Professor Kieran Walshe, from the Centre for Public Policy and Management at Manchester Business School in the UK, addressed the HARC network in April 2008 about how analysis of public service failures can help organisations learn and improve their performance.
HARC stands for the Hospital Alliance for Research Collaboration. HARC is a collaborative network of researchers, health managers, clinicians and policy makers based in NSW, Australia managed by the Sax Institute.
HARC Forums bring members of the HARC network together to discuss the latest research and analysis about important issues facing our hospitals.
For more information visit saxinstitute.org.au.
Greece: Primary Care in a time of crisis. 2nd VdGM Forum, Dublin 2015Evangelos Fragkoulis
2nd Vasco Da Gama Movement Forum, Dublin 2015
The Effect of the Economic Crisis on the Health Systems of the peripheral countries: Greece, Ireland, Spain, Portugal and Italy.
Ρητορική και πολιτική στην Πρωτοβάθμια Φροντίδα. Η αναγκαιότητα μιας τεκμηριω...Evangelos Fragkoulis
Παρούσιαση μου στα πλαίσια του 13ου Health Policy Forum, με θέμα:
"Πρωτοβάθμια Φροντίδα Υγείας: Προϋποθέσεις Ανασυγκρότησης και Ανάπτυξης"
Αρχαία Ολυμπία, 15-17 Απριλίου 2016
http://www.healthpolicy.gr/13%CE%B7-%CF%83%CF%85%CE%BD%CE%AC%CE%BD%CF%84%CE%B7%CF%83%CE%B7-%CE%B1%CF%81%CF%87%CE%B1%CE%AF%CE%B1-%CE%BF%CE%BB%CF%85%CE%BC%CF%80%CE%AF%CE%B1-2016/
Clinical Governance: As Drive for Patient Safety in Clinical Dentistry Ruby Med Plus
The focus on patient safety is an international phenomenon. Patient safety is an integral component of the quality of care. The governance of patient safety ‘encompasses panoply of regulatory processes that directly or indirectly intend to manage, prevent or limit iatrogenic events in oral health care services’.
Greece: Primary Care in a time of crisis. 2nd VdGM Forum, Dublin 2015Evangelos Fragkoulis
2nd Vasco Da Gama Movement Forum, Dublin 2015
The Effect of the Economic Crisis on the Health Systems of the peripheral countries: Greece, Ireland, Spain, Portugal and Italy.
Ρητορική και πολιτική στην Πρωτοβάθμια Φροντίδα. Η αναγκαιότητα μιας τεκμηριω...Evangelos Fragkoulis
Παρούσιαση μου στα πλαίσια του 13ου Health Policy Forum, με θέμα:
"Πρωτοβάθμια Φροντίδα Υγείας: Προϋποθέσεις Ανασυγκρότησης και Ανάπτυξης"
Αρχαία Ολυμπία, 15-17 Απριλίου 2016
http://www.healthpolicy.gr/13%CE%B7-%CF%83%CF%85%CE%BD%CE%AC%CE%BD%CF%84%CE%B7%CF%83%CE%B7-%CE%B1%CF%81%CF%87%CE%B1%CE%AF%CE%B1-%CE%BF%CE%BB%CF%85%CE%BC%CF%80%CE%AF%CE%B1-2016/
Clinical Governance: As Drive for Patient Safety in Clinical Dentistry Ruby Med Plus
The focus on patient safety is an international phenomenon. Patient safety is an integral component of the quality of care. The governance of patient safety ‘encompasses panoply of regulatory processes that directly or indirectly intend to manage, prevent or limit iatrogenic events in oral health care services’.
Nick Goodwin - Bringing integrated care to lifeAge UK
Dr Nick Goodwin, Senior Fellow, The King's Fund - presentation from Age UK's For Later Life conference, 25th April.
