The use of email in a child and adolescent mental health service: are staff ready?

All staff members of a child and adolescent mental health service were invited to participate in a survey about the use of email. Sixty-two of the 105 staff members responded to the survey, a participation rate of 59%. Of the respondents, 32 were allied health staff, 10 were nurses, seven were administrative staff, six were medical staff, three were operational staff and four were acting in a combination of these roles. The respondents reported extensive work-related email usage and considered that they were confident in using email despite low levels of training. However, they did not feel that they understood the legal and ethical issues involved. Furthermore, there was limited incorporation of email into standard record keeping. The majority of respondents thought that increased use of email would lead to a greater workload, a consequence they considered would probably increase over time. Many commented on the quick and practical use of this medium, but were wary about using email with individuals outside the service organization, especially if it were to contain clinical material. There was low use of email directly with clients, and clinicians were ambivalent about incorporating email into therapy. The results suggest that it is timely to consider the utility and appropriateness of email communication with clients and external service providers, and to formulate guidelines and procedures to ensure the confidentiality of client information and the safety of clients and staff.

External audit in the National Health Service in England and Wales:a study of an oversight body's control of auditor remuneration

In the National Health Service (NHS) in England and Wales an oversight body, the Audit Commission (AC), defines the scope of the external auditors’ work, appoints the auditors and has oversight of their fees and audit quality. This heavily regulated audit regime mitigates some of the deficiencies observed in high profile corporate failures. Independence, it has been argued, is influenced by the total auditor remuneration paid by the client. In this study we examine total auditor remuneration in a regulated market which seeks to ensure audit independence and audit quality. In particular we undertake rigorous analysis of auditor remuneration by the type of auditor: We place emphasis on the differentiation between private sector firms and the AC’s in-house auditors (District Audit). Individual private audit firms charge premiums (up to 16%) for particular audit work in identified locations, but no premiums were found when we examined total auditor remuneration. The regime appears to permit efficient operation of the audit market while safeguarding both audit independence and standards.

Managing people and performance:An evidence based framework applied to health service organizations

People and their performance are key to an organization's effectiveness. This review describes an evidence-based framework of the links between some key organizational influences and staff performance, health and well-being. This preliminary framework integrates management and psychological approaches, with the aim of assisting future explanation, prediction and organizational change. Health care is taken as the focus of this review, as there are concerns internationally about health care effectiveness. The framework considers empirical evidence for links between the following organizational levels: 1. Context (organizational culture and inter-group relations; resources, including staffing; physical environment) 2. People management (HRM practices and strategies; job design, workload and teamwork; employee involvement and control over work; leadership and support) 3. Psychological consequences for employees (health and stress; satisfaction and commitment; knowledge, skills and motivation) 4. Employee behaviour (absenteeism and turnover; task and contextual performance; errors and near misses) 5. Organizational performance; patient care. This review contributes to an evidence base for policies and practices of people management and performance management. Its usefulness will depend on future empirical research, using appropriate research designs, sufficient study power and measures that are reliable and valid.