The document summarizes the report of the Mid Staffordshire Public Inquiry led by Robert Francis. It discusses the background of poor care at the Mid Staffordshire Foundation Trust, the Healthcare Commission report that uncovered issues, and the two reports produced by Francis: the Independent Inquiry ("Francis 1") and the subsequent Public Inquiry ("Francis 2"). Key findings included a negative culture that tolerated poor standards, lack of clinical governance, prioritization of financial targets over patient care, and failure of oversight bodies to identify issues sooner. Francis made over 290 recommendations focused on improving culture, transparency, and oversight.
Assertive Community Treatment as a Case Study of Outpatient ComplianceThe Bridge
This document summarizes a presentation on Assertive Community Treatment (ACT) teams and outpatient compliance. It describes the history and structure of ACT teams, their effectiveness in reducing hospitalization and increasing housing stability, and criticisms of them being too intensive, costly, and potentially coercive. It also discusses strategies ACT teams use to manage client adherence, including intensive monitoring, empathy, rewarding compliance, and forging mental linkages between goals and treatment. Some see ACT teams as supportive while others argue they undermine recovery through surveillance and control.
The document discusses limitations in medical malpractice research due to issues with data availability and methodology. It notes that missing or inaccurate data from various sources like jury verdicts and insurance claims, as well as lack of standardized research methods, have led to inconsistent findings. The document describes efforts by researchers to address these weaknesses through improved data collection and more rigorous study designs in order to provide stronger evidence to guide policy solutions.
This document summarizes major European explorers between 1400-1550 who explored far-flung places, including Marco Polo, Ferdinand Magellan, Sir Francis Drake, Christopher Columbus, Francisco Pizarro, Vasco de Gama, and Hernando Cortes. It discusses the main motivations for these explorations as being gold, God, and glory. Additionally, it outlines the economics of exploration including trade, competitive advantage, investment, and finding gold, spices, and trade routes. The document also notes how European contact introduced diseases and crops to new areas of the world.
The document provides a detailed history and overview of bread. It discusses how bread originated over 30,000 years ago and was one of the earliest prepared foods. It became a staple with the development of agriculture around 10,000 years ago. The document outlines the various methods of leavening bread throughout history in different parts of the world. It also describes major advances in bread production, such as the Chorleywood bread process in 1961. Finally, the document lists many different types and uses of bread beyond just food.
The document describes a proposed band management service that would provide tools to help musicians manage band activities like schedules, setlists, finding new members, and communication. It discusses results from a survey of bands that found they currently rely on social media and do not pay for advertising. Interviews with potential customers revealed that bands' biggest challenges are promotion and finding local musicians, and that the service should focus on core useful features and be low-cost or free. The conclusion is that the service could evaluate creating a streaming radio to further promote independent bands.
This document describes a new sport called "Ice Drying" where competitors use a hair dryer, ice pick, and towels to dry a 50 centimeter ice cube as quickly as possible. The sport can be played individually or in teams, with the goal being to dry the ice cube faster than the opponent using any strategy but only the provided tools.
The document outlines marketing strategies and plans for an education platform targeting teachers in Brazil. It discusses:
- The target market of over 2 million teachers in Brazil.
- Marketing strategies will include Google AdWords, blogs, email marketing, and social media. The budget will be split mainly between AdWords and direct marketing.
- Goals are to acquire 6,000 teachers in 6 months for $14,000, working out to a $2.33 cost per teacher and $0.112 per student.
- Effectiveness of strategies will be evaluated monthly to refine the approach. Magazine advertising is deemed too expensive initially.
The document describes observations from visits to four different stores in a mall - a bookstore, clothing store, traditional clothing store, and music store. For each store, details are provided about the lighting, music, temperature, smells, products, customers, and sales interactions. Key differences between the modern versus traditional clothing stores are noted in terms of the customer demographics they attract.
Assertive Community Treatment as a Case Study of Outpatient ComplianceThe Bridge
This document summarizes a presentation on Assertive Community Treatment (ACT) teams and outpatient compliance. It describes the history and structure of ACT teams, their effectiveness in reducing hospitalization and increasing housing stability, and criticisms of them being too intensive, costly, and potentially coercive. It also discusses strategies ACT teams use to manage client adherence, including intensive monitoring, empathy, rewarding compliance, and forging mental linkages between goals and treatment. Some see ACT teams as supportive while others argue they undermine recovery through surveillance and control.
The document discusses limitations in medical malpractice research due to issues with data availability and methodology. It notes that missing or inaccurate data from various sources like jury verdicts and insurance claims, as well as lack of standardized research methods, have led to inconsistent findings. The document describes efforts by researchers to address these weaknesses through improved data collection and more rigorous study designs in order to provide stronger evidence to guide policy solutions.
This document summarizes major European explorers between 1400-1550 who explored far-flung places, including Marco Polo, Ferdinand Magellan, Sir Francis Drake, Christopher Columbus, Francisco Pizarro, Vasco de Gama, and Hernando Cortes. It discusses the main motivations for these explorations as being gold, God, and glory. Additionally, it outlines the economics of exploration including trade, competitive advantage, investment, and finding gold, spices, and trade routes. The document also notes how European contact introduced diseases and crops to new areas of the world.
The document provides a detailed history and overview of bread. It discusses how bread originated over 30,000 years ago and was one of the earliest prepared foods. It became a staple with the development of agriculture around 10,000 years ago. The document outlines the various methods of leavening bread throughout history in different parts of the world. It also describes major advances in bread production, such as the Chorleywood bread process in 1961. Finally, the document lists many different types and uses of bread beyond just food.
The document describes a proposed band management service that would provide tools to help musicians manage band activities like schedules, setlists, finding new members, and communication. It discusses results from a survey of bands that found they currently rely on social media and do not pay for advertising. Interviews with potential customers revealed that bands' biggest challenges are promotion and finding local musicians, and that the service should focus on core useful features and be low-cost or free. The conclusion is that the service could evaluate creating a streaming radio to further promote independent bands.