For more information: www.ageuk.org.uk/forlaterlife
Healthcare transition in GCC: Current Painful Realities & Proposed Strategic ...STELIOS PIGADIOTIS
Goals of research effort
1. Hands on analysis of GCC and specifically UAE healthcare market.
2. Proposed 2016 strategies for CEOs in GCC healthcare ecosystem
Top 3 Strategic Initiatives for Sustainable Results in Healthcare in Middle EastSTELIOS PIGADIOTIS
This research paper offers insights in three areas:
1. Current Challenges in GCC/Middle East Healthcare sector
2. Future Drivers for Healthcare Excellence
3. Future Strategic Initiatives for Sustainable Results
Evidencing the quality and productivity of Allied Health Professionals' (AHPs...NHS Improvement
We recently hosted four regional events ‘Evidencing the quality and productivity of AHPs care’ with a target audience of Allied Health Professional leads in NHS provider organisations.
These slides outline sessions from the events and provide an introduction to the Model Hospital, AHP job planning and the early findings of a deployment tracker metric ‘Therapy Hours to Contacts’ that is being implemented.
Sally Williams: acute trust responses to the Francis ReportNuffield Trust
In this slideshow, Sally Williams, Independent Health Policy Analyst and Researcher, presents findings from the Nuffield Trust report: The Francis Report: one year on, which looked at how acute trusts in England have responded to the Francis Report after one year.
Sally Williams spoke at the Nuffield Trust event: The Francis Inquiry: the impact one year on in February 2014.
Southwark and Lambeth-based projects Knee High Design Challenge, Diabetes Modernisation Initiative and Pathway explore what it takes to maintain change in the local healthcare system: understanding the issue & adapting to ever-changing context; gathering & maximising evidence; and building & maintaining meaningful relationships.
Find out more at www.gsttcharity.org.uk
Nick Goodwin - Bringing integrated care to lifeAge UK
Dr Nick Goodwin, Senior Fellow, The King's Fund - presentation from Age UK's For Later Life conference, 25th April.
For more information: www.ageuk.org.uk/forlaterlife
Healthcare transition in GCC: Current Painful Realities & Proposed Strategic ...STELIOS PIGADIOTIS
Goals of research effort
1. Hands on analysis of GCC and specifically UAE healthcare market.
2. Proposed 2016 strategies for CEOs in GCC healthcare ecosystem
Top 3 Strategic Initiatives for Sustainable Results in Healthcare in Middle EastSTELIOS PIGADIOTIS
This research paper offers insights in three areas:
1. Current Challenges in GCC/Middle East Healthcare sector
2. Future Drivers for Healthcare Excellence
3. Future Strategic Initiatives for Sustainable Results
Evidencing the quality and productivity of Allied Health Professionals' (AHPs...NHS Improvement
We recently hosted four regional events ‘Evidencing the quality and productivity of AHPs care’ with a target audience of Allied Health Professional leads in NHS provider organisations.
These slides outline sessions from the events and provide an introduction to the Model Hospital, AHP job planning and the early findings of a deployment tracker metric ‘Therapy Hours to Contacts’ that is being implemented.
Sally Williams: acute trust responses to the Francis ReportNuffield Trust
In this slideshow, Sally Williams, Independent Health Policy Analyst and Researcher, presents findings from the Nuffield Trust report: The Francis Report: one year on, which looked at how acute trusts in England have responded to the Francis Report after one year.
Sally Williams spoke at the Nuffield Trust event: The Francis Inquiry: the impact one year on in February 2014.
Southwark and Lambeth-based projects Knee High Design Challenge, Diabetes Modernisation Initiative and Pathway explore what it takes to maintain change in the local healthcare system: understanding the issue & adapting to ever-changing context; gathering & maximising evidence; and building & maintaining meaningful relationships.
Find out more at www.gsttcharity.org.uk
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
A presentation to start a workshop with community pharmacists on the contribution of pharmacy to the NHS Five Year Forward View, Health and Wellbeing Strategy and Sustainability and Transformation Plan
A national learning event took place in June 2014, to explore how best to present data from the Cancer Patient Experience Survey (CPES) in order to drive improvement.
