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 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 Assessing impacts of land abandonment on Mediterranean biodiversity using indicators based on bird and butterfly monitoring data

2015 ◽  
Vol 43 (1) ◽  
pp. 69-78 ◽  
Author(s):  
SERGI HERRANDO ◽  
LLUÍS BROTONS ◽  
MARC ANTON ◽  
FERRAN PÁRAMO ◽  
DANI VILLERO ◽  
...  
Keyword(s):  
Large Scale ◽  
Forest Cover ◽  
Habitat Preferences ◽  
Land Abandonment ◽  
Monitoring Data ◽  
Open Habitat ◽  
North East ◽  
The North ◽  
Butterfly Monitoring ◽  
The Impact

SUMMARYIn Europe, and particularly in the Mediterranean Basin, the abandonment of traditional land-use practices has been reported as one of the main causes of decline for open-habitat species. Data from large-scale bird and butterfly monitoring schemes in the north-east Iberian Peninsula were used to evaluate the impact that land abandonment has had on local biodiversity. Species’ habitat preferences, along a gradient from open to forest habitats, were significantly related to population trends: for both birds and butterflies, open-habitat species showed the most marked declines while forest species increased moderately. Multi-species indicators for tracking the impact of land abandonment on bird and butterfly populations were developed using habitat preference estimates and population trend indices. The patterns shown by these indicators were in line with the changes occurring in forest cover in the monitoring sites. This study reveals that multi-species indicators based on monitoring data from different taxonomic groups (here, birds and butterflies) may usefully be employed to track impacts of environmental change on biodiversity.

scholarly journals Impact of air–sea coupling on the climate change signal over the Iberian Peninsula

2021 ◽  
Author(s):  
Alba de la Vara ◽  
William Cabos ◽  
Dmitry V. Sein ◽  
Claas Teichmann ◽  
Daniela Jacob
Keyword(s):  
Climate Change ◽  
Iberian Peninsula ◽  
Mediterranean Sea ◽  
Large Scale ◽  
Regional Distribution ◽  
Coupled Model ◽  
Climate Change Signal ◽  
The North ◽  
The Mediterranean ◽  
The Impact

AbstractIn this work we use a regional atmosphere–ocean coupled model (RAOCM) and its stand-alone atmospheric component to gain insight into the impact of atmosphere–ocean coupling on the climate change signal over the Iberian Peninsula (IP). The IP climate is influenced by both the Atlantic Ocean and the Mediterranean sea. Complex interactions with the orography take place there and high-resolution models are required to realistically reproduce its current and future climate. We find that under the RCP8.5 scenario, the generalized 2-m air temperature (T2M) increase by the end of the twenty-first century (2070–2099) in the atmospheric-only simulation is tempered by the coupling. The impact of coupling is specially seen in summer, when the warming is stronger. Precipitation shows regionally-dependent changes in winter, whilst a drier climate is found in summer. The coupling generally reduces the magnitude of the changes. Differences in T2M and precipitation between the coupled and uncoupled simulations are caused by changes in the Atlantic large-scale circulation and in the Mediterranean Sea. Additionally, the differences in projected changes of T2M and precipitation with the RAOCM under the RCP8.5 and RCP4.5 scenarios are tackled. Results show that in winter and summer T2M increases less and precipitation changes are of a smaller magnitude with the RCP4.5. Whilst in summer changes present a similar regional distribution in both runs, in winter there are some differences in the NW of the IP due to differences in the North Atlantic circulation. The differences in the climate change signal from the RAOCM and the driving Global Coupled Model show that regionalization has an effect in terms of higher resolution over the land and ocean.

scholarly journals Employing Geographical Principles for Sampling in State of the Art Dialectological Projects

2013 ◽  
Vol 1 (2) ◽  
pp. 96-114 ◽  
Author(s):  
Isabelle Buchstaller ◽  
Seraphim Alvanides
Keyword(s):  
Large Scale ◽  
State Of The Art ◽  
Pilot Project ◽  
Linguistic Analysis ◽  
Human Geography ◽  
North East ◽  
The North ◽  
Functional Regions ◽  
Demographic Classification