This document describes a new sport called "Ice Drying" where competitors use a hair dryer, ice pick, and towels to dry a 50 centimeter ice cube as quickly as possible. The sport can be played individually or in teams, with the goal being to dry the ice cube faster than the opponent using any strategy but only the provided tools.
The document outlines marketing strategies and plans for an education platform targeting teachers in Brazil. It discusses:
- The target market of over 2 million teachers in Brazil.
- Marketing strategies will include Google AdWords, blogs, email marketing, and social media. The budget will be split mainly between AdWords and direct marketing.
- Goals are to acquire 6,000 teachers in 6 months for $14,000, working out to a $2.33 cost per teacher and $0.112 per student.
- Effectiveness of strategies will be evaluated monthly to refine the approach. Magazine advertising is deemed too expensive initially.
The document describes observations from visits to four different stores in a mall - a bookstore, clothing store, traditional clothing store, and music store. For each store, details are provided about the lighting, music, temperature, smells, products, customers, and sales interactions. Key differences between the modern versus traditional clothing stores are noted in terms of the customer demographics they attract.
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.
The Patton-Fuller Community Hospital has served for 35 years but lacks an ethics program, unlike most hospitals. It has sections on its website covering various departments but lacks a clear overall mission statement. There have been incidents of nurses giving the wrong medications or blood transfusions to patients resulting in harm, but these were only documented in employee files, not formally addressed. An ethics committee should be established to educate staff, review policies, handle ethics cases, and meet with management to prevent future issues. The hospital also drafted an ethics statement committing to patient confidentiality, protecting infectious patients, being honest with patients, and focusing on local healthcare needs over profits or unnecessary treatments.
Timed walk test
Grip strength test
Weight/BMI
Provider:
Risk of falls
Care Coordinator:
Phone follow-up
Pharmacist:
Medication review
Team determines if patient meets
criteria for frailty program
Care plan developed and shared
with patient/caregiver
Care Coordination Process
1. Medical Assistant screens patient for frailty criteria
2. Provider determines risk of falls and if 3 of 5 frailty criteria met
3. Care Coordinator enrolls patient, develops care plan with team
4. Pharmacist reviews medications
5
18.3)Gateway Hospital is a 500-bed tertiary-care hospital located inkendahudson
18.3)Gateway Hospital is a 500-bed tertiary-care hospital located in a busy metropolitan area. Arecent employee satisfaction survey scored well below the national norms on most scales. The hos-pital has been facing higher than average turnover and vacancy rates. Recruitment of profes-sional positions is very difficult because the hospital has gained a reputation as a bad place towork, especially if one is new; the term “eat their young” seems to be a prevalent description.Salaries are below the local market, as are annual pay increases. In many departments thereseems to be a critical shortage of staff, and closing services has been a recent topic of discussion. Additionally, the financial picture of the organization is bleak. The payor mix has changed;Medicare cutbacks are impacting the bottom line, as are changes in private insurance funding.Key physicians are beginning to take their services elsewhere, as they sense the inefficiency of thehospital processes.The various stresses appear to be having a significant impact on the overall morale of employ-ees. Poor teamwork is rampant, and communication breakdowns seem to be a normal occurrence.Several leaders have been let go in an effort to address issues.The leadership of Gateway Hospital is extremely concerned about the organizational prognosisand has decided to begin to address the issues by enlisting the assistance of a consulting team.One member of the team is a financial expert who has been hired to address the significant finan-cial issues affecting the hospital. The time frame on fixing the financial issues is one of a criticalneed; since the environment is rapidly changing, the consultant must get a handle on how to helpthe hospital operate successfully, given the current financial downslide.A second member of the team is hired to address the morale and employee issues. A review ofthe employee opinion survey is conducted, and trends are identified in exit interviews. Employeeinterviews and focus groups are held in an attempt to determine the root cause of the moraleissues, as well as the breakdown in teamwork and communication.The data collection is discussed with leadership; after a series of discussions, leadership admitsthat many of the financial pressures have created a “knee jerk” reaction to staffing issues, oftencutting back dramatically on employee hours. This would create a crisis mode and the need to askemployees to work harder. This cycle has created a significant lack of trust from the employee’sperspective, coupled with the fact that employees have not felt that they have been apprised of thereasons for the roller coaster changes and have not been offered any words of appreciation whenthey have either reduced their hours or worked in a crisis.The consultant and the leadership agree that in order to fix the “people” issues of the organiza-tion, there will need to be a culture shift of leadership and employee interactions so that a trustcan be rebuilt.Questions1. On the basi ...
State medical boards are tasked with disciplining healthcare professionals to protect the public, but their regulatory behavior is influenced by various political and economic factors. Most complaints come from the public and are investigated through a multi-step process involving various medical experts. Common grounds for discipline include substance abuse, sexual misconduct, incompetence, and malpractice issues. However, boards struggle to fulfill their constitutional mandate due to budget constraints, biases in expert testimony, and lack of standardized measures for determining negligence or sanctioning physicians. The disciplinary process can negatively impact physicians and encourages defensive practices without ensuring meaningful public protection.
This document summarizes the final report from the Forum on Teamworking in Primary Healthcare. The forum was convened by several national healthcare organizations to examine teamworking in primary care. The report found evidence that effective teamwork occurs when roles are clearly defined and rewarding, communication is good, and there are shared goals. It identified barriers like competing demands, status differences, and lack of resources. The report provides recommendations to improve teamworking at both the organizational and team member levels. It also highlights several examples of successful teamworking initiatives in UK primary care settings.
The document provides a brief history of health care-associated infections (HAIs), noting that while some understanding of cleanliness and isolation existed historically, the true germ theory of disease was not widely accepted until the late 19th century work of Koch, Pasteur, Lister, Semmelweis, Holmes, and Nightingale. Early hospitals often lacked basic sanitation and infection control practices, leading to high rates of surgical site infections, puerperal fever, and other HAIs. Over time hospitals implemented some segregation, handwashing, instrument cleaning, and environmental sanitation practices which helped reduce HAI transmission, though the
Thank you for the summary. I will take this information into consideration as we work to establish clear policies and processes around disruptive behavior at our institution.
