Organizing Health Inequalities? Employee-Driven Innovation and the Transformation of Care

This article responds to calls for new approaches to understanding and intervening in health inequalities and, in particular, for attention to the processes and relations that mediate structural inequality and everyday outcomes. Our contribution focuses on the part that healthcare organizations play in this. We draw on organizational sociology, which theorizes that while organizational structures, cultures, and practices may appear neutral – and rely for their legitimacy on this – they may, in fact, operate in the interests of some social groups and less in the interests of others. This proposition is worked through new empirical research on employee-driven innovation in the UK National Health Service. In both our case studies, front-line staff working with some of the most vulnerable citizens had identified the organization of care as both part of the problem and – potentially – part of the solution. In tracing their efforts to change the organization of care, we learn more about what it might take to mobilize resources in support of those whose lives are most affected by health inequalities.

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Peer influence as a driver of technological innovation in the UK National Health Service: a qualitative study of clinicians’ experiences and attitudes

BMJ Innovations ◽

10.1136/bmjinnov-2017-000208 ◽

2018 ◽

Vol 4 (2) ◽

pp. 68-74 ◽

Cited By ~ 3

Author(s):

Claire Greszczuk ◽

Faraz Mughal ◽

Rammya Mathew ◽

Ahmed Rashid

Keyword(s):

Peer Influence ◽

Qualitative Interviews ◽

Supporting Evidence ◽

Leadership Roles ◽

Front Line ◽

Change Initiatives ◽

Work Related ◽

Healthcare Settings ◽

Uk National Health Service ◽

The Uk

BackgroundAccelerating innovation to improve quality is a key policy target for healthcare systems around the world. Effectively influencing individuals’ behaviour is crucial to the success of innovation initiatives. This study explores UK clinicians’ lived experiences of, and attitudes towards, clinical peers endorsing healthcare innovations.MethodsQualitative interviews with UK-based clinicians in one of two groups: (1) clinicians working in ‘front-line’ service provision and (2) clinicians in strategic leadership roles within health institutions. Participants were identified through purposive sampling, and participated in semistructured telephone interviews. Thematic analysis was used to identify and analyse themes in the data.Results17 participants were recruited: eight clinicians from front-line UK healthcare settings and nine clinicians in leadership roles. Two major themes were identified from the interviews: power and trust. Participants recognised and valued peers’ powerful influence, exerted in person via social networks and routine work-related activities. Peers were implicitly trusted, although often on condition of their credibility and deservingness of respect, supporting evidence and absence of conflict of interest. While the groups shared similar views, they diverged on the subject of institutions, felt to be powerful by strategic leaders yet scarcely mentioned by front-line clinicians.ConclusionsUK clinicians view peers as a powerful and trustworthy source to promote innovative technologies. Policies that aim to support this process should seek to control the wider conditions that nurture peer-to-peer influence. Further research into interpersonal influence in health settings may improve implementation of change initiatives.

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Inequalities in healthcare disruptions during the Covid-19 pandemic: Evidence from 12 UK population-based longitudinal studies

10.1101/2021.06.08.21258546 ◽

2021 ◽

Author(s):

Jane Maddock ◽

Sam Parsons ◽

Giorgio Di Gessa ◽

Michael J Green ◽

Ellen J Thompson ◽

...

Keyword(s):

Social Class ◽

Longitudinal Studies ◽

Health Inequalities ◽

Meta Analysis ◽

Population Based ◽

Social Characteristics ◽

Logistic Regression Models ◽

Education Levels ◽

Uk National Health Service ◽

The Uk

Background: Health systems worldwide have faced major disruptions due to COVID-19 which could exacerbate health inequalities. The UK National Health Service (NHS) provides free healthcare and prioritises equity of delivery, but the pandemic may be hindering the achievement of these goals. We investigated associations between multiple social characteristics (sex, age, occupational social class, education and ethnicity) and self-reported healthcare disruptions in over 65,000 participants across twelve UK longitudinal studies. Methods: Participants reported disruptions from March 2020 up to late January 2021. Associations between social characteristics and three types of self-reported healthcare disruption (medication access, procedures, appointments) and a composite of any of these were assessed in logistic regression models, adjusting for age, sex and ethnicity where relevant. Random-effects meta-analysis was conducted to obtain pooled estimates. Results: Prevalence of disruption varied across studies; between 6.4% (TwinsUK) and 31.8 % (Understanding Society) of study participants reported any disruption. Females (Odd Ratio (OR): 1.27 [95%CI: 1.15,1.40]; I2=53%), older persons (e.g. OR: 1.39 [1.13,1.72]; I2=77% for 65-75y vs 45-54y), and Ethnic minorities (excluding White minorities) (OR: 1.19 [1.05,1.35]; I2=0% vs White) were more likely to report healthcare disruptions. Those in a more disadvantaged social class (e.g. OR: 1.17 [1.08, 1.27]; I2=0% for manual/routine vs managerial/professional) were also more likely to report healthcare disruptions, but no clear differences were observed by education levels. Conclusion: The COVID-19 pandemic has led to unequal healthcare disruptions, which, if unaddressed, could contribute to the maintenance or widening of existing health inequalities.

