Moving towards strategic commissioning: impact on clinical commissioning groups as membership organizations

Objective This paper aims to explore the nature of clinical commissioning groups (CCGs) in England as membership organizations. Utilizing the concept of meta-organization as a lens, we discuss the impact that this organizational form might have on CCGs’ ability to become ‘strategic commissioners’. Methods We used a longitudinal qualitative approach to explore the adoption and implementation of primary care co-commissioning. The study was undertaken between May 2015 and June 2017 and included interviews with senior policy makers, analysis of policy documents, two telephone surveys, and case studies in four CCGs nationally. Results CCGs operate as membership organizations with closed boundary and low stratification, whereby a consensus or majority needs to be reached by members when activities impact on membership or the CCG’s constitution. While CCGs should move towards a more strategic commissioning role that is focused on local priorities agreed by their members, they are faced with a complex system of accountabilities and responsibilities, which makes this difficult to achieve. Conclusions The nature of CCGs as membership-based meta-organizations has the potential to both help and hinder CCGs in becoming strategic commissioners. The complexities in accountability and governance that the membership approach introduces, and the potential difficulties that CCGs face with competing meta-organizations, raises questions about the future of CCGs as membership organizations.

Download Full-text

Achieving integrated care through commissioning of primary care services in the English NHS: a qualitative analysis

BMJ Open ◽

10.1136/bmjopen-2018-027622 ◽

2019 ◽

Vol 9 (4) ◽

pp. e027622 ◽

Cited By ~ 2

Author(s):

Imelda McDermott ◽

Kath Checkland ◽

Valerie Moran ◽

Lynsey Warwick-Giles

Keyword(s):

Primary Care ◽

Integrated Care ◽

Case Studies ◽

Models Of Care ◽

Telephone Surveys ◽

Care Services ◽

Primary Care Services ◽

Combining Data ◽

Care Systems ◽

The Impact

ObjectivesSince April 2015, Clinical Commissioning Groups (CCGs) have taken on the responsibility to commission primary care services. The aim of this paper is to analyse how CCGs have responded to this new responsibility and to identify challenges and factors that facilitated or inhibited achievement of integrated care systems.DesignWe undertook an exploratory approach, combining data from interviews and national telephone surveys, with analysis of policy documents and case studies in four CCGs. Data were analysed using thematic content analysis.Setting/participantsWe reviewed 147 CCG application documents and conducted two national telephone surveys with CCGs (n=49 and n=21). We interviewed 6 senior policymakers and 42 CCG staff who were involved in primary care co-commissioning (general practitioners and managers). We observed 74 primary care commissioning committee meetings and their subgroups (approx. 111 hours).ResultsCCGs in our case studies focused their primary care commissioning activities on developing strategic plans, ‘new’ primary care initiatives, and dealing with legacy work. Many plans focused on incentivising and supporting practices to work together and provide a broad range of services. There was a clear focus on ensuring the sustainability of general practice. Our respondents expressed mixed views as to what new collaborative service models, such as the new models of care and sustainability and transformation partnerships (STPs), would mean for the future of primary care and the impact they could have on CCGs and their members.ConclusionsThere is a disconnect between locally based primary care and the wider system. One of the major challenges we identified is the lack of knowledge and expertise in the field of primary care at STP level. While primary care commissioning by CCGs seems to be supporting local collaborations between practices, there is some way to go before this is translated into broader integration initiatives across wider footprints.

Download Full-text

An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

BMJ Open Quality ◽

10.1136/bmjoq-2019-000839 ◽

2021 ◽

Vol 10 (2) ◽

pp. e000839

Author(s):

Heather Cassie ◽

Vinay Mistry ◽

Laura Beaton ◽

Irene Black ◽

Janet E Clarkson ◽

...

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Case Studies ◽

Quality Care ◽

Theoretical Domains Framework ◽

Team Members ◽

Knowledge And Skills ◽

Scottish Government ◽

The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

Download Full-text

The TL;DR Charter: Speculatively Demystifying Privacy Policy Documents and Terms Agreements

Proceedings of the ACM on Human-Computer Interaction ◽

10.1145/3492842 ◽

2022 ◽

Vol 6 (GROUP) ◽

pp. 1-14

Author(s):

Lindah Kotut ◽

D. Scott McCrickard

Keyword(s):

Full Understanding ◽

Policy Makers ◽

Policy Documents ◽

Software Adoption ◽

User Data ◽

Alternate Reality ◽

Future Technologies ◽

Design Fiction ◽

The Impact

Privacy policy and term agreement documents are considered the gateway for software adoption and use. The documents provide a means for the provider to outline expectations of the software use, and also provide an often-separate document outlining how user data is collected, stored, and used--including if it is shared with other parties. A user agreeing with the terms, assumes that they have a full understanding the terms of the agreement and have provided consent. Often however, users do not read the documents because they are long and full of legalistic and inconsistent language, are regularly amended, and may not disclose all the details on what is done to the user data. Enforcing compliance and ensuring user consent have been persistent challenges to policy makers and privacy researchers. This design fiction puts forward an alternate reality and presents a policy-based approach to fording the consent gap with the TL;DR Charter: an agreement governing the parties involved by harnessing the power of formal governments, industry, and other stakeholders, and taking users expectation of privacy into account. The Charter allows us as researchers to examine the implications on trust, decision-making, consent, accountability and the impact of future technologies.

