Have you been disrupted recently? Do you sometimes feel like your organization is flailing, barely able to keep up with the pace of change? You are not alone. Industry disruption and accelerating change are no longer remarkable phenomena requiring a special response — they are part of the landscape. And organizations need more individual leaders who can help everyone navigate through the new, speeded-up and volatile world. Problem is, too many organizations approach this challenge with a one-size-fits-all idea of what change leaders should look like, and they train them accordingly.

In our research on change agents at the Phoenix Community of FCB Partners, we have found that there are three distinct challenges which require different kinds of change leaders: (1) transformational leaders, (2) innovation instigators, and (3) innovation managers.

Juan Ponce de León spent his life searching for the fountain of youth. I have spent mine searching for the ideal daily routine. But as years of color-coded paper calendars have given way to cloud-based scheduling apps, routine has continued to elude me; each day is a new day, as unpredictable as a ride on a rodeo bull and over seemingly as quickly.

Naturally, I was fascinated by the recent book, Daily Rituals: How Artists Work. Author Mason Curry examines the schedules of 161 painters, writers, and composers, as well as philosophers, scientists, and other exceptional thinkers.

As I read, I became convinced that for these geniuses, a routine was more than a luxury — it was essential to their work. As Currey puts it, “A solid routine fosters a well-worn groove for one’s mental energies and helps stave off the tyranny of moods.” And although the book itself is a delightful hodgepodge of trivia, not a how-to manual, I began to notice several common elements in the lives of the healthier geniuses (the ones who relied more on discipline than on, say, booze and Benzedrine) that allowed them to pursue the luxury of a productivity-enhancing routine:

Why do we not adopt the same level of focus on customer service within our health and social care services as they do in the business sector? The physical act of actually ‘paying’ for a service should be the only difference explains.

The experience of engaging the views and perspectives of people who use mental health services in the commissioning of those services has formed the basis of this article.

Look to the business sector to change the customer experience of healthcare – (HSJ Article request full text from Trust Library Services or call 01942 822508)

Reflection on Patient Safety which has been a key priority in NHS England’s first year. Outlines landmarks from this year and identifies the following priorities for next year.

Launch and roll-out of patient safety collaboratives.
Recruitment of patient safety improvement fellows.
Launch of patient safety data website.
Implementation of surgical never events taskforce recommendations including development of national standards.
National Reporting and Learning System (NRLS) redevelopment.
Launch of medication, mental health, maternity and paediatrics safety thermometers.

More than 75 different types of organisation are involved in a confusing health and care complaints system which is discouraging people from raising concerns, according to work done by Healthwatch England.

Healthwatch criticises ‘incredibly complex’ complaints system – (HSJ Article request full text from Trust Library Services or call 01942 822508)

Plans announced in the Budget to increase employer contributions to the NHS Pension Scheme are expected to increase costs by around £125m a year, HSJ can reveal.

The 2014 Budget Book, published by the Treasury this afternoon, confirmed plans to raise employer contributions to the scheme from April 2015.

Budget 2014: Pensions change to cost NHS £125m – (HSJ Article request full text from Tust Library Services or call 01942 822508)

Sir David Nicholson’s departure from NHS England leaves space for a new kind of leader to step up to the challenges facing the service

Sir David Nicholson’s retirement at the end of the month will be seen by many as the end of an era.

Autocrats, move over. It’s time for persuaders to step up – (HSJ Article request full text from Trust Library Services or call 01942 822508)

Find out how to use a formal agreement to improve performance.

Use this tool to deliver focused, effective feedback.

Learn how to deal with team members who produce sloppy work

Mindfulness is gaining popularity amongst CEOs in major organisations. These organisations recognise the need to take time to reflect on what’s most important in order to create ways to overcome difficult challenges. This post considers key qualities of mindful leaders and reflects how it can be used to improve personal health and wellbeing.

