scholarly journals Doing transformational change in the English NHS in the context of “big bang” redisorganisation

2015 ◽  
Vol 29 (1) ◽  
pp. 10-24 ◽  
Author(s):  
David J. Hunter ◽  
Jonathan Erskine ◽  
Adrian Small ◽  
Tom McGovern ◽  
Chris Hicks ◽  
...  
Keyword(s):  
Health Policy ◽  
Mixed Methods ◽  
Focus Groups ◽  
Observational Studies ◽  
Transformational Change ◽  
Content Type ◽  
North East ◽  
The North ◽  
East Region ◽  
The Uk

Purpose – The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended. Design/methodology/approach – The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.’s “receptive contexts for change” and four of the eight factors stood out as especially important and form the basis of the paper. Findings – The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very same pressures. Yet, despite having an enormous influence on health policy, the political context is frequently avoided in research or not regarded as instrumental in determining the outcomes in respect of transformational change. Research limitations/implications – The chief limitation is the credibility and authenticity of the interviews captured at particular points in time. These formed the datebase for subsequent analysis. The authors sought to guard against possible bias by supplementing interviews with observational studies and focus groups as well as running two dissemination events at which emerging findings from the study were subjected to independent external scrutiny and comment. These events provided a form of validation for the key study findings. Practical implications – The research findings demonstrate the importance of context for the likely outcome and success of complex transformational change initiatives. These require time to become embedded and demonstrate results especially when focused on changing culture and behaviour. But, in practice, allowing sufficient time during which the organisation may remain sufficiently stable to allow the change intervention to run its course and become embedded and sustainable is highly problematic. The consequence is that bold and ambitious efforts like the NETS are not given the space and stability to prove themselves. Too often, politics and external environmental pressures intrude in ways that may prove dysfunctional and negative. Social implications – Unless a different approach to transformational change and its leadership and management is adopted, then changing the NHS to enable it to appear more responsive to changing health care needs and expectations will remain a cause for concern. Ultimately the public will be the losers if the NHS remains insensitive to changing needs and expectations. The patient experience was at the centre of the NETS programme. Originality/value – The study is original insofar as no other has sought to evaluate the NETS independently and over a reasonable time period. The research design, based on a mixed-methods approach, is unusual in evaluations of this nature. The study’s conclusions are not so original but their value lies in largely confirming and reinforcing the findings from other studies. It perhaps goes further in stressing the impact of politics on health policy and the negative consequences of constant organisational change on attempts to achieve deep change in the way the NHS is organised and led.

scholarly journals A mixed-methods evaluation of transformational change in NHS North East

2014 ◽  
Vol 2 (47) ◽  
pp. 1-186 ◽  
Author(s):  
David J Hunter ◽  
Jonathan Erskine ◽  
Chris Hicks ◽  
Tom McGovern ◽  
Adrian Small ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Leadership Style ◽  
Large Scale ◽  
Research Programme ◽  
Transformational Change ◽  
North East ◽  
The North ◽  
Semistructured Interviews ◽  
The Impact

