Medicines management across the primary-hospital healthcare interface: a study of paediatric patients

A comparison of medicines management documents in use by NHS organisations in the West Midlands confirms that there are important differences between the primary care and hospital sectors in respect to medicines management interface issues. Of these, two aspects important to paediatric patients have been studied. These are the transfer of information as a patient is admitted to hospital, and access to long-term medicines for home-patients. National guidance provided by NICE requires medication reconciliation to be undertaken on admission to hospital for adults. A study of paediatric admissions, reported in this thesis, demonstrates that the clinical importance of this process is at least as important for children as for adults, and challenges current UK guidance. The transfer of essential medication information on hospital admission is central to the medication reconciliation process. Two surveys of PCTs in 2007 and again in 2009 demonstrate that very few PCTs provide guidance to GPs to support this process. Provision of guidance is increasing slowly but remains the exception. The provision of long-term medicines for children at home is hindered by this patient population often needing unlicensed drugs. Further studies demonstrate that primary care processes regularly fail to maintain access to essential drugs and patients and their carers frequently turn to hospitals for help. Surveys of hospital medical staff (single site) and hospital nurses (six UK sites) demonstrates the activity these healthcare workers perform to help children get the medicines they need. A similar survey of why carers turn to a hospital pharmacy department for urgent supplies (usually termed rescue-medicines) adds to the understanding of these problems and supports identifying service changes. A large survey of community pharmacies demonstrates the difficulties they have when dispensing hospital prescriptions and identifies practical solutions. This programme concludes by recommending service changes to support medication management for children.

The knowledge-based perspective of risk management in healthcare organisations

The aim of this research is to investigate how risk management in a healthcare organisation can be supported by knowledge management. The subject of research is the development and management of existing logs called "risk registers", through specific risk management processes employed in a N.H.S. (Foundation) Trust in England, in the U.K. Existing literature on organisational risk management stresses the importance of knowledge for the effective implementation of risk management programmes, claiming that knowledge used to perceive risk is biased by the beliefs of individuals and groups involved in risk management and therefore is considered incomplete. Further, literature on organisational knowledge management presents several definitions and categorisations of knowledge and approaches for knowledge manipulation in the organisational context as a whole. However, there is no specific approach regarding "how to deal" with knowledge in the course of organisational risk management. The research is based on a single case study, on a N.H.S. (Foundation) Trust, is influenced by principles of interpretivism and the frame of mind of Soft Systems Methodology (S.S.M.) to investigate the management of risk registers, from the viewpoint of people involved in the situation. Data revealed that knowledge about risks and about the existing risk management policy and procedures is situated in several locations in the Trust and is neither consolidated nor present where and when required. This study proposes a framework that identifies required knowledge for each of the risk management processes and outlines methods for conversion of this knowledge, based on the SECI knowledge conversion model, and activities to facilitate knowledge conversion so that knowledge is effectively used for the development of risk registers and the monitoring of risks throughout the whole Trust under study. This study has theoretical impact in the management science literature as it addresses the issue of incomplete knowledge raised in the risk management literature using concepts of the knowledge management literature, such as the knowledge conversion model. In essence, the combination of required risk and risk management related knowledge with the required type of communication for risk management creates the proposed methods for the support of each risk management process for the risk registers. Further, the indication of the importance of knowledge in risk management and the presentation of a framework that consolidates knowledge required for the risk management processes and proposes way(s) for the communication of this knowledge within a healthcare organisation have practical impact in the management of healthcare organisations.

Speech recognition use in healthcare applications

Speech recognition technology is regarded as a key enabler for increasing the usability of applications deployed on mobile devices -- devices which are becoming increasingly prevalent in modern hospital-based healthcare. Although the use of speech recognition is not new to the hospital-based healthcare domain, its use with mobile devices has thus far been limited. This paper presents the results of a literature review we conducted in order to observe the manner in which speech recognition technology has been used in hospital-based healthcare and to gain an understanding of how this technology is being evaluated, in terms of its dependability and reliability, in healthcare settings. Our intent is that this review will help identify scope for future uses of speech recognition technologies in the healthcare domain, as well as to identify implications for the meaningful evaluation of such technologies given the specific context of use.