Explains the basic concepts of storytelling through use of Freytag’s pyriamid and a basic overview of the neuroscience behind it’s effectiveness. The key example provided is a marketing promotion from Budweiser, but lessons can be used on how storytelling can be used to change attitudes and behaviours.

Dan Pallotta relates his experience as a CEO. Examples are given of CEOs who have adopted fear and intimidation tactics to run a company and an argument is made that there needs to be a balance between being kind and being nice to employees to get the best from them.

Personal explanations of the pressures exerted on CEOs and how it impacted on his behaviour are provided as he reflects on mistakes made. Key tips on how to manage employees to ‘make things happen’and develop the correct culture.

Reflection on a review of 90 undergraduate psychology students to determine how best to boost creativity.

The students were split into three groups and asked to complete a list of alternate uses for a sheet of paper. Each group was allocated precisely 4 minutes to achieve the list with one group working straight through, one group was interrupted at the half way point to complete another similar task and the final group were interrupted at the half way point to complete an unrelated task. The group which took a break to work on an unrelated task developed the longer list with more creative answers.

The post explores this research in context of commonly adopted methods for enhancing creativity and how to best construct your work day.

Gallup has found that one of the most important decisions companies make is simply whom they name manager. They also found that companies fail to make the correct decision 82% of the time. This impacts on employee engagement and cost businesses millions.

This post discusses the talents which are essential for great managers:

• They motivate every single employee to take action and engage them with a compelling mission and vision.
• They have the assertiveness to drive outcomes and the ability to overcome adversity and resistance.
• They create a culture of clear accountability.
• They build relationships that create trust, open dialogue, and full transparency.
• They make decisions that are based on productivity, not politics.

It concludes that statistically there is sufficient management talent exists in every company, the problem lies on how best to identify and make sure the right people are recruited.

Numerous papers have measured hospital efficiency, mainly using a technique known as data envelopment analysis (DEA). A shortcoming of this technique is that the number of outputs for each hospital generally outstrips the number of hospitals. In this paper, we propose an alternative approach, involving the use of explicit weights to combine diverse outputs into a single index, thereby avoiding the need for DEA.

Mounting pressures on England’s urgent and emergency care services have been well documented in local and national media over recent months. With headlines of “A&E in crisis” and “emergency services in meltdown” never too far from a front page, the topic has stimulated significant political and public debate. The task ahead for the NHS is to move beyond the headlines and handwringing and find practical whole-system solutions to address current pressures and avert future crises. Failure to find such solutions, and to act on them quickly, could have dire consequences for patients, and for the NHS as a whole.

The NHS Confederation’s Urgent and Emergency Care Forum brings together organisations from across the whole health and care system to debate, develop and share ideas for improving urgent and emergency care.

In Emergency care: an accident waiting to happen? the NHS Confederation noted concerns from members that only sticking plaster solutions were being offered. 
This follow-up report acts as a roadmap to the  fundamental changes required to create a sustainable and high-quality urgent and emergency care system that can meet the needs of patients now and in the future.

Since the launch of the Frontline First  campaign in July 2010, the Royal College of Nursing (RCN) has monitored the damaging impact of £20 billion of NHS efficiency savings in England and subsequent cuts to frontline jobs and services.
At the time, the Government claimed that it would be possible to make these efficiency savings without cutting frontline staff.
However, the RCN found that NHS trusts across the country were losing thousands of nursing posts, with proposals to cut many tens of thousands more.

Based on freedom of information data obtained from  the Health and Social Care Information Centre (HSCIC), this special report, More than just a number, confirms that senior nursing roles have borne the brunt of workforce cuts, leading to a dangerous loss of experience and skills that are essential to ensuring patient safety and driving up care standards.