Outcomes from the event will help to shape the future presentation of CPES data, so that it is more accessible and easier for professionals and the public to use and interpret.
The event was held by NHS Improving Quality's Experience of Care team, in partnership with Macmillan Cancer Support, and NHS England's Insight team, to bring together cancer managers, lead nurses and lead clinicians. They heard from speakers including patient Bonnie Green, Ben Page, chief executive of Ipsos Mori, and Sean Duffy, National Clinical Director for cancer. Delegates also undertook group activity looking at the barriers that exist in translating data into improvement, and tailoring data for the right audiences.
The event forms part of NHS Improving Quality's wider work with NHS England looking at how the NHS is using the CPES data to reduce variation in the cancer patient experience. CPES, part of the national survey programme commissioned by NHS England, generates data and insight into the experiences of cancer patients.
- See more at: http://www.nhsiq.nhs.uk/news-events/news/using-insight-data-to-improve-patient-experience.aspx#sthash.Yh1yiQ6y.dpuf
How to boost policy and program agencies’ use of researchSax Institute
Ms Gai Moore, Principal Analyst in the Sax Institute’s Knowledge Exchange division, presented new findings on what the evidence shows about what works in knowledge translation to the World Health Congress on Public Health in Melbourne in April.
The revised OECD Health Systems Performance Framework: methodological issues ...Sax Institute
The OECD is a leading organization in the international measurement of health system performance. The OECD Expert Group on Health Care Quality Indicators (HCQI) has recently revised its performance framework, identifying core indicators and highlighting new directions. Although improving, the capacity of countries to deliver more accurate standardized indicators still needs to be fostered. A particular aspect that deserves attention is the design, planning and implementation of public performance reporting. Such activity, strictly interrelated to the capacity of the information infrastructure, also depends from cultural, organizational and political conditions that can be differently present at the international level. The applicability of standardized principles and the evidence of improved outcomes due to public reporting systems is still questioned to a large extent. A first international conference on the topic of hospital performance reporting has been organized in Rome, Italy in 2014, followed by a second event held in Seoul, South Korea, in 2015. In his talk, Fabrizio Carinci will present recent developments of OECD projects, including:
• state of the art in the definition of OECD performance indicators
• challenges emerging from OECD R&D studies
• transferability and use of definitions at sub-national and provider level
• applicability for hospital performance benchmarking and geographical variation
• limitations imposed by the legislation on privacy and data protection
• an overarching vision of “essential levels of health information”
Through practical examples drawn from his direct experience as Member of the Bureau of the HCQI and other relevant Boards, Prof. Fabrizio Carinci will discuss the state of the art, the role played by national governments (including Australia), and potential avenues for mutual collaboration.
Evaluation of IC initiatives - challenges, approaches and evaluation of Engla...Sax Institute
This presentation from Nicholas Mays, Professor of Health Policy, Director, Policy Innovation Research Unit, Department of Health Services Research & Policy focuses on the challenges, approaches and evaluation of England's Pioneers.
Niek Klazinga | Performance reporting in OECD countriesSax Institute
Dr Niek Klazinga (Head of the Health Care Quality Indicators Project in the OECD Health Division) spoke with the HARC network in December 2014 about current developments in performance measurement and reporting.
HARC stands for the Hospital Alliance for Research Collaboration. HARC is a collaborative network of researchers, health managers, clinicians and policy makers based in NSW, Australia managed by the Sax Institute.
HARC Forums bring members of the HARC network together to discuss the latest research and analysis about important issues facing our hospitals.
For more information visit saxinstitute.org.au.