BackgroundThe North East Transformation System (NETS) was conceived as an experiment in adopting large-scale transformational change across a NHS region in England. Although the NHS in the North East performs well, the health of the population ranks among the poorest in the country. The NETS was viewed as a means of addressing this conundrum. It comprised three components: Vision, Compact and Method.ObjectivesThe evaluation study comprised six elements: a literature review; an evaluation of the evolution and impact of the NETS; an identification of the factors facilitating, and/or acting as barriers to, successful change; an assessment of the role of the NETS project team; establishing how far the changes introduced through the NETS became embedded and sustained; and an evaluation of the impact of the NETS on end users.DesignThe research comprised a longitudinal mixed-methods study conducted over 3.5 years. Research methods included 68 semistructured interviews, observation, two focus groups, documentary analysis and interrupted time series (ITS) analysis. The ITS component comprised analysis of five rapid process improvement workshops in two of the sites.SettingThe research setting was the NHS North East region until its abolition in April 2013 following the UK government’s NHS changes. Fourteen sites were selected for the study, comprising primary care trusts as commissioners, and provider trusts including mental health, community, acute care and ambulance services.ParticipantsThe study respondents were members of staff in the 14 sites drawn from different levels of their organisations.InterventionsThe NETS comprised a complex set of interventions aimed at improving the efficiency and effectiveness of care pathways for staff and patients.Main outcome measuresThe ‘receptive contexts for change’ framework was used to evaluate the transformational change process and its outcomes.Data sourcesQualitative parts of the study drew on semistructured interviews, focus groups, observation and documents. Quantitative parts of the study used routinely collected NHS data.ResultsTransformational change in a complex system takes time and demands consistency, constancy of purpose and organisational stability. The NETS was seriously disrupted by the NHS changes announced in July 2010. Progress was sustained at four of the study sites, but slowed or ceased at the other sites. Leadership style was found to be critical to the success of transformational change.ConclusionsThe NETS was a bold and ambitious initiative which succeeded in bringing about real and lasting change in some parts of the North East. However, it was unable to fully realise its vision and purpose partly because of the widespread reorganisation of the NHS by the new coalition government.Future workThere is a need to develop new methods to understand how change occurs, or fails, in complex settings like the NHS. There is a need for more in-depth studies in those sites that were able to implement and sustain change. This would inform future policy and practice. The results of the quantitative analyses were less conclusive than those obtained by qualitative methods. Further development of mixed-methods approaches would provide additional support for evidence-based decision-making.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Shifting the Goalposts: A Longitudinal Mixed-Methods Study of the Health of Long-Term Incapacity Benefit Recipients during a Period of Substantial Change to the UK Social Security System

2014 ◽  
Vol 43 (2) ◽  
pp. 311-330 ◽  
Author(s):  
KAYLEIGH GARTHWAITE ◽  
CLARE BAMBRA ◽  
JONATHAN WARREN ◽  
ADETAYO KASIM ◽  
GRAEME GREIG
Keyword(s):  
Mixed Methods ◽  
Social Security ◽  
Safety Net ◽  
Health State ◽  
Disabled People ◽  
Welfare Benefits ◽  
North East ◽  
The North ◽  
The Uk

AbstractThe UK social security safety net for those who are out of work due to ill health or disability has experienced significant change, most notably the abolition of Incapacity Benefit (IB) and the introduction of Employment and Support Allowance (ESA). These changes have been underpinned by the assumption that many recipients are not sufficiently sick or disabled to ‘deserve’ welfare benefits – claims that have been made in the absence of empirical data on the health of recipients. Employing a unique longitudinal and mixed-methods approach, this paper explores the health of a cohort of 229 long-term IB recipients in the North East of England over an eighteen-month period, during a time of significant changes to the UK welfare state. In-depth interviews with twenty-five of the survey cohort are also presented to illustrate the lived experiences of recipients. Contributing to debates surrounding the conceptualisation of work-readiness for sick and disabled people, findings indicate IB recipients had significantly worse health than the general population, with little change in their health state over the eighteen-month study period. Qualitative data reinforced the constancy of ill health for IB recipients. Finally, the paper discusses the implications for social policy, noting how the changing nature of administrative definitions and redefinitions of illness and capacity to work can impact upon the lives of sick and disabled people.

scholarly journals Tourism in the post(?) COVID-19 era: evidence from the hotel sector in the North East of England

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Maria Zoi Spanaki ◽  
Andreas Papatheodorou ◽  
Nikolaos Pappas
Keyword(s):  
Business Practices ◽  
Structured Interviews ◽  
Content Type ◽  
North East ◽  
The North ◽  
Short Period ◽  
Managerial Implications ◽  
Hotel Sector ◽  
The Uk ◽  
Hotel Managers

