scholarly journals How do National Health Service (NHS) organisations respond to patient concerns? A qualitative interview study of the Patient Advice and Liaison Service (PALS)

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053239
Author(s):  
Keegan Shepard ◽  
Ruta Buivydaite ◽  
Charles Vincent
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Qualitative Content Analysis ◽  
Waiting Times ◽  
National Policy ◽  
Qualitative Interview Study ◽  
Semistructured Interviews ◽  
Patient Advocates ◽  
Patient Advice

ObjectivesTo describe the current work of the Patient Advice and Liaison Service (PALS) and assess the service’s potential to resolve concerns and contribute to organisational learning.DesignA qualitative study using semistructured interviews.SettingFour mental health trusts and four acute trusts in the English National Health Service, a total of eight PALS across different trusts.ParticipantsTwenty-four participants comprising of PALS staff and clinicians working with PALS teams.MethodsSemistructured interviews were undertaken with participants using video conferencing software. The framework method was used for the analysis of the large qualitative dataset, which is a conventional method of analysis, similar to thematic or qualitative content analysis.ResultsPALS teams fulfil their core responsibilities by acting as point of contact for patients, providing information and resolving a variety of recurrent problems, including PALS staff communication, staff attitudes and waiting times. The remit and responsibilities of each PALS has often broadened over time. Barriers to resolving concerns included a lack of awareness of PALS, limited to no policies informing how staff resolve concerns, an emphasis on complaints and the attitude of clinical staff. Senior management had widely differing views on how the PALS should operate and the management of complaints is a much higher priority. Few PALS teams carried out any analysis of the data or shared data within their organisations.ConclusionsPALS teams fulfil their core responsibilities by acting as point of contact for patients, providing information and resolving concerns. PALS staff also act as navigators of services, mediators between families and staff and, occasionally, patient advocates in supporting them to raise concerns. PALS has the potential to reduce complaints, increase patient satisfaction and provide rapid organisational feedback. Achieving this potential will require more awareness and support within organisations together with updated national policy guidance.

scholarly journals Are advanced clinical practice roles in England’s National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives

2021 ◽  
pp. 135581962110367
Author(s):  
Vari M Drennan ◽  
Linda Collins ◽  
Helen Allan ◽  
Neil Brimblecombe ◽  
Mary Halter ◽  
...  
Keyword(s):  
Clinical Practice ◽  
National Health Service ◽  
Health Service ◽  
Diffusion Of Innovation ◽  
National Health ◽  
National Policy ◽  
Relative Advantage ◽  
Structural Support ◽  
Development Scenarios ◽  
Qualitative Interview Study

Objective A major issue facing all health systems is improving population health while at the same time responding to both growing patient numbers and needs and developing and retaining the health care workforce. One policy response to workforce shortages has been the development of advanced clinical practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior managers’ and senior clinicians’ perceptions of factors at the organization level that support or inhibit the introduction of advanced clinical practice roles. The investigation was framed by theories of the diffusion of innovation and the system of professions. Methods We conducted a qualitative interview study of 39 senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organizations across a metropolitan area in 2019. Results Small numbers of advanced clinical practice roles were reported, often in single services. Four main influences were identified in the development of advanced clinical practice roles: staff shortages (particularly of doctors in training grades) combined with rising patient demand, the desire to retain individual experienced staff, external commissioners or purchasers of services looking to shape services in line with national policy, and commissioner-funded new roles in new ambulatory care services and primary care. Three factors were reported as enabling the roles: finance for substantive posts, evidence of value of the posts, and structural support within the organization. Three factors were perceived as inhibiting developing the roles: confusion and lack of knowledge amongst clinicians and managers, the availability of finance for the roles, and a nervousness (sometimes resistance) to introducing the new roles. Conclusions While the national policy was to promote advanced clinical practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios, research and business evidence of relative advantage will be important, as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced clinical practice roles across the specialties and professions in different contexts requires urgent attention.

scholarly journals Impact of the Manchester Glaucoma Enhanced Referral Scheme on NHS costs

2019 ◽  
Vol 4 (1) ◽  
pp. e000278 ◽  
Author(s):  
Hannah Forbes ◽  
Matt Sutton ◽  
David F Edgar ◽  
John Lawrenson ◽  
Anne Fiona Spencer ◽  
...  
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Observational Study ◽  
Cost Analysis ◽  
National Health ◽  
False Positive ◽  
Waiting Times ◽  
Outpatient Visits ◽  
Audit Data ◽  
The Cost