Sally Redman | Early findings from SPIRITSax Institute
Professor Sally Redman AM, CEO of the Sax Institute, recently addressed a CIPHER forum to share how the SPIRIT trial is testing a program designed to increase the use of research in policy and programs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Warwick Anderson | Research funding perspectives for CIPHER forumSax Institute
Professor Warwick Anderson AM, CEO of the National Health and Medical Research Council, recently addressed a CIPHER forum to share how the NHMRC was testing ways to better match research funding with policy needs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Kieran Walshe | Capitalising on opportunities for hospital reform
1. Centre for Public Policy
and Management
HARC Forum – 1 April 2008
Turnaround in healthcare
organisations: lessons from
research
Kieran Walshe
Professor of Health Policy and Management
Manchester Business School, UK
kieran.walshe@mbs.ac.uk
Combining the strengths of UMIST and
The Victoria University of Manchester
2. Centre for Public Policy
and Management
Overview
• What’s the problem?
• What goes wrong and why?
• Dealing with failing
organisations
• Approaches to turnaround
• Conclusions
Combining the strengths of UMIST and
The Victoria University of Manchester
3. Centre for Public Policy
and Management
Public service failures are not rare and are often
very costly – in financial and human terms
• Child Support Agency
• Home Office Immigration and Nationality Department
• Rural Payments Agency
• NHS University
• North Bristol NHS Trust
• Kent and Canterbury Hospital
Combining the strengths of UMIST and
The Victoria University of Manchester
4. Centre for Public Policy
and Management
So what goes wrong?
• Financial failures
– North Bristol NHS Trust – ran up £44.3 million overspend
in one year
• Governance/ethical failures
– NHS University – spent £50 million in brief life, lost
confidence of all its key stakeholders, wound up
• Clinical/performance failures
– Maidstone and Tunbridge Wells NHS Trust – saw two
uncontrolled outbreaks of C difficile in 2005 and 2006
with 500+ patients infected and 60 deaths
Combining the strengths of UMIST and
The Victoria University of Manchester
5. Centre for Public Policy
and Management
North Bristol NHS Trust: financial crisis in
2002/03
• Ended 2001/02 with £966k deficit on turnover of about £250m
• Board told balanced budget at start of financial year (April)
• SHA concerned as year progressed and called in auditors who in
month 9 (Dec) predicted £11.6m deficit
• Board reports in month 11 (February) restated £11.6m deficit, but
in March Board told it was up to £15.1m;
• SHA told privately in March it could be as much as £25m
• Actual outturn for 2002/03 deficit of £44.3m on turnover of c£300m
Combining the strengths of UMIST and
The Victoria University of Manchester
6. Centre for Public Policy
and Management
North Bristol NHS Trust: financial crisis in
2002/03
• £10.2m nurse staffing (agency/bank)
• £10.2m cost improvements not realised
• £9.5m excess costs of achieving waiting list targets
• £7.3m other directorates (not nursing) overspend
• £3.6m contract overperformance
• £3.5m unrealised income targets
Combining the strengths of UMIST and
The Victoria University of Manchester
7. Centre for Public Policy
and Management
North Bristol NHS Trust finances 2002/03
Combining the strengths of UMIST and
The Victoria University of Manchester
8. Centre for Public Policy
and Management
Maidstone and Tunbridge Wells NHS Trust –
outbreak of Clostridium difficile in 2005/06
• Two outbreaks of C difficile in October 2005 and April
2006, affecting over 500 patients and resulting in at
least 60 deaths in that period (more before and since)
• First outbreak unrecognised; second reported and
managed more effectively
• Took 4 months to establish an isolation unit for nursing
patients with C difficile – many patients nursed on open
wards, not even in single rooms
• Patients with C difficile not cared for adequately –
lapses in antibiotic therapy and complication
monitoring
Combining the strengths of UMIST and
The Victoria University of Manchester
9. Centre for Public Policy
and Management
Maidstone and Tunbridge Wells NHS Trust –
outbreak of Clostridium difficile in 2005/06
• Poor nursing care – call bells not answered; patients
left in wet/soiled sheets; wards, equipment and
bathrooms not cleaned; “escalation areas” used
inappropriately for inpatient care
• Poor response caused partly by pressure on beds
(90%+ occupancy) and trust’s desire to meet waiting
list targets
• Inadequate director of infection control and CoI team,
CoI policies absent or out of date, CoI training sporadic
• Board oversight lacking – “appeared to be insulated
from the realities and problems on the general ward”
Combining the strengths of UMIST and
The Victoria University of Manchester
10. Centre for Public Policy
and Management
Some key questions
• Why do organisations decline and fail? Is it inevitable
(or even desirable) that some are going to go to the
wall?
