessment of performance and productivity of health centres in Seychelles

Purpose - The purpose of this paper is to measure the technical and scale efficiency of health centres; to evaluate changes in productivity; and to highlight possible policy implications of the results for policy makers. Design/methodology/approach - Data envelopment analysis (DEA) is employed to assess the technical and scale efficiency, and productivity change over a four-year period among 17 public health centres. Findings - During the period of study, the results suggest that the public health centres in Seychelles have exhibited mean overall or technical efficiency of above 93 per cent. It was also found that the overall productivity increased by 2.4 per cent over 2001-2004. Research limitations/implications - Further research can be undertaken to gather data on the prices of the various inputs to facilitate an estimation of the allocative efficiency of clinics. If such an exercise were to be undertaken, researchers may also consider collecting data on quantities and prices of paramedical, administrative and support staff to ensure that the analysis is more comprehensive than the study reported in this paper. Institutionalization of efficiency monitoring would help to enhance further the already good health sector stewardship and governance. Originality/value - This paper provides new empirical evidence on a four-year trend in the efficiency and productivity of health centres in Seychelles. © Emerald Group Publishing Limited.

Reducing medicines waste in the community

There is increasing concern at the amount and cost of prescribed medicines that are unused or wasted and then have to be disposed of. Previous studies have used health promotion and Dispose Unwanted Medicines Properly campaigns targeted at the patient to describe and quantify the annual cost of waste. The reasons patients return unused drugs to pharmacies have also been explored. The paper focuses on patient explanations for not needing medication; categorized as: over-collection in the past, self-management strategies, changes in medical condition, other changes in patient circumstances, or the repeat medicines policy at the surgery. The aim of the original study was to make a measurable change in prescribed medicines with a reduction in medicines wastage, whilst at the same time achieving improved standards of pharmaceutical care. Information on patient needs and behaviour came from consultation in the pharmacy monitoring forms and interview. The study was based on two medical practices in the West Midlands, UK, comparing an outer city and an inner city population. The participants were general practitioners, pharmacists and 350 repeat prescription patients. Prescriptions were issued for two three-month periods. The outcome was that 23.8% of the prescribed items were not dispensed, at a value of £13.1K, 58% of the medications that would be expected to be regularly supplied were collected. The study suggests that closer professional management at the point of dispensing and an understanding of patient experiences can help reduce the amount of unwanted medication collected by patients.

Reform of the New Zealand Health System:problematization, mobilization and change

This paper will seek to explicate the changes in the New Zealand health sector informed by the concepts of problematization, inscription and the construction of networks (Callon, 1986; Latour, 1987, 1993). This will involve applying a framework of interpretation based on the concepts of Latour's sociology of translation. Material on problematization and inscription will be incorporated into the paper in order to provide an explanatory frame of reference which will enable us to make sense of the processes of change in the New Zealand health sector. The sociology of translation will be used to explain the processes which underlie the changes and will be used to capture effects, such as changes in policy and structure, producing new networks within which 'allies' could be enrolled in support of the health reforms.

Leadership clarity and team innovation in health care

The relationships among leadership clarity (i.e., team members' consensual perceptions of clarity of and no conflict over leadership of their teams), team processes, and innovation were examined in health care contexts. The sample comprised 3447 respondents from 98 primary health care teams (PHCTs), 113 community mental health teams (CMHTs), and 72 breast cancer care teams (BCTs). The results revealed that leadership clarity is associated with clear team objectives, high levels of participation, commitment to excellence, and support for innovation. Team processes consistently predicted team innovation across all three samples. Team leadership predicted innovation in the latter two samples, and there was some evidence that team processes partly mediated this relationship. The results imply the need for theory that incorporates clarity and not just style of leadership. For health care teams in particular, and teams in general, the results suggest a need to ensure leadership is clear in teams when innovation is a desirable team performance outcome. © 2003 Elsevier Inc. All rights reserved.

Greening operations management:an online sustainable procurement course for practitioners

In the Operations Management field, sustainable procurement has emerged as a way to green the purchasing and supply process. This paper explores issues in sustainable procurement training. The authors formed an interdisciplinary team to design, deliver and evaluate a training programme to promote and develop sustainable procurement in the United Kingdom health sector. Particular features of the project were its engagement with evolving and contested understandings of sustainable procurement and of the underlying concept of sustainable development and its recognition that relevant knowledge in the field is both incomplete and widely diffused through the procurement community. Eight practitioner groups worked together on themes to develop their understanding of sustainable procurement using the Blackboard virtual learning environment. Group interviews were conducted upon completion of the course and again three months later to explore qualitatively participants' experience of learning and implementing sustainable procurement. Although the course was delivered to practitioners, it might be modified for undergraduate and graduate students as it comprised the use of online activities in virtual learning environments, case studies and a broad range of literature. The course was also particularly significant in the context of contemporary policy moves in the United Kingdom and elsewhere to promote the role of higher education institutions in delivering workplace-based, high-skills education consistent with strategic policy considerations (see, for example, DIUS, 2008).