Bronwyn Shumack, Clinical Excellence CommissionSax Institute
The document discusses a scholarship recipient's trip to study how other health jurisdictions apply human factors principles in healthcare. Some of the locations visited included hospitals in Paris, Toronto, Vancouver, Calgary, and conferences. The key learnings were that few presentations or organizations demonstrated a thorough understanding of applying human factors concepts to healthcare, and that specialist skills are required to properly incorporate human factors into areas like clinical redesign and medical device procurement.
PowerPoint Presentation #1TOPIC- Mental health illness in adults w.docxIRESH3
This document outlines the key components of a powerpoint presentation on mental health issues among adults with substance abuse. It discusses conducting an epidemiological assessment of the target population that describes demographic information, identifies the health issue and risk factors, and explains how monitoring health and diagnosing/investigating diseases apply. It also covers analyzing existing policies around the issue, developing new potential policies, and identifying stakeholders. Finally, it discusses providing assurances around enforcing laws/regulations, linking people to services, ensuring a competent workforce, and evaluating programs. The conclusion examines legal/ethical considerations and how research/innovation can help address the issue through assessment, policy development, and assurance.
Financial Statements and Ratios for Decision-MakingRequirements.docxAKHIL969626
Financial Statements and Ratios for Decision-Making
Requirements:
APA of 1600 words, include in-text citations and references in APA format (Referenced necessary) on the following subjects:
1. How to Create, evaluate, and analyze the balance sheet.
2. How to Perform vertical and horizontal analysis of the balance sheet.
3. How to Create, evaluate, and analyze the income statement.
4. How to Perform vertical and horizontal analysis of the income statement.
5. Difference between balance sheet and income statement.
6. Horizontal and vertical analyses of each statement.
7. Use financial ratios to make investment decisions.
8. what would be the consequences of a manager/leader who disregards using these statements as a management tool? On the other hand, can a manager place too much emphasis on the numbers to the detriment of the organization?
Note: you will need access to the book, please contact me for access
Deactivated
Carlos Lopez
2 posts
Re:Topic 7 DQ 1
In an article published by Harris, et. al (2011), they stated “some evidence-based practices spread passively and are adopted without additional support or instigation from outside the user organization”. Depending on the practice being spread, this can determine how to spread it. One internal dissemination method could be via the office’s intranet. Using this method, it allows everyone in the office access to the results. As this project is based out of a health clinic, it will allow all the providers to see and review all the results, as well as decide if they will implement it into their project, as well as how they will. This can be done via a community board that allows others to put forth their input, allowing a group discussion that can be constructive and productive. This could be considered a more passive approach. An external approach could be putting on an act in a theater. While this may seem out in left field, there have been successes using this method. Keen and Todres (2007) highlight some examples, such as Handle with Care, No Big Deal, Syncing Out Loud, and Busting. These used research-based theater/ethnodrama to represent their ideas and get the information out to the public. They used transcripts from their research interviews to make the scripts. No Big Deal, for example “lasts 40 minutes and is followed by a 15-minute facilitated discussion period”, making it “designed to fit into a one-hour time-slot for a hospital round or lunch break” (Keen & Todres, 2007). This helps to disseminate the information to other clinics, or hospitals, helping to get the word out.
It is important to pass this information out, not only internally but externally as well, because in the end, the care of the patients, and our quality and ability to do so, is what is important. The more EBP that is out there, the better we can provide that care. In terms of my communication strategies, they would differ slightly. Internally, it is more informal, whereas externally, it would ...
Jocelyn Cornwell: How can organisations support patients to lead quality impr...The King's Fund
Jocelyn Cornwell, Director, the Point of Care Foundation and Senior Fellow, The King's Fund spoke on the benefits of involving patients in leadership at our 2013 Leadership Summit. She drew on her experience of the Point of Care Programme and examples from other organisations, including Kingston General Hospital in Canada, to prove that once you involve patients and carers in quality improvements, the changes stick.
Health impact assessments of health sector proposalsBen Harris-Roxas
This document summarizes a review of health impact assessments (HIAs) conducted on health sector proposals. The review identified 14 HIAs from Australia, Korea, and the UK that assessed various health services, plans, and policies. The HIAs used a variety of evidence sources and methods. Most assessments were of projects or programs rather than policies. The quality of reporting varied and there is opportunity to strengthen documentation of scoping and monitoring/evaluation steps. While HIAs have been conducted in developed countries, there is limited evidence of their use to assess clinical services plans within the health sector.
Our June litigation and inquest forum for NHS staff covers:
• apologies, explanations and press statements - how to navigate the minefield, by Richard Briggs and Jonathan Fuggle. This session looks at the differing practices of trusts and care providers both when the NHSLA is involved and when it is not. Practice tips and recommendations on how to handle specific scenarios will be explored
• what makes a good investigation and writing it right, by Lucy Reid, AnaKrisis. Lucy Reid is a professional advisor to the CQC and has provided support and advice to numerous healthcare boards on corporate and clinical governance, risk management, reporting structures and assurance framework. Lucy discusses internal investigations and process, report writing and patient safety/learning from incidents
• CQC and RCA/internal investigations, by Andrew Hopkin and Carl May-Smith. Andrew and Carl take a look at the CQC’s response to reported SIs, their approach to assessing the quality of SI investigation reports and Trust’s learning from mistakes, key lines of enquiry during inspections and practicalities associated with inadequate investigations and implications stemming from same.
https://www.brownejacobson.com/health/services/inquests-and-investigations
Care Quality Commission: Driving improvement in the investigation of deathsCare Quality Commission
A regulators perspective: supporting learning and driving improvement in the investigations of deaths
Presentation by Kim Forrester, Mental Health Act Policy Manager, and Karen Bennet-Wilson, Head of Inspection to the Improving Quality and Learning from Investigation of Deaths in Mental Health & Learning Disability Services event, Wednesday 22 June 2016, Hallam Conference Centre, London.