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Urological litigation trends in the UK National Health Service (NHS): An analysis of claims over 20 years

BJU International ◽

10.1111/bju.15411 ◽

2021 ◽

Author(s):

Jenni Lane ◽

Rahul Bhome ◽

Bhaskar Somani

Keyword(s):

National Health Service ◽

Health Service ◽

National Health ◽

Uk National Health Service ◽

The Uk

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Beyond Teenage and Young Adult Cancer Care: Care Experiences of Patients Aged 25–39 Years Old in the UK National Health Service

Clinical Oncology ◽

10.1016/j.clon.2021.02.010 ◽

2021 ◽

Author(s):

E. Lidington ◽

A.S. Darlington ◽

C. Vlooswijk ◽

S. Beardsworth ◽

S. McCaffrey ◽

...

Keyword(s):

National Health Service ◽

Young Adult ◽

Health Service ◽

National Health ◽

Cancer Care ◽

Uk National Health Service ◽

The Uk ◽

Young Adult Cancer

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Efficacy and safety data for the Ab interno XEN45 gel stent implant at 3 Years: A retrospective analysis

European Journal of Ophthalmology ◽

10.1177/11206721211014381 ◽

2021 ◽

pp. 112067212110143

Author(s):

Itay E Gabbay ◽

Mordechai Goldberg ◽

Felicity Allen ◽

Zhiheng Lin ◽

Christine Morley ◽

...

Keyword(s):

Intraocular Pressure ◽

Failure Rate ◽

Open Angle Glaucoma ◽

Safety Data ◽

Angle Closure ◽

Efficacy And Safety ◽

Antihypertensive Medications ◽

Uk National Health Service ◽

The Uk ◽

Comparative Audit

Purpose: To report efficacy and safety measures of the XEN45 gel stent at 36 months in the UK National Health Service setting. Methods: Retrospective non-comparative audit of the records of patients who underwent XEN45 implantation between June 2015 and May 2017 was performed. Main outcome measures were intraocular pressure and number of antihypertensive medications used. Failure was defined as need for further surgery or stent removal. Success was defined as a 20% decrease in intraocular pressure without the need for additional glaucoma medications or a reduction in antihypertensive medications without an increase in baseline intraocular pressure. Needling rates and preoperative factors effect were assessed. Results: The cohort included 205 patients (205 eyes) with primary open angle glaucoma (84.4%), angle closure glaucoma (7.8%), or refractory glaucoma (7.8%), 62.9% had a stand-alone procedure and 37.1%, a combined phaco-XEN45 procedure. Mean intraocular pressure was 22.6 ± 7.0 mmHg at baseline compared to 14.7 ± 3.8 mmHg at 24 months and 14.0 ± 2.9 mmHg at 36 months ( p < 0.001 for both). Mean number of medications used was 2.6 ± 1.1 at baseline compared to 0.5 ± 0.9 and 0.6 ± 1.0, at 24- and 36-months, respectively ( p < 0.001 for both). The failure rate at 36 months was 25%. Needling was required in 36.6%. Evaluation of background factors yielded an increased failure rate in non-Caucasians compared to Caucasians (74% vs 21%, p < 0.001). Conclusion: XEN45 implantation is effective and safe at 36 months’ follow-up. Patients should be advised regarding the risk of failure and possible need for bleb revisions. Careful patient selection may be required.

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Social Polarisation at the Local Level: A Four-Town Comparative Study on the Challenges of Politicising Inequality in Britain

Sociology ◽

10.1177/0038038520975593 ◽

2020 ◽

pp. 003803852097559 ◽

Cited By ~ 1

Author(s):

Insa Koch ◽

Mark Fransham ◽

Sarah Cant ◽

Jill Ebrey ◽

Luna Glucksberg ◽

...

Keyword(s):

Comparative Study ◽

Local Level ◽

Social Groups ◽

Community Analysis ◽

Common Features ◽

Social Polarisation ◽

The Uk ◽

Missing Middle ◽

Insight Into

This article examines how intensifying inequality in the UK plays out at a local level, in order to bring out the varied ways polarisation takes place ‘on the ground’. It brings a community analysis buttressed by quantitative framing to the study of economic, spatial and relational polarisation in four towns in the UK. We distinguish differing dynamics of ‘elite-based’ polarisation (in Oxford and Tunbridge Wells) and ‘poverty-based’ polarisation (in Margate and Oldham). Yet there are also common features. Across the towns, marginalised communities express a sense of local belonging. But tensions between social groups also remain strong and all towns are marked by a weak or ‘squeezed middle’. We argue that the weakness of intermediary institutions, including but not limited to the ‘missing middle’, and capable of bridging gaps between various social groups, provides a major insight into both the obstacles to, and potential solutions for, re-politicising inequality today.

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