This report explores the association between income and health throughout the life course and within families.
Improving the income of the poorest members of society is often proposed as a way of improving their health, and hence reducing health inequalities.
However, for this policy to be effective, it is important to understand how  money influences health. Effective policy responses must take all the factors that link income and health into account.
The report identifies key theories that explain how money influences health, including:
• materialist arguments: for example, money buys health-promoting goodsand the ability to engage in a social life in ways that enable people to be healthy;
• psychosocial mechanisms: for example, the stress of not having enough money may affect health;
• behavioural factors: people living in disadvantaged circumstances may be more likely to have unhealthy behaviours;
• being in poor health may affect education and employment opportunities in ways that affect subsequent health. 

Describes the development of the Determinants of Implementation Behavior Questionnaire (DIBQ) and investigates the reliability and validity of this Theoretical Domains Framework (TDF)-based questionnaire. The study developed a valid and reliable questionnaire that can be used to assess potential determinants of healthcare professional implementation behavior following the theoretical domains of the TDF. The DIBQ can be used by researchers and practitioners who are interested in identifying determinants of implementation behaviors in order to be able to develop effective strategies to improve healthcare professionals’ implementation behaviors. Furthermore, the findings provide a novel validation of the TDF and indicate that the domain ‘Environmental context and resources’ might be divided into several environment-related domains.

Implementation Science 2014, 9:33 doi:10.1186/1748-5908-9-33

Uses a collaborative approach for the development and evaluation of a toolbox for development, implementation, revision, and evaluation of guidelines. This approach yielded a potentially powerful toolbox for improving the quality and implementation of Dutch clinical guidelines. Collaboration between guideline organizations within this project led to stronger linkages, which is useful for enhancing coordination of guideline development and implementation and preventing duplication of efforts. Use of the toolbox could improve quality standards in the Netherlands, and might facilitate the development of high-quality guidelines in other countries as well.

Implementation Science 2014, 9:34 doi:10.1186/1748-5908-9-34

NHS England bite-size guides, to support patient and public participation in the NHS.  Identifies 6 practical stems to ensure participation in commissioning.

NHS England bite-size guides, to support Governance for participation. Identifies 9 practical stems to ensure good governance in participation.

NHS England bite-size guides, to support Budgeting for participation. Identifies 9 practical stems to ensure good budgeting in participation.

NHS England bite-size guides, to support Planning for participation. Identifies 6 practical stems to ensure good planning for participation.

Quality improvement collaboratives (QICs) continue to be widely used, yet evidence for their effectiveness is equivocal. We sought to explain what happened in Stroke 90:10, a QIC designed to improve stroke care in 24 hospitals in the North West of England. This study drew in part on the literature on collective action and inter-organizational collaboration. Finds a mixed picture of collaboration, competition and free-riding. Suggests time and resources need to be appropriate and management is required to reduce poor behaviours within the collaborative. Costs and benefits of collaboration need to be weighed up by organisations.

Implementation Science 2014, 9:32 doi:10.1186/1748-5908-9-32

Identifies that there is a growing body of evidence that an intervention that was successful in one location doesn’t deliver the same results elsewhere. Why is this? Alongside the importance of what you do
(intervention), and how you do it (implementation), the environment or context that you do it in also matters. It is the interaction between these three elements that makes for success.

According to routine data, the overall Adverse Drug Events (ADE)  prevalence rates for England, Germany, and the USA are
different. However, the differences are narrower than those determined from the rates of ADEs or adverse drug
reactions inferred from prospective or retrospective pharmacoepidemiological studies. Since the ADEs in the
countries examined in this study share several characteristics, the use of routine data for transnational research on
ADEs is feasible

BMC Health Services Research, 2014, 14:125

Briefing paper that describes current UK telehealth and telecare initiatives and the role they may play in delivering future care. It is written to brief politicians to inform them that as the UK’s elderly population is growing and with it the number of people with long-term health problems. This is putting pressure on the health and social care systems. Increased use of technology such as telehealth and telecare may help to improve quality of care and reduce costs.