• Updates on the CQC review into investigations of deaths in NHS Trusts
• Learning from Southern Health
• What should be reported to CQC
• Moving forward...
Presentations from the patient safety conference held at Teesside University on 1 and 2 September 2014 - Students at the forefront of continuing and improving our culture of safe care
Occ Psychology and Culture Change reportBarbara Wren
The chapter discusses values-based recruitment (VBR) for NHS roles and training programs. It argues that VBR is important for achieving patient-centered care by prioritizing the assessment of applicants' values, as outlined in the NHS constitution. It describes the VBR program led by Health Education England to recruit staff and students with values focused on high quality, safe care. The authors conducted an evaluation of the evidence on VBR concepts, methods and effectiveness. Key findings were that recruiting individuals with values centered on compassionate patient care is important, and that situational judgement tests can reliably assess values for large applicant pools. The chapter advocates adopting VBR using situational judgement tests to recruit staff aligned with delivering excellent patient experiences.
This document summarizes a presentation on public and global health informatics from 2014. For public health informatics, it reviewed literature from 2013-2014 and found articles focused on syndromic surveillance, immunization registries, and population health. It noted ongoing challenges around interoperability and jurisdictional silos. For global health informatics, it described the search strategy and inclusion/exclusion criteria used to identify 199 relevant articles published between 2012-2013. The majority of global health informatics articles covered telemedicine, mHealth, and EMR/EHR technologies.
CASE 6From Nothing to Something Defining Governance and Infrast.docxtroutmanboris
CASE 6
From Nothing to Something: Defining Governance and Infrastructure in a Small Medical Practice
Dea Robinson
Midtown Neurology was started by a single physician who had been practicing in the community for nearly 20 years. As the practice grew, it evolved from a “mom-n-pop” operation to a more complex model. The founding physician recruited four new neurologists to join and continue to help build the practice. Subsequently, however, the new doctors took over and forced him out of the practice.
The large urban hospital with which Midtown was affiliated achieved Level 1 trauma status, providing additional new opportunities for the practice. The neurologists took on the many responsibilities, including one of stroke team for the hospital. Contractual rural outreach was practiced utilizing telemedicine throughout the state and provided a robust revenue stream.
While still a small physician group, it required a difficult call schedule. Tracking call and distributing it equitably became a challenge. The main reason for this was the founding physician had written a proprietary program exclusively for this purpose. Now the practice was beholden to the very person they had forced out of the practice for a vital part of communication with the other practices regarding the call schedule. This was very unusual, as physicians don’t typically write proprietary software for a practice. In addition, the entire platform including the billing program, which he also developed, used MS-DOS.
The practice employed a practice manager who had started with the founding physician. As the practice grew, the manager did not keep up with the basics of managing a practice. Her information relating to billing, reimbursement, and changes to current CPT and ICD-9 issues was out of date. She was also ignorant of the contracts the practice had, but more importantly the impact of those contracts on the practice and how to carry them out appropriately.
While the physicians were very productive, several significant management problems became apparent as the practice grew. In particular, the infrastructure suffered and there was no governance. Infrastructure for a private practice is different from that of a corporate model. For example, in a corporate model individual departments exist with defined responsibilities to support the needs of the corporation and other areas of the entity, such as an IT department. Conversely, in a private practice when IT systems need repair, the responsibility falls to the administrator or manager, and this individual must know how to address and fix the problem. In this instance, the IT department and the owner of the practice were one and the same. Because of the proprietary nature of the software, outsourcing was not an option. The practice essentially was backed into a corner because of the lack of necessary infrastructure upgrades, such as in the case of IT. This dynamic created tension and frustration for the manager of the practice and t.
Medical students' understandings of professionalism in response to ethical di...rosiebelcher
Medical students frequently encounter ethical dilemmas during their training that involve conflicts between different understandings of professionalism. This study interviewed 14 medical students about ethical dilemmas they experienced to understand their conceptions of professionalism. Students saw tensions between feeling like "just a student" with limited power and knowledge, and striving for the standards of conduct expected of doctors, or "student professionalism". Dilemmas often arose in navigating this conflict, such as whether to question concerning behaviors witnessed. Students developed by discussing dilemmas and gradually integrating professionalism into their identities through clinical experience.
Students perceptions of the purpose and use of an electronic portfolio - pres...rosiebelcher
Students perceived the intended purpose of the electronic portfolio differently than its actual use. They felt it was intended to provide feedback and monitor progress, but it actually served as a logbook and way to practice clinical skills. Students saw little improvement in feedback from the portfolio and felt it did not help monitor their progress as intended. They suggested improvements like a mobile app to allow clinicians to provide contemporaneous feedback.
More Related Content
Similar to The report of the Mid Staffs public inquiry
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.
The Patton-Fuller Community Hospital has served for 35 years but lacks an ethics program, unlike most hospitals. It has sections on its website covering various departments but lacks a clear overall mission statement. There have been incidents of nurses giving the wrong medications or blood transfusions to patients resulting in harm, but these were only documented in employee files, not formally addressed. An ethics committee should be established to educate staff, review policies, handle ethics cases, and meet with management to prevent future issues. The hospital also drafted an ethics statement committing to patient confidentiality, protecting infectious patients, being honest with patients, and focusing on local healthcare needs over profits or unnecessary treatments.