Purpose This paper aims to examine developments in tourism during the COVID-19 pandemic using the hotel sector in the North-East of England as the area of study. The country has attracted a lot of attention not only because of its importance as a tourism destination but also due to its rather controversial management of the pandemic at least in its early stages. Design/methodology/approach Fifteen semi-structured interviews based on ten open-ended questions were conducted with North East of England-based hotel managers of international brands on the level of their hotels’ preparedness to effectively deal with pandemic cases. The interviews took place in August and September 2020 with participants kept anonymous. Findings Meeting new operational and bureaucratic requirements added to the cost structure and proved a major challenge for managers who saw their hotel occupancy rates and revenue collapsing within a short period of time. Innovative and aggressive pricing strategies were introduced to lure especially younger travelers in the absence of business clientele. Staff were made redundant and/or asked to work overtime making effective human resource management very difficult. Originality/value This is one of the first research attempts to highlight the importance of the COVID-19 pandemic for the hotel sector in a major region of the UK. The paper also attempts some generalization by discussing managerial implications and suggesting a possible way forward for the hotel sector. Developing resilience by building on previously used successful business practices proves of essence.

How well do children in the North East of England function after a crisis: a service evaluation

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Emily Staite ◽  
Lynne Howey ◽  
Clare Anderson ◽  
Paula Maddison
Keyword(s):  
Mental Health ◽  
Young People ◽  
Health Services ◽  
Service Evaluation ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Content Type ◽  
North East ◽  
The North ◽  
The Uk

Purpose Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors’ knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis. Design/methodology/approach This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019. Findings There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p < 0.001) with a small effect size (d = −0.36). Sixteen (15%) patients exhibited significant and reliable change (i.e. functioning improved). A further four (4%) patients exhibited no change (i.e. functioning did not deteriorate despite being in crisis). No patients significantly deteriorated in functioning after accessing the crisis service. Practical implications Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a “healthy” level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people’s functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team. Originality/value This paper evaluates a young person’s functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England.

Task Forces and the Organisation of Economic Development: The Case of the North East Region of England

10.1068/c23m ◽  
2002 ◽  
Vol 20 (5) ◽  
pp. 717-739 ◽  
Author(s):  
Andy Pike
Keyword(s):  
Economic Development ◽  
Private Sector ◽  
Task Force ◽  
Governance System ◽  
Development Activity ◽  
Task Forces ◽  
North East ◽  
The North ◽  
East Region ◽  
The Uk

The task force has emerged as a mechanism for coordinating economic development activity in the context of the current New Labour government's emphasis upon including ‘stakeholders’ in ‘joined-up’ approaches to ‘crosscutting’ issues. In this paper I examine the use of task forces to organise economic development at employer, sectoral, and territorial levels at the local and regional scales in the North East region of England. It is argued that New Labour's experimental use of task forces reflects a particular mediation of more general tendencies in the historical evolution of state modernisation, which varies in particular and contingent ways at the local and regional levels. The research reveals the continued importance of the existing public-sector and public—private-sector institutions, the less significant and contingent role of the private sector, and the contribution of the task force to the ‘quasi-governance’ of the United Kingdom, with its problems of coordination, transparency, and accountability. A renewed politics of economic development governance is required to establish the accountability and legitimacy of such bodies in the context of the emergent multilayered governance system of the UK political economy.

scholarly journals Offenders’ perceptions of the UK prison smoking ban

2019 ◽  
Vol 15 (2) ◽  
pp. 114-125 ◽  
Author(s):  
Stephanie Dugdale ◽  
Heather Semper ◽  
Rachel Povey ◽  
Sarah Elison-Davies ◽  
Glyn Davies ◽  
...  
Keyword(s):  
Focus Groups ◽  
Thematic Analysis ◽  
Design Methodology ◽  
Leisure Activities ◽  
Smoking Ban ◽  
Content Type ◽  
The North ◽  
Prison Environment ◽  
The Uk ◽  
Smoking Behaviours