Photonic crystal fiber Bragg grating based sensors : opportunities for applications in healthcare

We review the state-of-the-art in photonic crystal fiber (PCF) and microstructured polymer optical fiber (mPOF) based mechanical sensing. We first introduce how the unique properties of PCF can benefit Bragg grating based temperature insensitive pressure and transverse load sensing. Then we describe how the latest developments in mPOF Bragg grating technology can enhance optical fiber pressure sensing. Finally we explain how the integration of specialty fiber sensor technology with bio-compatible polymer based micro-technology provides great opportunities for fiber sensors in the field of healthcare.

Gaining social values of wireless technology:an interpretive case study in the healthcare institutional context

The existing literature has given little consideration to social values of information technology in general or of wireless technology in particular. The purpose of this paper is thus to shed new light on this issue. Based on an interpretive case study, we examine two healthcare organisations and discover that social values are often manifested beyond, as well as within, organisations. A matrix of social values in relation to technology changes and their interactions with various stakeholders is further discussed. The matrix helps understand how various social values emerge from and revolve around organisations’ strategic management of information technology. The implications of the findings about social values are discussed and future research directions are suggested.

Can incident reporting improve safety? Healthcare practitioners' views of the effectiveness of incident reporting

OBJECTIVE: Recent critiques of incident reporting suggest that its role in managing safety has been over emphasized. The objective of this study was to examine the perceived effectiveness of incident reporting in improving safety in mental health and acute hospital settings by asking staff about their perceptions and experiences. DESIGN: /st>Qualitative research design using documentary analysis and semi-structured interviews. SETTING: /st>Two large teaching hospitals in London; one providing acute and the other mental healthcare. PARTICIPANTS: /st>Sixty-two healthcare practitioners with experience of reporting and analysing incidents. RESULTS: /st>Incident reporting was perceived as having a positive effect on safety, not only by leading to changes in care processes but also by changing staff attitudes and knowledge. Staff discussed examples of both instrumental and conceptual uses of the knowledge generated by incident reports. There are difficulties in using incident reports to improve safety in healthcare at all stages of the incident reporting process. Differences in the risks encountered and the organizational systems developed in the two hospitals to review reported incidents could be linked to the differences we found in attitudes to incident reporting between the two hospitals. CONCLUSION: /st>Incident reporting can be a powerful tool for developing and maintaining an awareness of risks in healthcare practice. Using incident reports to improve care is challenging and the study highlighted the complexities involved and the difficulties faced by staff in learning from incident data.

Implementing collaborative practices in the healthcare supply chain:insights into hospital-vendor operations

The paper discusses the characteristics of healthcare supply chains, and puts particular emphasis on the implementation of VMI/CMI in this sector specific context. By the means of case study research the paper provides empirical data on the benefits of the above collaborative practices for both the hospital and vendors. The paper contributes to the stream of research on VMI/CMI in the healthcare sector, where limited research attempts have been conducted so far. In contrast to other surveys this case study shows that specific and measurable cost reductions exist, in addition to other improvements such as better control over the inventories, and also in reduction of administrative work. Results obtained may be also relevant to other hospitals and vendors and as they can form a basis for comparisons. Copyright © 2013 Inderscience Enterprises Ltd.

The impact of a father's presence during newborn resuscitation:a qualitative interview study with healthcare professionals

Objective: To explore healthcare professionals’ experiences around the time of newborn resuscitation in the delivery room, when the baby’s father was present. Design: A qualitative descriptive, retrospective design using the critical incident approach. Tape-recorded semistructured interviews were undertaken with healthcare professionals involved in newborn resuscitation. Participants recalled resuscitation events when the baby’s father was present. They described what happened and how those present, including the father, responded. They also reflected upon the impact of the resuscitation and the father’s presence on themselves. Participant responses were analysed using thematic analysis. Setting: A large teaching hospital in the UK. Participants: Purposive sampling was utilised. It was anticipated that 35–40 participants would be recruited. Forty-nine potential participants were invited to take part. The final sample consisted of 37 participants including midwives, obstetricians, anaesthetists, neonatal nurse practitioners, neonatal nurses and paediatricians. Results: Four themes were identified: ‘whose role?’ ‘saying and doing’ ‘teamwork’ and ‘impact on me’. While no-one was delegated to support the father during the resuscitation, midwives and anaesthetists most commonly took on this role. Participants felt the midwife was the most appropriate person to support fathers. All healthcare professional groups said they often did not know what to say to fathers during prolonged resuscitation. Teamwork was felt to be of benefit to all concerned, including the father. Some paediatricians described their discomfort when fathers came to the resuscitaire. None of the participants had received education and training specifically on supporting fathers during newborn resuscitation. Conclusions: This is the first known study to specifically explore the experiences of healthcare professionals of the father’s presence during newborn resuscitation. The findings suggest the need for more focused training about supporting fathers. There is also scope for service providers to consider ways in which fathers can be supported more readily during newborn resuscitation.