Timed walk test
Grip strength test
Weight/BMI
Provider:
Risk of falls
Care Coordinator:
Phone follow-up
Pharmacist:
Medication review
Team determines if patient meets
criteria for frailty program
Care plan developed and shared
with patient/caregiver
Care Coordination Process
1. Medical Assistant screens patient for frailty criteria
2. Provider determines risk of falls and if 3 of 5 frailty criteria met
3. Care Coordinator enrolls patient, develops care plan with team
4. Pharmacist reviews medications
5
18.3)Gateway Hospital is a 500-bed tertiary-care hospital located inkendahudson
18.3)Gateway Hospital is a 500-bed tertiary-care hospital located in a busy metropolitan area. Arecent employee satisfaction survey scored well below the national norms on most scales. The hos-pital has been facing higher than average turnover and vacancy rates. Recruitment of profes-sional positions is very difficult because the hospital has gained a reputation as a bad place towork, especially if one is new; the term “eat their young” seems to be a prevalent description.Salaries are below the local market, as are annual pay increases. In many departments thereseems to be a critical shortage of staff, and closing services has been a recent topic of discussion. Additionally, the financial picture of the organization is bleak. The payor mix has changed;Medicare cutbacks are impacting the bottom line, as are changes in private insurance funding.Key physicians are beginning to take their services elsewhere, as they sense the inefficiency of thehospital processes.The various stresses appear to be having a significant impact on the overall morale of employ-ees. Poor teamwork is rampant, and communication breakdowns seem to be a normal occurrence.Several leaders have been let go in an effort to address issues.The leadership of Gateway Hospital is extremely concerned about the organizational prognosisand has decided to begin to address the issues by enlisting the assistance of a consulting team.One member of the team is a financial expert who has been hired to address the significant finan-cial issues affecting the hospital. The time frame on fixing the financial issues is one of a criticalneed; since the environment is rapidly changing, the consultant must get a handle on how to helpthe hospital operate successfully, given the current financial downslide.A second member of the team is hired to address the morale and employee issues. A review ofthe employee opinion survey is conducted, and trends are identified in exit interviews. Employeeinterviews and focus groups are held in an attempt to determine the root cause of the moraleissues, as well as the breakdown in teamwork and communication.The data collection is discussed with leadership; after a series of discussions, leadership admitsthat many of the financial pressures have created a “knee jerk” reaction to staffing issues, oftencutting back dramatically on employee hours. This would create a crisis mode and the need to askemployees to work harder. This cycle has created a significant lack of trust from the employee’sperspective, coupled with the fact that employees have not felt that they have been apprised of thereasons for the roller coaster changes and have not been offered any words of appreciation whenthey have either reduced their hours or worked in a crisis.The consultant and the leadership agree that in order to fix the “people” issues of the organiza-tion, there will need to be a culture shift of leadership and employee interactions so that a trustcan be rebuilt.Questions1. On the basi ...
State medical boards are tasked with disciplining healthcare professionals to protect the public, but their regulatory behavior is influenced by various political and economic factors. Most complaints come from the public and are investigated through a multi-step process involving various medical experts. Common grounds for discipline include substance abuse, sexual misconduct, incompetence, and malpractice issues. However, boards struggle to fulfill their constitutional mandate due to budget constraints, biases in expert testimony, and lack of standardized measures for determining negligence or sanctioning physicians. The disciplinary process can negatively impact physicians and encourages defensive practices without ensuring meaningful public protection.
This document summarizes the final report from the Forum on Teamworking in Primary Healthcare. The forum was convened by several national healthcare organizations to examine teamworking in primary care. The report found evidence that effective teamwork occurs when roles are clearly defined and rewarding, communication is good, and there are shared goals. It identified barriers like competing demands, status differences, and lack of resources. The report provides recommendations to improve teamworking at both the organizational and team member levels. It also highlights several examples of successful teamworking initiatives in UK primary care settings.
The document provides a brief history of health care-associated infections (HAIs), noting that while some understanding of cleanliness and isolation existed historically, the true germ theory of disease was not widely accepted until the late 19th century work of Koch, Pasteur, Lister, Semmelweis, Holmes, and Nightingale. Early hospitals often lacked basic sanitation and infection control practices, leading to high rates of surgical site infections, puerperal fever, and other HAIs. Over time hospitals implemented some segregation, handwashing, instrument cleaning, and environmental sanitation practices which helped reduce HAI transmission, though the
Thank you for the summary. I will take this information into consideration as we work to establish clear policies and processes around disruptive behavior at our institution.
Bronwyn Shumack, Clinical Excellence CommissionSax Institute
The document discusses a scholarship recipient's trip to study how other health jurisdictions apply human factors principles in healthcare. Some of the locations visited included hospitals in Paris, Toronto, Vancouver, Calgary, and conferences. The key learnings were that few presentations or organizations demonstrated a thorough understanding of applying human factors concepts to healthcare, and that specialist skills are required to properly incorporate human factors into areas like clinical redesign and medical device procurement.
PowerPoint Presentation #1TOPIC- Mental health illness in adults w.docxIRESH3
This document outlines the key components of a powerpoint presentation on mental health issues among adults with substance abuse. It discusses conducting an epidemiological assessment of the target population that describes demographic information, identifies the health issue and risk factors, and explains how monitoring health and diagnosing/investigating diseases apply. It also covers analyzing existing policies around the issue, developing new potential policies, and identifying stakeholders. Finally, it discusses providing assurances around enforcing laws/regulations, linking people to services, ensuring a competent workforce, and evaluating programs. The conclusion examines legal/ethical considerations and how research/innovation can help address the issue through assessment, policy development, and assurance.
Financial Statements and Ratios for Decision-MakingRequirements.docxAKHIL969626
Financial Statements and Ratios for Decision-Making
Requirements:
APA of 1600 words, include in-text citations and references in APA format (Referenced necessary) on the following subjects:
1. How to Create, evaluate, and analyze the balance sheet.
2. How to Perform vertical and horizontal analysis of the balance sheet.
3. How to Create, evaluate, and analyze the income statement.
4. How to Perform vertical and horizontal analysis of the income statement.
5. Difference between balance sheet and income statement.
6. Horizontal and vertical analyses of each statement.
7. Use financial ratios to make investment decisions.
8. what would be the consequences of a manager/leader who disregards using these statements as a management tool? On the other hand, can a manager place too much emphasis on the numbers to the detriment of the organization?