Download Full-text

Linking Scientific Research to Development Agenda

Advances in Geospatial Technologies - Handbook of Research on Geospatial Science and Technologies ◽

10.4018/978-1-5225-3440-2.ch023 ◽

2018 ◽

pp. 374-391

Author(s):

P. K. Kenabatho ◽

B. P. Parida ◽

B. Matlhodi ◽

D.B. Moalafhi

Keyword(s):

Case Studies ◽

Scientific Community ◽

Scientific Research ◽

Decision Makers ◽

Knowledge Generation ◽

Policy Makers ◽

Scientific Investigations ◽

Development Agenda ◽

The Impact

In recent years, the scientific community has been urged to undertake research that can immediately have impact on development issues, including national policies, strategies, and people's livelihoods, among others. While this is a fair call from decision makers, it should also be realized that science by nature is about innovation, discovery and knowledge generation. In this context, there is need for a balance between long term scientific investigations and short term scientific applications. With regard to the former, researchers spend years investigating (or need data of sufficient record length) to provide sound and reliable solutions to a problem at hand while in the latter, it is possible to reach a solution with few selected analyses. In all cases, it is advisable that researchers, where possible should link their studies to topical development issues in their case studies. In this paper, we use a hydrometeorological project in the Notwane catchment, Botswana, to show the importance of linking research to development agenda for mutual benefit of researchers and policy makers. The results indicate that some key development issues are being addressed by the Project and the scope exists to improve the impact of the project.

Download Full-text

Assessing the Impact of E-Commerce on SMEs in Value Chains

Electronic Commerce in Small to Medium-Sized Enterprises ◽

10.4018/978-1-59140-146-9.ch011 ◽

2004 ◽

pp. 180-198

Author(s):

Judith Jeffcoate ◽

Caroline Chappell ◽

Sylvie Feindt

Keyword(s):

Case Studies ◽

Value Chain ◽

Analytical Framework ◽

Qualitative Approach ◽

Future Trends ◽

Multiple Case ◽

Multiple Case Studies ◽

The Impact ◽

Chain Transformation ◽

Specific Contribution

This chapter is intended as a contribution to the establishment of a theoretical foundation for the e-commerce field. Our specific contribution to methodology is through the description of a qualitative approach based on multiple case studies across industry and country boundaries. This has enabled us to propose an analytical framework that will identify the triggers for value chain transformation that will encourage SMEs to adopt e-commerce. The chapter describes seven elements that make up this framework, including the automation of value activity interactions between partners in the value chain. These elements form the basis for a discussion of future trends.

Download Full-text

Privatisation and Workers’ Compensation in Privatised State-Owned Enterprises in Bangladesh

Business Management and Strategy ◽

10.5296/bms.v12i1.18070 ◽

2020 ◽

Vol 12 (1) ◽

pp. 16

Author(s):

Mehadi Mamun ◽

Mamun Billah

Keyword(s):

Case Studies ◽

Qualitative Data ◽

Qualitative Approach ◽

Workers Compensation ◽

Complete Report ◽

The Impact ◽

Privately Owned ◽

Insight Into

This paper examines the impact of privatisation on workers’ compensation in privatised state-owned enterprises in Bangladesh. The study employs five case studies using a qualitative approach. Studying multiple cases is considered more reliable as it permits replication and extension. The qualitative approach helps to build a holistic picture, which allows for the assembling of a comprehensive and complete report of the issues under investigation. The research finds that workers’ compensations in most privatised case study organisations are less than their counterparts in comparable state-owned and privately-owned organisations. The findings have important implications for the privatisation programmes in Bangladesh as the study focuses on workers who are the major workforce of privatised organisations and generates qualitative data that provides greater insight into the impact of privatisation on workers’ compensation in Bangladesh.