The relationship between transformational leadership and innovative behaviour in a healthcare context:a team learning versus a cohesion perspective

The purpose of this study was to explore whether the relationship between transformational leadership and innovative behaviour is explained via the mediating role of team learning, or whether instead team cohesion mediates this relationship. Using survey data from 158 professionals within 21 teams in the Dutch healthcare context, we tested by means of hierarchical regression analyses: (a) the relationship between transformational leadership and innovative behaviour; (b) whether team learning or cohesion mediates this relationship; and (c) the relationship between team learning and cohesion, in relation to transformational leadership. Results showed that transformational leadership is positively related to innovative behaviour and that both cohesion and team learning mediate this relationship, with team learning being the strongest mediator. Addressing a neglected area, our study provides evidence to show that managers who enhance team learning are likely to maximise employees' scope for engaging in innovative behaviours. © 2012 Inderscience Enterprises Ltd.

Managing wireless networks in the healthcare sector:emerging experiences of cultural impacts

The existing body of knowledge has generally supported that organizational culture plays a significant role in shaping group identity, work pattern, communication schemes, and interpersonal relations; all of these cultural elements are important organizational factors that shape workplaces and operational routines. In the context of emerging information technology, it has also been suggested that organizational culture could affect IT implementation and management. However, little is known about how emerging information technology shapes organizational culture, which in turn helps reshape the organization as a whole. The purpose of this paper is thus to build empirical understanding of how IT in general and emerging wireless networks in particular reshapes organizational culture. Case studies conducted in two hospitals situated in southwest U.S.A. illustrated that the implementation of wireless networks indeed helped shape and/or reshape organizational culture in the healthcare sector and in turn enhance healthcare organizations’ competitiveness in the marketplace. For IT managers and practitioners in healthcare institutions, effective strategy to plan and manage emerging ITs such as wireless networks will thus have long-term implications on cultivating organizational culture that could eventually reshape workplace and competitiveness.

Linguistic identifiers of L1 Persian speakers writing in English:NLID for authorship analysis

This research focuses on Native Language Identification (NLID), and in particular, on the linguistic identifiers of L1 Persian speakers writing in English. This project comprises three sub-studies; the first study devises a coding system to account for interlingual features present in a corpus of L1 Persian speakers blogging in English, and a corpus of L1 English blogs. Study One then demonstrates that it is possible to use interlingual identifiers to distinguish authorship by L1 Persian speakers. Study Two examines the coding system in relation to the L1 Persian corpus and a corpus of L1 Azeri and L1 Pashto speakers. The findings of this section indicate that the NLID method and features designed are able to discriminate between L1 influences from different languages. Study Three focuses on elicited data, in which participants were tasked with disguising their language to appear as L1 Persian speakers writing in English. This study indicated that there was a significant difference between the features in the L1 Persian corpus, and the corpus of disguise texts. The findings of this research indicate that NLID and the coding system devised have a very strong potential to aid forensic authorship analysis in investigative situations. Unlike existing research, this project focuses predominantly on blogs, as opposed to student data, making the findings more appropriate to forensic casework data.

Self-assessment benchmarking as a quality management tool in primary healthcare

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Integration issues in the healthcare supply chain

The efficacy, quality, responsiveness, and value of healthcare services provided is increasingly attracting the attention and the questioning of governments, payers, patients, and healthcare providers. Investments on integration technologies and integration of supply chain processes, has been considered as a way towards removing inefficiencies in the sector. This chapter aims to initially provide an in depth analysis of the healthcare supply chain and to present core entities, processes, and flows. Moreover, the chapter explores the concept of integration in the context of the healthcare sector, and indentifies the integration drivers, as well as challenges.

Occupational exposure to blood borne pathogens among healthcare workers and preventative strategies

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