Purpose Despite overall reductions in levels of smoking in the UK, rates of offender smoking remain high. In 2016, it was announced that prisons in England and Wales would gradually introduce a smoking ban. The purpose of this paper is to explore offenders’ perceptions around the upcoming smoking ban. Design/methodology/approach A total of eight focus groups were conducted in four prisons across the North of England. Both smoking and non-smoking offenders participated in the focus groups, and thematic analysis was used to explore the findings. Findings Themes generated from the data were “freedom and rights”, “the prison environment” and “guiding support”. Participants discussed how the smoking ban was viewed as a punishment and restricted their freedom, with perceptions as to why the ban was being implemented centring around others trying to control them. Participants expressed concerns around the financial implications of the smoking ban on already stretched prison resources. Participants also recommended improving the nicotine replacement therapy on offer, and increasing the range of leisure activities within the prison to prepare for the smoking ban. Originality/value Overall, it was apparent that participants’ awareness of the smoking ban was generally poor. It is recommended that offenders need to be made more aware of the smoking cessation support they will receive and given the opportunity to ask questions about the smoking ban. Increasing offenders’ awareness of the ban may reduce stress associated with a perceived lack of choice around their smoking behaviours.

The Performance of Business Incubators and their Potential Development in the North East Region of England

2005 ◽  
Vol 20 (2) ◽  
pp. 205-220 ◽  
Author(s):  
Pooran Wynarczyk ◽  
Arnold Raine
Keyword(s):  
New Technology ◽  
Good Practice ◽  
Local Economy ◽  
North East ◽  
The North ◽  
East Region ◽  
Potential Development ◽  
The Creation ◽  
The Uk ◽  
Enterprise Creation

The creation of incubators is viewed by many local and regional strategic bodies in the UK and abroad as an effective way of nurturing and facilitating the success of new technology-based companies. Drawing on a survey of 17 incubators operating in the North East of England, based on original findings, this paper empirically examines the crucial role of existing incubators in the local economy in enterprise creation and attempts to identify areas of good practice that can be used as benchmarks for the creation of future Incubators.

scholarly journals Updated Incidence of Thyroid Cancer in the North East Region of Romania after 35 Years of Chernobyl Fallout. Is There a Link between?

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 907
Author(s):  
Laura Teodoriu ◽  
Maria Christina Ungureanu ◽  
Letitia Leustean ◽  
Cristina Preda ◽  
Delia Ciobanu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Age Distribution ◽  
Age Groups ◽  
Chernobyl Fallout ◽  
Statistical Correlations ◽  
North East ◽  
The North ◽  
East Region ◽  
Radioactive Cloud ◽  
The Moment

Thyroid cancer (TC) represents a worldwide problem, the consistent growth of the incidence increment issues about management of risk factors and curative treatment. Updated statistical data are not complete in the North East region of Romania and need to be improved. Therefore, through this study, we aim to renew the existing data on thyroid cancer. We conducted a retrospective study covering a period of 10 years. Data were collected from a hospital information system (InfoWorld) between 2009 and 2019. Patients’ age groups were stratified in relation with the age at the moment of the Chernobyl event. A database was obtained (Microsoft Excel) and statistical correlations were applied. In the studied period, 1159 patients were diagnosed: 968 females and 191 males, distributed by region, with the highest addressability in Iasi (529), followed by neighboring counties. Age distribution displayed that most of the thyroid cancers were in the range 4060 years old (50.94%), followed by 60–80 years old (32.41%). Most patients were diagnosed with papillary carcinoma 63.10%, then follicular 14.7%, medullary 6.74% and undifferentiated 1.02%. Romania was in the vicinity of the radioactive cloud at Chernobyl fallout, so we must deliberate whether the increased incidence of thyroid cancer in the age group 40–60 years is associated with radiogenicity (iodine 131) given the fact that over has 35 years and the half-life of other radioisotopes like Caesium-137 and Strontium -90 is completed.

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