Download Full-text

Decisions and Transitions: Meeting the Needs of the ‘Knowledge Economy’

Environment and Planning C Government and Policy ◽

10.1068/c0658 ◽

2008 ◽

Vol 26 (5) ◽

pp. 924-937 ◽

Cited By ~ 8

Author(s):

Molly Warrington

Keyword(s):

Higher Education ◽

Cultural Capital ◽

Knowledge Economy ◽

Focused Attention ◽

Policy Makers ◽

Policy Documents ◽

Social And Cultural Capital ◽

North East ◽

Relative Differences ◽

The Impact

Governments worldwide have focused attention on improving educational attainment in order to meet the labour demands of the knowledge economy. I explore decisions taken concerning further and higher education among seventy-one students from a highly successful comprehensive school in North East England, and argue that the postulated links between attainment, higher education, and secure well-paid employment are more complicated than policy documents suggest. Instead, I argue for a greater understanding among policy makers of the specificity of place and of the impact of relative differences in economic, social, and cultural capital.

Download Full-text

An Ecosystem Model of Small and Medium Sized Enterprises Publisher ‘Tiers’: Publisher Size, Sustainability and Cultural Policy

Publishing Research Quarterly ◽

10.1007/s12109-021-09811-y ◽

2021 ◽

Author(s):

Claire Squires ◽

Helena Markou

Keyword(s):

Life Cycle ◽

Case Studies ◽

Cultural Policy ◽

Ecosystem Model ◽

Qualitative Model ◽

Policy Makers ◽

Developmental Sense ◽

The Uk ◽

The Impact ◽

Support Model

AbstractThis article establishes a quantitative and qualitative model of small and medium-sized enterprises (SME) publisher ‘Tiers’, in order to enable researchers and cultural policy makers to have a more granular understanding of the impact of publisher size. Through an aggregated set of case studies deriving from the UK, the article also develops an understanding of how to build a cultural support model for publishing based on publisher size, sustainability and company life cycle. What the Tiers model underpins in terms of cultural policy funding for publishers is a rigorous and developmental sense of a publishing ecosystem, offering a framework which is attendant to industry and broader contexts, and enables cultural policy funding to take into account publisher development, challenge and growth.

Download Full-text

Vulnerability, legal need and technology in England and Wales

International Journal of Discrimination and the Law ◽

10.1177/13582291211031375 ◽

2021 ◽

pp. 135822912110313

Author(s):

Daniel Newman ◽

Jess Mant ◽

Faith Gordon

Keyword(s):

Social Welfare ◽

Case Studies ◽

The State ◽

Specific Context ◽

Policy Documents ◽

England And Wales ◽

Legal Advice ◽

Vulnerability Theory ◽

The Impact ◽

Critical Consideration

This paper explores legal need and legal advice in England and Wales during the COVID-19 pandemic. It uses the lens of vulnerability theory to examine the ways in which this crisis exposed pre-existing fragilities between the state and its relationship with the advice sector, and the individuals who experience social welfare problems. The paper commences by exploring Fineman’s vulnerability thesis and its application to those experiencing social welfare-related issues, as well as the vulnerability of the systems operating to give advice. The paper then considers the specific context of the COVID-19 pandemic and the impact on needs, and the ability of the sector to meet these needs. Drawing on policy documents, reports and three case studies from law centres in England and Wales, it discusses the concept of legal need and the realities being experienced. These case studies assist us in being able to critically consider the topics of vulnerability, changing needs and the role that technology is, and can play during the pandemic and beyond. Lastly, the paper points to the need for a critical consideration of the sustainability and format of legal advice in addressing legal need in the post-COVID-19 landscape.

Download Full-text

Pemahaman Dampak Game Online pada Anak-Anak Nelayan di Kota Makassar

Communicatus: Jurnal Ilmu komunikasi ◽

10.15575/cjik.v4i2.7999 ◽

2020 ◽

Vol 4 (2) ◽

pp. 165-184

Author(s):

Arianto Arianto ◽

Tuti - Bahfiarti

Keyword(s):

Case Studies ◽

Interpersonal Relationships ◽

Internet Addiction ◽

Participant Observation ◽

Low Frequency ◽

Online Games ◽

Qualitative Approach ◽

The Impact ◽

Depth Interviews ◽

Very High

Understanding the impact of fishermen children's online games is a phenomenon because it has the potential to cause internet addiction, decreased learning achievement, and even the destruction of interpersonal relationships. The purpose of this study is to categorize the understanding of fishermen children in the use of online games in Makassar City. This type of research uses a qualitative approach referring to case studies that specifically reveal children's understanding of the impact of online games, especially fishing communities. Data was collected through non-participant observation, and in-depth interviews with children aged 7-12 years chosen by purposive sampling. The results found that fishermen children's understanding of the impact of online games is high. First, the category of high comprehension is characterized by duration and low frequency or children do not play online games, high interactivity playing with peers. Second, the category of understanding being children tends to divide the time playing online games and learning with minimal duration and frequency of time. Third, the category of understanding is low in characteristics, children are very intensive to have the duration and frequency of playing online games very high, the level of interactivity with peers is low.

Download Full-text