• Can we predict and even prevent performance
decline? What causes it?
• When failures occur – how are they best managed?
• What strategies are there for performance turnaround
and do they work?
Combining the strengths of UMIST and
The Victoria University of Manchester
11. Centre for Public Policy
and Management
What do we know?
• Lots of research on failure/turnaround in the for-profit
sector – some transferable ideas and findings
• Inquiries and investigations into failures – no shortage
of case studies and recommendations for change
• Growing body of research into failure and turnaround in
health, local government, schools, and other parts of
the public sector
Combining the strengths of UMIST and
The Victoria University of Manchester
12. Centre for Public Policy
and Management
Failure and turnaround: a simple model
Performance
decline
Failure
crisis
Turnaround
process
Improved
performance
Combining the strengths of UMIST and
The Victoria University of Manchester
13. Centre for Public Policy
and Management
Performance decline
Normal variation or failure?
High
Performance
Low
Combining the strengths of UMIST and
Time
The Victoria University of Manchester
14. Centre for Public Policy
and Management
Performance decline
High
Reported
Performance
Actual
Low
Combining the strengths of UMIST and
Time
The Victoria University of Manchester
15. Centre for Public Policy
and Management
Recognising performance decline
• Performance is naturally cyclical
• Need for a range of “hard” and “soft” indicators of
performance
• Overall level may be less important than rate of change
and trajectory
• Performance decline is relative, not absolute
• Differentiating “normal variation” and “incipient failure”
• True performance may be masked in reported
performance
Combining the strengths of UMIST and
The Victoria University of Manchester
16. Centre for Public Policy
and Management
Hard indicators of performance
• Is the organisation achieving key performance targets and
maintaining financial balance?
• What is the level of complaints? How many of these are serious,
enduring complaints, and how well are they resolved?
• What is the level and severity of patient safety incidents?
• What do the findings from audit projects at a clinical and
organisational level show? Are they acted upon?
• What are the results from external reviews such as Healthcare
Commission, national staff surveys, national patient surveys,
national audit programmes, external audit, etc?
• Are there reviews into specific incidents underway e.g. special
investigations?
• What is the level of staff turnover? Are there problems in relation
to recruitment and retention of staff?
Combining the strengths of UMIST and
The Victoria University of Manchester
17. Centre for Public Policy
and Management
Soft indicators of performance
• How well does the organisation make use of available data?
• How does the organisation respond to signs of decline - what is
the level of internal challenge and debate?
• Is the organisation ‘in touch’ with what is happening, both
internally and externally?
• How likely is the organisation to be distracted by other major
initiatives, changes or problems?
• How is potential for innovation, creativity and learning used?
• How good are clinical-managerial relationships in the
organisation?
• How is staff morale?
• What is the quality of external relationships?
• What are relationships and reputation with the local media like?
Combining the strengths of UMIST and
The Victoria University of Manchester
18. Centre for Public Policy
and Management
Health community views of five SHAs
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Combining the strengths of UMIST and
C
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The Victoria University of Manchester
C
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19. Centre for Public Policy
and Management
Health community views of five SHAs
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Combining the strengths of UMIST and
The Victoria University of Manchester
A B C D E
20. Centre for Public Policy
and Management
Health community views: SHA D
• “It does not deal effectively with difficult strategic issues”
• “As you can tell I am unimpressed. … the SHA has been of little help.