The aims of this paper are twofold. First, we locate the most effective human geographical methods for sampling across space in large-scale dialectological projects. We propose two geographical concepts as a basis for sampling decisions: Geo-demographic classification, which is a multidimensional method used for the socio-economic grouping of areas; we also develop an updated version of functional regions that can be used in sociolinguistic research. We then report on the results of a pilot project that applies these models to collect data regarding the acceptability of vernacular morphosyntactic forms in the North East of England. Following the method of natural breaks advocated for dialectology by Horvath & Horvath (2002), we interpret breaks in the probabilistic patterns as areas of dialect transitions. This study contributes to the debate about the role and limitations of spatiality in linguistic analysis. It intends to broaden our knowledge about the interfaces between human geography and dialectology.

scholarly journals Impacts of Large-Scale Circulation on Urban Ambient Concentrations of Gaseous Elemental Mercury in New York, USA

2017 ◽  
Author(s):  
Huiting Mao ◽  
Dolly Hall ◽  
Zhuyun Ye ◽  
Ying Zhou ◽  
Dirk Felton ◽  
...  
Keyword(s):  
New York ◽  
North American ◽  
Large Scale ◽  
Measurement Data ◽  
Elemental Mercury ◽  
Urban Site ◽  
Large Scale Circulation ◽  
Gaseous Elemental Mercury ◽  
The North ◽  
The Impact

Abstract. The impact of large-scale circulation on urban gaseous elemental mercury (GEM) was investigated through analysis of 2008–2015 measurement data from an urban site in New York City (NYC), New York, USA. Distinct annual cycles were observed in 2009–2010 with mixing ratios in warm seasons (i.e. spring–summer) 10–20 ppqv (~ 10 %–25 %) higher than in cool seasons (i.e. fall–winter). This annual cycle was disrupted in 2011 by an anomalously strong influence of the North American trough in that warm season and was reproduced in 2014 with annual amplitude enhanced up to ~ 70 ppqv associated with a particularly strong Bermuda High. North American trough axis index (TAI) and intensity index (TII) were used to characterize the effect of the North American trough on NYC GEM especially in winter and summer. The intensity and position of the Bermuda High had a significant impact on GEM in warm seasons supported by a strong correlation (r reaching 0.96, p 

Study of sand wave migration over five years as observed in two windfarm development areas, and the implications for building on moving substrates in the North Sea

2014 ◽  
Vol 105 (4) ◽  
pp. 241-249 ◽  
Author(s):  
Ken P. Games ◽  
David I. Gordon
Keyword(s):  
Case Studies ◽  
Large Scale ◽  
Oil And Gas ◽  
Sand Wave ◽  
Sand Waves ◽  
Migration Rates ◽  
The North ◽  
The North Sea ◽  
Wave Migration ◽  
The Impact

ABSTRACTSand waves are well known indicators of a mobile seabed. What do we expect of these features in terms of migration rates and seabed scour? We discuss these effects on seabed structures, both for the Oil and Gas and the Windfarm Industries, and consider how these impact on turbines and buried cables. Two case studies are presented. The first concerns a windfarm with a five-year gap between the planning survey and a subsequent cable route and environmental assessment survey. This revealed large-scale movements of sand waves, with the displacement of an isolated feature of 155 m in five years. Secondly, another windfarm development involved a re-survey, again over a five-year period, but after the turbines had been installed. This showed movements of sand waves of ∼50 m in five years. Observations of the scour effects on the turbines are discussed. Both sites revealed the presence of barchans. Whilst these have been extensively studied on land, there are few examples of how they behave in the marine environment. The two case studies presented show that mass transport is potentially much greater than expected and that this has implications for choosing turbine locations, the effect of scour, and the impact these sediment movements are likely to have on power cables.

scholarly journals Capitalismo distrettuale, localismi d'impresa, globalizzazione

2008 ◽  
Keyword(s):  
Industrial Development ◽  
Large Scale ◽  
International Markets ◽  
Scope Economies ◽  
North East ◽  
The North ◽  
Productive System ◽  
Dimensional Growth ◽  
It Revolution ◽  
Made In

From the late Sixties on, industrial development in Italy evolved through the spread of small and medium sized firms, aggregated in district networks, with an elevated propensity to enterprise and the marked presence of owner-families. Installed within the local systems, the industrial districts tended to simulate large-scale industry exploiting lower costs generated by factors that were not only economic. The districts are characterised in terms of territorial location (above all the thriving areas of the North-east and Centre) and sector, since they are concentrated in the "4 As" (clothing-fashion, home-decor, agri-foodstuffs, automation-mechanics), with some overlapping with "Made in Italy". How can this model be assessed? This is the crucial question in the debate on the condition and prospects of the Italian productive system between the supporters of its capacity to adapt and the critics of economic dwarfism. A dispassionate judgement suggests that the prospects of "small is beautiful" have been superseded, but that the "declinist" view, that sees only the dangers of globalisation and the IT revolution for our SMEs is risky. The concept of irreversible crisis that prevails at present is limiting, both because it is not easy either to "invent", or to copy, a model of industrialisation, and because there is space for a strategic repositioning of the district enterprises. The book develops considerations in this direction, showing how an evolution of the district model is possible, focusing on: gains in productivity, scope economies (through diversification and expansion of the range of products), flexibility of organisation, capacity to meld tradition and innovation aiming at product quality, dimensional growth of the enterprises, new forms of financing, active presence on the international markets and valorisation of the resources of the territory. It is hence necessary to reactivate the behavioural functions of the entrepreneurs.