Reflecting on time, timing and timeliness in public sector supply networks

Despite recent research on time (e.g. Hedaa & Törnroos, 2001), consideration of the time dimension in data collection, analysis and interpretation in research in supply networks is, to date, still limited. Drawing on a body of literature from organization studies, and empirical findings from a six-year action research programme and a related study of network learning, we reflect on time, timing and timeliness in interorganizational networks. The empirical setting is supply networks in the English health sector wherein we identify and elaborate various issues of time, within the case and in terms of research process. Our analysis is wide-ranging and multi-level, from the global (e.g. identifying the notion of life cycles) to the particular (e.g. different cycle times in supply, such as daily for deliveries and yearly for contracts). We discuss the ‘speeding up’ of inter-organizational ‘e’ time and tensions with other time demands. In closing the paper, we relate our conclusions to the future conduct of the research programme and supply research more generally, and to the practice of managing supply (in) networks.

Accounting information systems as knowledge objects:some effects of objectualization

This paper will outline a research methodology informed by theorists who have contributed to actor network theory (ANT). Research informed from such a perspective recognizes the constitutive role of accounting systems in the achievement of broader social goals. Latour, Knoor Cetina and others argue that the bringing in of non-human actants, through the growth of technology and science, has added immeasurably to the complexity of modern society. The paper ‘sees’ accounting and accounting systems as being constituted by technological ‘black boxes’ and seeks to discuss two questions. One concerns the processes which surround the establishment of ‘facts’, i.e. how ‘black boxes’ are created or accepted (even if temporarily) within society. The second concerns the role of existing ‘black boxes’ within society and organizations. Accounting systems not only promote a particular view of the activities of an organization or a subunit, but in their very implementation and operation ‘mobilize’ other organizational members in a particular direction. The implications of such an interpretation are explored in this paper. Firstly through a discussion of some of the theoretic constructs that have been proposed to frame ANT research. Secondly an attempt is made to relate some of these ideas to aspects of the empirics in a qualitative case study. The case site is in the health sector and involves the implementation of a casemix accounting system. Evidence from the case research is used to exemplify aspects of the theoretical constructs.

Spatial aspects of MRSA epidemiology:A case study using stochastic simulation, kernel estimation and SaTScan

The identification of disease clusters in space or space-time is of vital importance for public health policy and action. In the case of methicillin-resistant Staphylococcus aureus (MRSA), it is particularly important to distinguish between community and health care-associated infections, and to identify reservoirs of infection. 832 cases of MRSA in the West Midlands (UK) were tested for clustering and evidence of community transmission, after being geo-located to the centroids of UK unit postcodes (postal areas roughly equivalent to Zip+4 zip code areas). An age-stratified analysis was also carried out at the coarser spatial resolution of UK Census Output Areas. Stochastic simulation and kernel density estimation were combined to identify significant local clusters of MRSA (p<0.025), which were supported by SaTScan spatial and spatio-temporal scan. In order to investigate local sampling effort, a spatial 'random labelling' approach was used, with MRSA as cases and MSSA (methicillin-sensitive S. aureus) as controls. Heavy sampling in general was a response to MRSA outbreaks, which in turn appeared to be associated with medical care environments. The significance of clusters identified by kernel estimation was independently supported by information on the locations and client groups of nursing homes, and by preliminary molecular typing of isolates. In the absence of occupational/ lifestyle data on patients, the assumption was made that an individual's location and consequent risk is adequately represented by their residential postcode. The problems of this assumption are discussed, with recommendations for future data collection.

CSR and the "underserving":a role for the state, civil society and business?

Purpose – The purpose of this paper is to demonstrate how the conceptual lens of corporate social responsibility (CSR), business and civil society can be used to explore “less popular causes” (in this case, a community-based public sector empirical study of initiatives with offenders) and, in particular, respond to the question used by Walzer “In which society can lives be best led?” Design/methodology/approach – This is a formative and summative evaluation study of a National Offender Management “community payback” offender scheme based in the UK using a mixed method, predominantly qualitative approach that integrates theory and practice. Findings – The paper finds that citizenship actions of front-line public sector employees, working in partnership with other agencies in the community, embody the essence of Walzer's notion of CSR and civil society by going beyond the call of duty to provide additional training and moral support for the community offenders. Originality/value – The paper contributes towards an understanding of how CSR and civil society debates can inform wider aspects of public policy and business through its application to areas of society that are perceived to be “challenging” and “undeserving”.

Competence requirements for managing supply in interorganizational networks

The authors address the growing call for research into the management of supply networks serving the public sector. Building on prior action research, this empirical paper focuses on the management of supply in interorganizational, health sector networks identifying the competence requirements (skills, knowledge, traits, and behavioural indicators) associated with effective team performance. Drawing on empirical data, the authors present a competence framework that aims to capture a team’s tacit understanding of strategic supply management. Competence indicators are organized into six themes: network understanding; developing network position; relationship management; learning, knowledge and knowledge management; strategy formulation; strategy implementation. Finally, the relevance of the framework to boundary spanning personnel outside the purchasing function and to other organizations is considered.

Outsourced services and 'imbalanced' supply markets

In the UK public sector, procurement decisions for outsourced services are usually taken at a local level, for example by a hospital trust or a local government authority. Cumulatively, these fragmented decisions can lead to ‘imbalanced’ supply markets (too few or too many suppliers), to the detriment of both suppliers and purchasers. This paper considers what can be done to manage imbalanced supply markets resulting from the fragmented procurement of outsourced services across a sector, using the case of the English National Health Service. The types and levels of action available within the health sector are explored.