ObjectivesGlaucoma filtering schemes such as the Manchester Glaucoma Enhanced Referral Scheme (GERS) aim to reduce the number of false positive cases referred to Hospital Eye Services. Such schemes can also have wider system benefits, as they may reduce waiting times for other patients. However, previous studies of the cost consequences and wider system benefits of glaucoma filtering schemes are inconclusive. We investigate the cost consequences of the Manchester GERS.DesignObservational study.MethodsA cost analysis from the perspective of the National Health Service (NHS) was conducted using audit data from the Manchester GERS.Results2405 patients passed through the Manchester GERS from April 2013 to November 2016. 53.3% were not referred on to Manchester Royal Eye Hospital (MREH). Assuming an average of 2.3 outpatient visits to MREH were avoided for each filtered patient, the scheme saved the NHS approximately £2.76 per patient passing through the scheme.ConclusionOur results indicate that glaucoma filtering schemes have the potential to reduce false positive referrals and costs to the NHS.

scholarly journals Explaining the Gender Gap in Waiting Times for Scheduled Surgery in the Portuguese National Health Service

2021 ◽  
pp. 1-8
Author(s):  
Joana Cima ◽  
Paulo Guimarães ◽  
Álvaro Almeida
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Gender Gap ◽  
Fixed Effects ◽  
Waiting Times ◽  
Explanatory Variables ◽  
Explanatory Factors ◽  
Parametric Specification ◽  
The Difference

Objective: This paper evaluates the gender gap in waiting times for scheduled surgery, using information on 2.6 million surgical episodes in Portuguese National Health Service hospitals covering the period from 2011 to 2015. Methodology: We estimated the gross gender gap, i.e., the differential between the waiting times of men and women, and then add several explanatory variables that can account for this difference to estimate an adjusted gender gap. The variables are added in a way that permits the most flexible parametric specification. Next, we used Gelbach’s decomposition to understand the contribution of each variable to the difference between the gross and the adjusted gender gaps. Results: The gross gender gap of 10% is reduced to a 3% adjusted gender gap after accounting for observable explanatory factors. Gelbach’s decomposition shows that patient priority and hospital-fixed effects are the variables that contribute the most to the explained component of the gap. The analysis suggests that men tend to be ranked with more severe priorities, and that there are hospital specificities that cause men to have shorter waiting times. Conclusions: Overall, we identified a gender bias against women in surgery waiting times, but the size of the bias is smaller than was previously suggested in the literature.

scholarly journals Senior stakeholder views on policies to foster a culture of openness in the English National Health Service: a qualitative interview study

2018 ◽  
Vol 112 (4) ◽  
pp. 153-159 ◽  
Author(s):  
Graham Paul Martin ◽  
Sarah Chew ◽  
Mary Dixon-Woods
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Cultural Change ◽  
Qualitative Interviews ◽  
Third Sector ◽  
Employee Voice ◽  
Speaking Up ◽  
Qualitative Interview Study ◽  
Third Sector Organisations

Summary Objectives To examine the experiences of clinical and managerial leaders in the English healthcare system charged with implementing policy goals of openness, particularly in relation to improving employee voice. Design Semi-structured qualitative interviews. Setting National Health Service, regulatory and third-sector organisations in England. Participants Fifty-one interviewees, including senior leaders in healthcare organisations (38) and policymakers and representatives of other relevant regulatory, legal and third-sector organisations (13). Main outcome measures Not applicable. Results Participants recognised the limitations of treating the new policies as an exercise in procedural implementation alone and highlighted the need for additional ‘cultural engineering’ to engender change. However, formidable impediments included legacies of historical examples of detriment arising from speaking up, the anxiety arising from increased monitoring and the introduction of a legislative imperative and challenges in identifying areas characterised by a lack of openness and engaging with them to improve employee voice. Beyond healthcare organisations themselves, recent legal cases and examples of ‘blacklisting’ of whistle-blowers served to reinforce the view that giving voice to concerns was a risky endeavour. Conclusions Implementation of procedural interventions to support openness is challenging but feasible; engineering cultural change is much more daunting, given deep-rooted and pervasive assumptions about what should be said and the consequences of mis-speaking, together with ongoing ambivalences in the organisational environment about the propriety of giving voice to concerns.

NHS Modernisation Programme: A Guide with Links to Government NHS Web Sites for Further Information

2004 ◽  
Vol 5 (1) ◽  
pp. 12-15
Author(s):  
Pat Smedley
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
Patient Experience ◽  
National Health ◽  
Web Sites ◽  
Waiting Times ◽  
Rapid Pace ◽  
The Uk ◽  
Improve Patient

The rapid pace of change in the National Health Service (NHS) over the last five years has resulted in significant alterations to the way health care is, and will be delivered in the UK. The essential aims are to cut down waiting times, put more money into the system &C use it more effectively to improve patient experience through setting practice standards/maximising on staff potential/empowering patients/funding more beds and much more.

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