We suffer from a failure of joint commissioning by our PCTs and the SHA
has shirked its responsibility to make them collaborate. As a result
clinical services are suffering. The SHA will teach Pontius Pilate a thing
or two about not getting too involved. General style is remote and high
handed”
• “SHA veers from a very hands off approach to a very interventionist
approach with nothing in between and no agreed strategy. Sometime the
SHA deals with individual organisations and sometimes with health
economy - there is no logic to this”
• “The SHA is reluctant to work with other than (a) a complete "hands off"
or (b) directive intervention too late mode. It needs to develop more
effective participating modes to really work with local Trusts/systems”
Combining the strengths of UMIST and
The Victoria University of Manchester
21. Centre for Public Policy
and Management
The causes of performance decline and failure
• Markers, symptoms or warning signs
– Poor relationships, financial deficits, targets missed,
• Secondary causes
– Lack of controls, weak strategy, poor leadership
– Increased competition, innovations, policy changes
• Primary causes
– Organisational culture and attitudes
– Introspection, arrogance, myopia, trauma
– Failure to learn, adapt, change appropriately
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Crisis and declaration of failure
• External assessment/review – by key stakeholders
– Report from Audit Commission or Healthcare
Commission, publication of performance data,
• An egregious event – disasters and major failures
– High profile patient safety incident, major complaint
investigation, whistleblower, scandal
• Change of perspective
– New chief executive or senior management team, new
governance, new partners/views in public service
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Performance decline
High Self regulating response to decline
Performance
Low Failing response to decline
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The response to failure
• Multifactorial, multidimensional symptoms/causes
which are interrelated and interact
• The self-regulating response to decline
– Recognition, willingness to change, open about
problems/data, internal capacity to tackle problems
• The failing response to decline
– Fallacy of success, fortress mentality, retrospective view,
hide the data, no internal capacity to act
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Approaches to turnaround
• Range of actors
– Government departments
– Regulators, inspectors and oversight agencies
– Other, neighbouring public organisations
– New boards/management teams
– Management consultancies
• Three basic – and complentary - strategies
– Replacement, retrenchment and renewal
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Replacement
• Serves both a functional and a symbolic/political
purpose with stakeholders
• Deals with responsibility for failure and allows the
organisation to draw a line and move on
• Brings in necessary new skills and expertise – but risk
of losing key experience, knowledge and
understanding – flight of talent
• Who gets replaced – the organisation’s leadership?
• May be necessary, but not a sufficient response – and
what happens if the new team fails too?
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Retrenchment
• Addressing most important performance issues and
bringing them under control as soon as possible
• Mechanistic, process-focused, operational changes to
structures and systems
• Financial control, achievement of key activity targets,
tightened monitoring and management
• Short term, stemming losses and halting decline –
focus on symptoms and secondary causes of failure
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Renewal
• Establishing new vision and purpose for the
organisation – redefining its mission
• Developing clear future long term strategy for return to
growth and future success
• Changing organisational culture, attitudes and
behaviour, focusing on organisational development
• Long-term, fundamental, focused on primary causes of
failure
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Does turnaround work?
• Not all turnarounds work - reasons for failed
turnarounds and permanently failing organisations
• Timescale for turnaround and likelihood of successful
turnaround variable but can be long
• Added value and impact of external intervention: what
would have happened without it?
• Embedding renewal – avoiding a return to failure when
intervention/support is removed
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Conclusions
• Public service failures are important – functionally and
symbolically, as part of a wider political narrative
• We can do more to understand, predict and engage
with (?prevent) performance decline and failure
• There is growing expertise and experience with
approaches to turnaround which seem to “work”, but its
neither simple nor quick
• It may be helpful to see failure and turnaround in terms
of organisational capacities to learn, or to use
information to improve performance
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