Note: you will need access to the book, please contact me for access
Deactivated
Carlos Lopez
2 posts
Re:Topic 7 DQ 1
In an article published by Harris, et. al (2011), they stated “some evidence-based practices spread passively and are adopted without additional support or instigation from outside the user organization”. Depending on the practice being spread, this can determine how to spread it. One internal dissemination method could be via the office’s intranet. Using this method, it allows everyone in the office access to the results. As this project is based out of a health clinic, it will allow all the providers to see and review all the results, as well as decide if they will implement it into their project, as well as how they will. This can be done via a community board that allows others to put forth their input, allowing a group discussion that can be constructive and productive. This could be considered a more passive approach. An external approach could be putting on an act in a theater. While this may seem out in left field, there have been successes using this method. Keen and Todres (2007) highlight some examples, such as Handle with Care, No Big Deal, Syncing Out Loud, and Busting. These used research-based theater/ethnodrama to represent their ideas and get the information out to the public. They used transcripts from their research interviews to make the scripts. No Big Deal, for example “lasts 40 minutes and is followed by a 15-minute facilitated discussion period”, making it “designed to fit into a one-hour time-slot for a hospital round or lunch break” (Keen & Todres, 2007). This helps to disseminate the information to other clinics, or hospitals, helping to get the word out.
It is important to pass this information out, not only internally but externally as well, because in the end, the care of the patients, and our quality and ability to do so, is what is important. The more EBP that is out there, the better we can provide that care. In terms of my communication strategies, they would differ slightly. Internally, it is more informal, whereas externally, it would ...
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Our June litigation and inquest forum for NHS staff covers:
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• what makes a good investigation and writing it right, by Lucy Reid, AnaKrisis. Lucy Reid is a professional advisor to the CQC and has provided support and advice to numerous healthcare boards on corporate and clinical governance, risk management, reporting structures and assurance framework. Lucy discusses internal investigations and process, report writing and patient safety/learning from incidents
• CQC and RCA/internal investigations, by Andrew Hopkin and Carl May-Smith. Andrew and Carl take a look at the CQC’s response to reported SIs, their approach to assessing the quality of SI investigation reports and Trust’s learning from mistakes, key lines of enquiry during inspections and practicalities associated with inadequate investigations and implications stemming from same.
https://www.brownejacobson.com/health/services/inquests-and-investigations
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Presentation by Kim Forrester, Mental Health Act Policy Manager, and Karen Bennet-Wilson, Head of Inspection to the Improving Quality and Learning from Investigation of Deaths in Mental Health & Learning Disability Services event, Wednesday 22 June 2016, Hallam Conference Centre, London.
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Presentations from the patient safety conference held at Teesside University on 1 and 2 September 2014 - Students at the forefront of continuing and improving our culture of safe care
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CASE 6From Nothing to Something Defining Governance and Infrast.docxtroutmanboris
CASE 6
From Nothing to Something: Defining Governance and Infrastructure in a Small Medical Practice
Dea Robinson
Midtown Neurology was started by a single physician who had been practicing in the community for nearly 20 years. As the practice grew, it evolved from a “mom-n-pop” operation to a more complex model. The founding physician recruited four new neurologists to join and continue to help build the practice. Subsequently, however, the new doctors took over and forced him out of the practice.
The large urban hospital with which Midtown was affiliated achieved Level 1 trauma status, providing additional new opportunities for the practice. The neurologists took on the many responsibilities, including one of stroke team for the hospital. Contractual rural outreach was practiced utilizing telemedicine throughout the state and provided a robust revenue stream.
While still a small physician group, it required a difficult call schedule. Tracking call and distributing it equitably became a challenge. The main reason for this was the founding physician had written a proprietary program exclusively for this purpose. Now the practice was beholden to the very person they had forced out of the practice for a vital part of communication with the other practices regarding the call schedule. This was very unusual, as physicians don’t typically write proprietary software for a practice. In addition, the entire platform including the billing program, which he also developed, used MS-DOS.
The practice employed a practice manager who had started with the founding physician. As the practice grew, the manager did not keep up with the basics of managing a practice. Her information relating to billing, reimbursement, and changes to current CPT and ICD-9 issues was out of date. She was also ignorant of the contracts the practice had, but more importantly the impact of those contracts on the practice and how to carry them out appropriately.
While the physicians were very productive, several significant management problems became apparent as the practice grew. In particular, the infrastructure suffered and there was no governance. Infrastructure for a private practice is different from that of a corporate model. For example, in a corporate model individual departments exist with defined responsibilities to support the needs of the corporation and other areas of the entity, such as an IT department. Conversely, in a private practice when IT systems need repair, the responsibility falls to the administrator or manager, and this individual must know how to address and fix the problem. In this instance, the IT department and the owner of the practice were one and the same. Because of the proprietary nature of the software, outsourcing was not an option. The practice essentially was backed into a corner because of the lack of necessary infrastructure upgrades, such as in the case of IT. This dynamic created tension and frustration for the manager of the practice and t.
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1. +
The report of the Mid Staffs
Public Inquiry
Dr Rosie Belcher
ST6 St Mary’s Hospital
16.3.13
2. +
Content
Background: the situation at Mid Staffs
Report of the Independent Inquiry (“Francis 1”)
Report of the Public Inquiry (“Francis 2”)
This is a look at the Francis report and it’s potential implications for
individual doctors and jobbing geriatricians. I’ve also looked in
particular at his recommendations for medical education and
training. It is not a comprehensive summary! I’ve skipped a lot of
stuff about standards as this is of less immediate relevance.
I have indicated Recommendations from Francis like this.
Numbers in brackets refer to the number of the recommendation in
the report (in case you want to check up). There are 290
recommendations in total.
3. +
Mid Staffordshire Foundation Trust
Concerns about lack of clinical governance, low staff levels and
poor standards at the Trust had existed for some time (at least
prior to 2004)
Trying to become a Foundation Trust 2005-2008
2007 Concerns raised about mortality rates (SHMR)
Although there has been interesting debates about these since – see
http://www.bmj.com/content/346/bmj.f562, and the linked editorial, and
responses from others.