Councils and NHS commissioners are set to share pooled budgets of more than £5bn in 2015-16 under the better care fund, HSJ has learned.

They have agreed to pool more than a third over and above the £3.8bn they are required to do under the policy, according to early indications in their plans.

CCGs and councils set to pool more than £5bn in 2015-16 – (HSJ Article request full text from Trust Library Services or call 01942 822508)

A mixed methods study involving over 254 interviews and collection of quantitative data investigating the process of service redesign in three acute trusts. Aims to investigate change in depth and detail. Findings include:

• Planned change projects were subject to alteration as a result of external policy shifts and financial constraint impacted them.
• Change is reliant on local leadership and is inevitably localised.
• Knowledge transfer was dependent on the nature of evidence, local leadership, strategic leadership and policy changes.

Suggests the most effective route to change is to focus on teams focussing on patient/clinical concerns.

Introduction

The term ‘second victim’ refers to the healthcare professional who experiences emotional distress following an adverse event. This distress has been shown to be similar to that of the patient—the ‘first victim’. The aim of this study was to investigate how healthcare professionals are affected by their involvement in adverse events with emphasis on the organisational support they need and how well the organisation meets those needs.

Methods

21 healthcare professionals at a Swedish university hospital who each had experienced an adverse event were interviewed. Data from semi-structured interviews were analysed by qualitative content analysis using QSR NVivo software for coding and categorisation.

Results

Our findings confirm earlier studies showing that emotional distress, often long-lasting, follows from adverse events. In addition, we report that the impact on the healthcare professional was related to the organisation’s response to the event. Most informants lacked organisational support or they received support that was unstructured and unsystematic. Further, the formal investigation seldom provided adequate and timely feedback to those involved. The insufficient support and lack of feedback made it more difficult to emotionally process the event and reach closure.

Discussion

This article addresses the gap between the second victim’s need for organisational support and the organisational support provided. It also highlights the need for more transparency in the investigation of adverse events. Future research should address how advanced support structures can meet these needs and provide learning opportunities for the organisation. These issues are central for all hospital managers and policy makers who wish to prevent and manage adverse events and to promote a positive safety culture.

This resource requires an OpenAthens account you can register here from an NHS connected computer (you can email us to request one) or call the Trust Library Service on 01942 822508.

Abstract: Introduction

Pay for performance is increasingly used as a way of improving the quality of medical care. We previously showed that a pay for performance scheme targeting a range of processes measures in hospitals in the North West of England was associated with a substantial reduction in mortality for pneumonia, myocardial infarction and heart failure equivalent to 890 fewer deaths (Sutton et al. Reduced Mortality with Hospital Pay for Performance in England. New England Journal of Medicine 2012;367:1821–28). This analysis only assessed mortality in the first 18 months after introduction of the scheme. We now report mortality outcomes at 42 months to see whether the effect was sustained.

Methods

Difference-in-differences regression analysis based on mortality for 230,985 patients admitted with pneumonia, myocardial infarction and heart failure to incentivised hospitals 18 months before and 42 months after the introduction of the program. These were compared with mortality in the following control groups: 1,260,545 patients admitted for the same three conditions to all 132 other hospitals in England, 50,400 patients admitted for six non-incentivised conditions to the incentivised group of hospitals and 285,301 patients admitted for non-incentivised conditions to all other hospitals in England. Analyses were adjusted for differences in age, gender, primary diagnosis, co-morbidities, type of admission, and location from which the patient was admitted.

Results

Preliminary analyses suggest that the gains in mortality seen 18 months after the introduction of the pay for performance programme were not sustained at 42 months.

Discussion

Pay for performance schemes remain controversial, and there are many unanswered questions about how and when they work. Our previous analyses were important because the incentive scheme that was introduced (Premier HQID) had no impact on mortality when introduced in the US, but appeared to have a substantial impact on mortality when introduced in the UK. However, our long term analyses suggest that these improvements were not sustained. We will comment on a number of possible reasons for the observed effects. One factor is that during the study period, the financial incentives changed from being bonuses to penalties for hospitals in the scheme.

