Steve harrison
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This document discusses performance management in the NHS. It outlines how performance indicators can be used formatively to facilitate local management or summatively to set targets and hold locals accountable. Summative performance management has led to problems like gaming the system, faking data, and prioritizing what is measured over patient care. Governments continue this approach for political reasons even though it undermines trust and honesty. Potential remedies include random monitoring, inspections, and abandoning quantitative targets in favor of understanding work and improving systems for patients.
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This document discusses community development and its potential benefits for improving population health outcomes. It summarizes the HELP (Health Empowerment Leveraging Partnerships) project approach, which involves working with local residents and services to tackle issues, build social networks and make services more responsive. Evidence suggests that stronger social networks can reduce mortality risk and help address health inequalities. The HELP model has led to improved outcomes such as more responsive local services and reductions in health indicators like CVD admissions. Cost-benefit analysis indicates the HELP approach can save money compared to the investment required.
Community development, transformation and deprived communities
This document discusses community development and its potential benefits for improving population health outcomes. It summarizes the HELP (Health Empowerment Leveraging Partnerships) project approach, which involves working with local residents and services to tackle issues, build social networks and make services more responsive. Evidence suggests that stronger social networks can reduce mortality risk and help address health inequalities. The HELP model has led to improved outcomes such as more responsive local services and reductions in health indicators like CVD admissions. Cost-benefit analysis indicates the HELP approach can save money compared to the investment required.
Disparaties in access sha
This document summarizes evidence of ethnic inequalities in access to and outcomes of healthcare in the UK. It finds that while primary care use is not matched by greater secondary care, ethnic minorities experience longer wait times, poorer quality of infrastructure, and less access to follow-up and specialist care. The study aims to examine inequalities in access to primary, outpatient, and inpatient care, as well as outcomes for conditions like hypertension, cholesterol, and diabetes using UK health surveys from 1999-2004. Logistic regression is used to analyze differences in access after adjusting for demographics and health status.
Sha sustrans presentation final
The document discusses how transport policy has negatively impacted public health by contributing to issues like climate change, air pollution, obesity, and road danger. It notes that global climate change poses significant health risks and that many countries, especially the US, are experiencing obesity epidemics due to inactive lifestyles. The document argues that environments can be made more "obesogenic" and that physical activity should be incorporated into everyday activities like walking and cycling instead of driving. It provides examples from places like the UK, Switzerland, Germany, and Denmark that have successfully increased active transport through measures like reallocating road space, building bike infrastructure networks, and restricting car traffic.
Groningen 2006 12 mar07
Richard Armitage gave a presentation about cycling in Groningen, Netherlands, a city known as a "cycling heaven." Some key points: Over 60% of journeys within a 3km radius of the city center are made by bike. The city has invested heavily in cycling infrastructure since the 1970s, allocating 42% of its transportation budget to cycling facilities in 1976. Groningen's success is attributed to ambitious long-term planning, large investments in cycling networks and facilities, prioritizing cycling over cars in the city center, and establishing cycling as part of local culture.
Groningen2006
The document discusses the city of Groningen in the Netherlands as a model "cycle city" that has invested heavily in cycling infrastructure and policies since the 1970s. Some key facts about Groningen are that over 37% of all trips within a 3km radius of the city center are made by bike. The city has over 10,000 bikes parked at its rail station every day. The document contrasts Groningen's success in promoting cycling with the lack of progress in the UK, citing issues such as poor leadership, low funding for cycling projects compared to driving projects, and a lack of long-term strategic vision and planning for cycling.
Reintroductioncompetition
The introduction of competition into the English NHS appears to have had some positive effects according to evidence from the Health Reform Evaluation Programme. Competition was associated with improved clinical outcomes and shorter hospital stays. Payment by results reduced lengths of stay and increased day surgery rates more in foundation trusts. However, patient choice directly affected only a small percentage of patients and barriers limited new provider entry. Overall, the evidence suggests the NHS market reforms have had some success in improving quality but implementation has been variable.
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
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Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
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Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
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Steve harrison
- 1. Some reflections on NHS ‘performance’ management Steve Harrison School of Social Sciences & National Primary Care R&D Centre University of Manchester stephen.harrison@manchester.ac.uk
- 2. INPUTS Cost- effectiveness WORK PROCESSES Efficiency Effectiveness OUTPUTS OUTCOMES Basic concepts of ‘performance’
- 3. Approaches to performance management • Formative = PIs as the means of facilitating local management enquiry into organisational performance & thereby facilitating local approaches to differences/ problems identified • Summative = PIs define key aspects of organisational performance, thereby providing targets (absolute or relative) to be pursued, & by which locals account to the management hierarchy • Informational = PIs used by consumers as one element in making choices • Tendency in NHS for formative to drift into summative over time; not much evidence of informational usage
- 4. Problems of summative performance management in the NHS – 1 (Bevan & Hood 2006) • Incentives to perform in relation to what is measured drives out concern with what is unmeasured but still important (eg cancelling ophthalmic follow-ups to reduce new o/p waits) • Faking performance data (eg ‘correction’ of ambulance response times) • Biasing samples/ statistical associations (eg extra staff in A&E sample week) • Queuing to queue (eg pts in ambulances outside A&E; pt records in desk drawer)
- 5. Problems of summative performance management in the NHS - 2 • Evading definitions (eg A&E trolleys become ‘beds’) • ‘Creaming’ (eg surgeons avoid operating on high-risk cases; QOF exception reporting by GPs) • Overall – – to turn honest managers etc into dishonest (‘knights’ into ‘knaves’) – tendency to make public less trusting (Tsoukas’s ‘tyranny of light’)
- 6. So why do governments do it? • Symbolic political defence against criticisms of public sector (eg Brown ‘something for something’) • Allows governments to maintain distance from work that they don’t understand, yet maintains illusion of being in control • Performance ‘industry’ provides lots of money and jobs • ‘Winners’ validate the regime, whereas ‘losers’ are just losers! • Number of losers usually manageable by government turning a blind eye in many cases • Path-dependence – difficult to stop performance management without accusations of cover-up etc
- 7. Possible remedies? • Random monitoring - makes various forms of gaming less practicable • Face-to-face inspections more difficult to game and may provoke ‘tip-offs’ from staff • Abandon summative quantitative performance management in favour of understanding work & systems, & organising them to be better for patients