April 2008 Healthcare Commission (HCC) launched investigation,
NOT as a result of the actual mortality stats, but due to concern
about:
The Trust’s reaction to the mortality stats
The Trust’s reaction to complaints
4. +
Healthcare Commission report
Healthcare Commission (HCC) reported in March 2009 on failings in emergency care.
Triggered
Review of hospital’s procedures for emergency admissions and treatment
Investigation of how commissioning and performance management systems missed what was
happening in the department
But there were focused on A&E. There was growing pressure from the public, particularly a
local group (Cure the NHS, set up by a relative of someone who had died at Mid Staffs) to
look at other departments, and to do this through a Public Inquiry.
July 2009 Andy Burnham conceded and set up an Independent Inquiry and Robert Francis
QC.
Reported Feb 2010 on:
Individual patient cases and internal operations of the Trust
Identify further lessons to be learned
Suggest additional action to be taken to ensure good care
5. +
Independent Inquiry (“Francis 1”)
Lack of basic care across numerous wards and departments
Culture at the Trust was not helpful
Fear of adverse consequences for reporting problems
Low morale
High priority placed on achievement of (financial) targets and acceptance of poor
standards
Consultant body was dissociated from management
Management dominated by financial targets and achieving Foundation status
No effective clinical governance, and a failure to recognize or attempt to correct
this
Statistics and data were preferred to patient experience data, focus on systems
not outcomes
Where problems were recognized, there was a lack of urgency in solving them.
6. +
Independent Inquiry (“Francis 1”):
recommendations
The Trust should make visible it’s first priority to deliver a high standard of care and should
develop links with other organizations to help it do this
The Trust, the Royal Colleges, the deanery and the school of nursing should review their
training programmes
Improve audit and clinical governance processes
Foster a culture of openness, including openness to staff members who raise concerns
about care
Sec State for Health and Monitor should review the appointment and accountability of
directors of NHS Trusts, with a view to creating professional standards overseen by an
independent body
Consider an “independent examination of the operation of commissioning, supervisory and
regulatory bodies in relation to their monitoring role at Stafford hospital with the objective of
learning lessons about how failing hospitals are identified”
i.e. Francis was recommending a further, more wide-ranging inquiry in to why it took so
long for the bodies that were supposed to regulating the hospital to notice
7. +
Public Inquiry (“Francis 2”)
So a Public Inquiry, under the Inquiries Act 2005 was set up to do this.
Public Inquiries can
Compel individuals to give evidence
Command documentary evidence (eg can demand to see internal Trust
communication, minutes of meetings etc)
They are held in public (obviously!). Francis held most hearings in
Stafford, to give locally affected people the opportunity to attend.
Commissioned to examine:
Commissioning, supervisory and regulatory organizations in relation to their
monitoring role at Mid Staffs
Why serious problems at the Trust were not identified or acted on sooner
Identify lessons to be drawn
Make recommendations to the Secretary of State for Health
Reported Feb 6th 2013
8. +
Public Inquiry: themes
Certain themes keep recurring in the report
Culture of the Trust
Need for more information sharing/co-working between
organizations with different but overlapping
interests/responsibilities
Constant structural change, with consequent loss of
expertise/information
Makes lots of recommendations, on a wide range of topics.
Following slides are a summary of some sections of the report,
with the relevant recommendations
9. +
Public Inquiry: Introduction 1
Received numerous requests to examine failures of systems in other Trusts and services
“Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not
been and will not be repeated” (para 76)
Francis does not go so far as to say that he thinks there are definitely other instances of care as poor
as at Mid Staffs, but implies this is likely to be the case
Notes that the Health and Social Care Act 2012 was passed during the Inquiry
Structural changes in the NHS
Numerous bodies investigated to longer exist in their previous form (eg HCC CQC)
“This report should not be understood as intending to offer a comprehensive and up to the minute
account of the current position” (para 37)
There is a sense of frustration in the report that the ground was shifting underneath him and in some
ways the report was already out of date by the time it was published
Recommendation: “Before a proposal for any major structural change to the healthcare system is
accepted, an impact and risk assessment should be undertaken by the DH and should be debated
publicly.” (286)
Recommendation: Future transitions should be managed in reasonable timescales, maintaining
corporate memory, and information and documentation (286)
10. +
Public Inquiry: Introduction 2
Previous inquiries have resulted in a lack of accountability for
implementing changes
Recommendation: All healthcare organizations should consider how
the findings and recommendations of the report should be applied to
them, and announce publically how they are going to respond (1)
Recommendation: Healthcare organizations should then publish at
least annually information about their actions on the
recommendations (1)
Recommendation: DH should collate this information (1)
I cannot find any responses on local Trust websites, including
Imperial.
11. +
Public Inquiry: “Warning signs”
Managers and regulators consistently said they had no idea about the problems
throughout both inquiries
Francis dismisses this and gives a number of warning signs which should have been
heeded:
Negative culture Professional disengagement
Tolerance of poor standards Especially senior consultants
Isolation from practice elsewhere
Denial when concerns were raised
Poor governance
Clinical governance systems were
Culture of self promotion rather
than critical analysis “vestigial”
Patients not heard Focus on finances not standards of
care
Procedures for dealing with
complaints and SUIs were
inadequate Inadequate risk assessment of staff
reduction
Staff and patient surveys showed
dissatisfaction, but were ignored
12. +
Culture
Francis comments repeatedly on the culture at the Trust, where
staff generally had low morale and were disengaged from
management processes. The culture tolerated poor standards and
discouraged staff from raising their concerns
Francis suggests there needs to be more openness, transparency
and candour
Recommendation: “Gagging” clauses should not be permitted (179)
Recommendation: A statutory duty of candour by healthcare workers
towards individual patients when there has been an error (174, 181)
Recommendation: A statutory duty of candour by healthcare
organisations towards regulatory and commissioning bodies (176, 182)
Including a criminal offence for any registered healthcare
professional, manager or director to make an untruthful statement to
a regulator, or obstruct the performance of a regulator’s duties (183)
13. +
GPs
Local GPs only expressed concerns after the HCC
investigation was announced
Were they unaware, or aware and apathetic?