Declaration of competing interests

None.

This resource requires an OpenAthens account you can register here from an NHS connected computer (you can email us to request one) or call the Trust Library Service on 01942 822508.

Introduction

Hospital mortality, readmission and length of stay (LOS) are commonly used measures for quality of care, given availability in administrative data. However, these measures are interrelated. For example, a short LOS due to patient’s death should be interpreted differently than short LOS in survivors. And patients who died cannot be readmitted. In this study we aim to disentangle the relationship between mortality, readmission and LOS and propose a way to jointly report the three figures to facilitate insight and evaluation of quality of care.

Methods

Data from the Global Comparators Project were used, in which 22 hospitals from 5 countries have reconciliated the different coding systems of their administrative admission data to obtain risk-adjusted hospital outcomes. Patients discharged between 2007–2011 were included. Three outcomes were considered: mortality, readmission, and prolonged LOS (>75 percentile). We analyzed all patients, stroke patients and colorectal patients as we expected these conditions to vary in short-term mortality and readmission/long LOS.

We assessed the correlations between the three standardized outcomes: mortality versus readmission (survivors), mortality versus long LOS, readmission (survivors) versus long LOS (survivors) and long LOS (deaths) versus long LOS (survivors). Second we constructed a composite measure with 5 levels: survivors no readmission normal LOS (best), survivors no readmission long LOS, survivors readmission normal LOS, survivors readmission long LOS, deaths (worst). This composite measure was analyzed using ordinal regression, to obtain a single standardized rate to compare hospitals.

Results

A total of 4,134,359 admissions were included in the analysis, with 76,517 for stroke and 31,736 for colorectal patients. The overall mortality rate was 3.1%, the readmission rate (in survivors) was 7.4% and 20.5% of the admissions had a long LOS (for stroke: 13.9%, 7.1% and 23.0%; for colorectal: 5.0%, 10.4% and 45.7%).

The median number of admission per hospital was 170,497 (range 9,294 to 430,731). Standardized (risk-adjusted) outcome rates varied largely between hospitals: 55–140 (mortality), 58–116 (readmission), 50–165 (long LOS).

No correlation was found between standardized mortality and readmission rates, and between readmission and long LOS rates (survivors). However, standardized mortality and long LOS rates were positively correlated (r=0.73, p=0.0001), indicating longer hospital stay in patients who died. Long LOS (survivors) was highly correlated with long LOS (deaths) (r=0.74 p<0.01), indicating that some hospital had a long LOS regardless of their mortality rates.

The figure shows the variation in the composite outcome measure, consistent with a variation in standardized rates between 43 and 171 (for stroke: 34–162; for colorectal: 33–1.9).

This composite measure correlated well with all individual measures, except readmission (r=0.06 p=0.79) caused by the smaller variation between hospitals in readmission rates, therefore weighted less.

Discussion

The three outcome measures were highly related. Disentangling the interrelations in outcomes facilitates insight so that hospitals get better directions for quality improvement. We propose to summarize the three outcomes into a single composite measure. The variation between hospitals in this composite measure is larger than for the individual measures, indicating a more accurate (detailed) representation of quality of care.

Declaration of competing interests

None.

This resource requires an OpenAthens account you can register here from an NHS connected computer (you can email us to request one) or call the Trust Library Service on 01942 822508.

Abstract: Introduction
Twitter and other social media are increasingly used by patients to discuss their experiences of healthcare. Social media might provide a new way for health services to listen to the voices of patients and improve their services. Little is known about how patients are communicating with hospitals via this route, and whether there is any association with traditional measures of patient experience such as surveys.