scholarly journals The effect of the north-east ice stream on the Greenland ice sheet in changing climates

2007 ◽  
Vol 1 (1) ◽  
pp. 41-76 ◽  
Author(s):  
R. Greve ◽  
S. Otsu
Keyword(s):  
Large Scale ◽  
Ice Sheet ◽  
Greenland Ice Sheet ◽  
Simulation Code ◽  
North East ◽  
The North ◽  
Ice Stream ◽  
Basal Sliding ◽  
Speed Up ◽  
Fast Flow

Abstract. The north-east Greenland ice stream (NEGIS) was discovered as a large fast-flow feature of the Greenland ice sheet by synthetic aperture radar (SAR) imaginary of the ERS-1 satellite. In this study, the NEGIS is implemented in the dynamic/thermodynamic, large-scale ice-sheet model SICOPOLIS (Simulation Code for POLythermal Ice Sheets). In the first step, we simulate the evolution of the ice sheet on a 10-km grid for the period from 250 ka ago until today, driven by a climatology reconstructed from a combination of present-day observations and GCM results for the past. We assume that the NEGIS area is characterized by enhanced basal sliding compared to the "normal", slowly-flowing areas of the ice sheet, and find that the misfit between simulated and observed ice thicknesses and surface velocities is minimized for a sliding enhancement by the factor three. In the second step, the consequences of the NEGIS, and also of surface-meltwater-induced acceleration of basal sliding, for the possible decay of the Greenland ice sheet in future warming climates are investigated. It is demonstrated that the ice sheet is generally very susceptible to global warming on time-scales of centuries and that surface-meltwater-induced acceleration of basal sliding can speed up the decay significantly, whereas the NEGIS is not likely to dynamically destabilize the ice sheet as a whole.

scholarly journals EVALUATION OF THE IMPACT OF ENVIRONMENTAL CONDITIONS ON THE STATUS OF THE BODY OF YOUNG PEOPLE OF 17-19 YEARS OF DIFFERENT ETHNIC GROUPS OF THE NORTH-EAST RUSSIA

2019 ◽  
Vol 96 (8) ◽  
pp. 766-769 ◽  
Author(s):  
Inessa V. Averyanova ◽  
S. I. Vdovenko ◽  
A. L. Maksimov
Keyword(s):  
Gas Exchange ◽  
Climatic Conditions ◽  
The Body ◽  
External Respiration ◽  
Adaptive Responses ◽  
Northeast Russia ◽  
North East ◽  
The North ◽  
Magadan Region ◽  
The Impact

Natural and climatic conditions of the environment of Northeast Russia and particularly Magadan region are the very factor mostly influencing adaptive responses by individuals inhabiting the region. Compensatory and adaptive responses in indigenes and newcomers of the region can be assumed to have their specific features. In 2009 there was executed the examination of the cardiovascular and respiratory systems and gas exchange in 392 cases aged of 17-19 years, including Europeans (Caucasians) born in the North in the 1st-2nd generation and indigenes. The methodologically similar study was carried out in 2014 in 265 persons, referred to the same cohorts of North-born Caucasians and Indigenes from the Magadan region. The results of the study executed in 2009 testified to a small number of physiological parameters that were reliably different in Caucasians vs. Indigene subjects. In 2014 no difference was found between the two examined cohorts throughout the observed parameters. The revealed changes in gas exchange, external respiration and cardiovascular systems demonstrated by modern young Indigenes of Northeast Russia testified to the fall in the effectiveness of their breathing. All that makes them farther from the classic “polar metabolic type” and their morphofunctional status becomes closer to European male subjects of Northeast Russia. Thus, we can observe a clear tendency towards “convergence in programs” of the adaptive changes between populations of the North residents undergoing similar natural, environmental and social factors.

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