Francis thinks GPs should monitor the care their patients get
from other local providers
Recommendation: GPs “should have an obligation to their patients
to keep themselves informed of the standard of service available
from providers” and make any concerns known to the CQC and
relevant commissioner (123)
Unclear if this is a collective or individual responsibility
14. +
Monitor
Determines whether Trusts can become Foundation trusts and
ensures that Foundation Trusts comply with their conditions
Is the Trust well governed?
Is the Trust financially viable?
Is the Trust legally constituted?
Francis comments that there was a failure of the application
process as it did not identify the problems at Mid Staffs
Monitor’s focus was on finance and corporate governance
Monitor relied on the Trust’s assurances on clinical issues, and did
not probe
Monitor did not talk to the HCC
15. +
Healthcare Commission
Aim was to promote and drive improvement in quality of
healthcare
Statutory duty to assess the provision and quality of healthcare
and review the performance of all NHS Trusts
Report criticises standards for being formulated by the DH with
little clinician input or buy-in. Standards are also mixture of very
general and v specific.
Reliance on self assessment and presence of systems, rather than
actual achievements and outcomes
Statements by the Trust were accepted at face value without
challenge
Thoroughness of the eventual investigation is praised however
16. +
Care Quality Commission
Report comments that has clearly faced a number of
challenges but seems to have planned activities to fit the
resources available, rather than the job it is commissioned to
do.
Report characterizes it as a defensive organization, which did
not respond to concerns about itself constructively
Report makes a large number of recommendations about these
organizations (or their successors) and in particular about the
standards that they use.
17. +
Information
There was a lack of information sharing between all
organizations.
Recommendation: All healthcare providers should publish
information on the performance of their consultants and specialist
teams (262)
Morbidity
Mortality
Outcomes
Patient satisfaction
Recommendation: Health and Social Care Information Centre for
collection analysis and publication of healthcare information (257)
To include some of the functions of the National Patient Safety
Agency
Recommendation: Electronic patient records, with the facility for
patients to read and comment on them (244)
18. +
GMC and NMC
Three doctors are facing fitness to practice hearings
All had significant managerial responsibilities as MD/deputy MD
GMC and NMC are criticized for dealing with cases individually only
Recommendation: Should have a policy covering generic complaints were
no individuals or multiple individuals are named (222)
Recommendation: Should be more proactive in investigating based on
monitoring fitness to practice, not just complaints (222)
Recommendation: Should liaise more closely with each other and the
CQC (234)
Recommendation: Suggests there should be an independent tribunal to
deal with issues involving professionals from more than one field (235)
19. +
Medical Education and Training 1
No concerns about the Trust were raised through those with
oversight of training of healthcare professionals
Concerns about bullying/abuse of students and trainees were
not followed up
Recommendation: Medical schools should actively seek feedback
from students about the quality of care on their placements (158)
Recommendation: Medical students and trainees should be
surveyed about their perceptions of the standards of care in their
placements (159)
This is started in 2012 in the new GMC survey for trainees. 5% of
trainees suggested they had concerns about care in their
workplace. See www.gmc-
uk.org/NTS_2012_response_to_concerns_summary.pdf_5023779
2.pdf
20. +
Medical education and training 2
PMETB/GMC/Deaneries did not consider patient safety
standards as relevant to them
There is little communication between patient safety/clinical
standards organizations and medical education organizations.
Recommendation: Any organization which identifies a problem with
patient care which is potentially relevant to training should be
required to inform the training regulator (152)
Recommendation: Statutory duty of co-operation and information
sharing between deanery (?LETB et al) CMG, CQC and Monitor
(153)
21. +
Medical education and training 3
There is a general reluctance to impair the provision of services
through the removal of trainees
Good care is critical for good training. Those with oversight of
training must be aware of the standards of care in
organizations in which they place their students/trainees
Recommendation: Should be standard requirements for routine
visits to training providers. Visits should involved deanery, Royal
College and lay representation, and should be informed by other
sources of info eg CQC (155)
Recommendation: Areas which do not comply with fundamental
patient safety and quality standards should not be allowed to take
trainees or students (162)
22. +
Caring for patients, particularly the
elderly
The elderly seemed to be particularly effected by poor nursing
care
Recommendation: All ward rounds should include the nurse
responsible for those patients (238)
23. +
Summary: for debate
Highly critical in particular of the culture of the Trust
Recommendations
Statutory duty of candour
GPs have duty to monitor standards of care at secondary care facilities.
Is this practical? Is it reasonable?
GMC should investigate when no individuals are named
Something similar to the concept of corporate manslaughter. But how
practical is it for the GMC to do this? Such investigations could be
extremely large.
Publication of performance data for all clinical teams/consultants
Controversial, there is some evidence that it improves quality of care.
But in the UK so far has only been done for surgeons, within specific
fields. How practical is this for other specialties?
24. +
For more info…
A cluster of BMJ articles
www.bmj.com/about-bmj/article-clusters/mid-staffs
The public inquiry website.
The executive summary of the report contains a reasonable level of
detail and is very readable.
www.midstaffspublicinquiry.com
The independent inquiry website
www.midstaffsinquiry.com
Review article re performance data and quality of care
http://annals.org/article.aspx?articleid=738899
Editor's Notes
During 2008/9 there was increasing public outcry from locals, ecp CURE – Cure the NHS. Campaigned for a public inquiry. Reviews were in part in response to this. But did not satisfy concerns of CURE, who continued to demand public inquiry. Burnham therefore set up independent inquiry – but this cannot compel witnesses or evidence, and was focussed on problems in the Trust.
Public inquiry – public access to hearings, can compel people to give evidence and require evidence eg documents to be produced. Hearingss took place mostly in public, and mostly in Stafford, to give local people access.
Does not go so far as to say there are other Staffords out there, but
Trust applied in Jan 2008 – Monitor had no role in what went on before this. However, by setting the standards, they influenced the Trust