Methods
We recorded tweets aimed at all acute hospital trusts with Twitter accounts in England for one year from April 2012. We performed a qualitative content analysis of a random sample of 1000 tweets, to see what information they contained about care quality. Using natural language processing techniques, we calculated the sentiment of all the tweets towards hospital. We compared twitter sentiment to patient experience measured by traditional survey at the hospital level, using Spearmans rank correlation coefficient.

Results
We collected 187,000 tweets over one year. The mean number of tweets per trust was 2499. 9.8% of tweets were related to quality of care care – and most of these related to patients experience of interactions with staff. We found no correlation between the sentiment of tweets about hospitals and patient experience measure by traditional survey methodology (Rho=0.08, p=0.56).

Discussion
Although social media are increasingly used by both the public and healthcare professionals to communicate, caution should be taken in using social media data to measure care quality. The information contained within tweets was able to provide valuable individual insights about some patients experiences of care, however the views expressed appeared less likely to be representative of the experiences of the wider population receiving care.

Declaration of competing interests
This work has been funded by the Commonwealth Fund.

This resource requires an OpenAthens account you can register here from an NHS connected computer (you can email us to request one) or call the Trust Library Service on 01942 822508.

The article discusses a British government plan to reform long-term sick leave, designed to engage private specialist services in support of employees and bring them back to work faster. Comments from human resources (HR) professionals on the issue are presented, including Chartered Institute of Personnel &amp; Development (CIDP) head of public policy Ben Willmott, British Labour party shadow work and pensions minister Kate Green, and Frances O’Grady of the Trades Union Congress (TUC).

This resource requires an OpenAthens account you can register here from an NHS connected computer (you can email us to request one) or call the Trust Library Service on 01942 822508.

Article outlining approaches to 5 key HR conversations, from dealing with a bully to proving the value of the HR function.

In England, the NHS is ‘organising itself around a single definition of quality: care that is effective, safe and provides as positive an experience as possible’ enshrined in the NHS Outcomes Framework, as a set of measurable indicators.

Delays in discharging patients from hospital while they are waiting for social care to be arranged are costing the NHS in England about £100m each year, a documentary claims

Hospital discharge delays ‘cost NHS £100m’ – (HSJ Article request full text from Trust Library Services or call 01942 822508)

Team leadsers should be the ones agitating for radical change.

Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area. Finds some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare.

BMC Health Services Research 2014, 14:99 doi:10.1186/1472-6963-14-99

Health Foundation report on a roundtable discussion, 30 January 2014.  This report highlights the following key points from the presentations and discussions on the day:

1. The extent of the £30bn financial gap was accepted, but it may be too optimistic if the NHS budget is not protected in future years.
2. The NHS in England does not appear particularly ‘flabby’ next to health systems in other developed countries.
3. The current financial squeeze might affect the system’s ability to achieve the service transformation required to close the £30bn funding gap by 2021. Asking the system to deliver radical, transformational change may be unrealistic given the day-to-day pressures to deliver, but the financial squeeze may prompt the action needed.
4. Proper alignment between quality, efficiency and funding decisions is vital. Short-term interventions to improve quality must not increase the scale of the financial challenge to come.
5. There are a number of cultural barriers which make innovation more challenging. The system rarely tackles failure well and there is very little recognition or reward for success. As a sector, the health system could be much better at ‘spread’ of good and innovative practice.
6. Radical transformation of services is required.
7. The centre should play a bold, supportive and facilitative role and avoid the perception of micro-management.
8. The time has come for an honest conversation with the public about what the NHS might look like over the next decade and how that vision might be funded.
9. There are signs of optimism despite the financial challenges. For example, the prominent focus on integration and person-centred care could bring about positive changes.

The report also summarises some potential areas of focus to support the NHS to deliver improved efficiency in both the short and medium term.

The Fair Deal policy allows newly transferring staff continued access to a public service pension scheme. It replaces the previous policy which required employers to provide transferring staff access to a broadly comparable pension scheme and the option of a transfer of their accrued pension rights.