how heart failure nursing service reduces hospital admissions

Lincolnshire Knowledge and Resource Service This search summary contains the results of a literature search undertaken by the Lincolnshire Knowledge and Resource Service librarians in May 2012 All of the literature searches we complete are tailored to the specific needs of the individual requester If you would like this search re-run with a different focus or updated to accommodate papers published since the search was completed please let us know We hope that you find the information useful If you would like the full text of any of the abstracts listed please let us know Alison Price alisonpricelpctnhsuk Janet Badcock janetbadcocklpctnhsuk Librarians Lincolnshire Knowledge and Resource Service NHS Lincolnshire Beech House Waterside South Lincoln LN5 7JH

Date 11th May 2012 By Jan Badcock

Latest figures on how heart failure nursing service reduces hospital admissions middot What causes heart failure patients to be re-admitted middot Poor discharges for heart failure - what stats are there - why does it happen middot latest evidence on effectiveness of heart failure service - especially home visits middot anything that demonstrates heart failure service is welled liked by patients middot Anything that demonstrates heart failure services are worthwhile commissioning and save monies middot If there is local information that would help a lot too middot Is there any evidence to show that it reduces burden of GP consultations Latest figures on how heart failure nursing service reduces hospital admissions Heart failure nurse services in England Heart failure nurses saw 34 of all patients discharged from hospital with a diagnosis of heart failure in the 12 month period bull The number of all cause readmissions during this period was 35 less than in the 12 months prior to the nurses coming into post bull Patients seen by heart failure specialist nurses were less likely to be readmitted but when they were they tended to be admitted for a longer duration (116 nights compared to 86 nights before the nurses were in post) bull Heart failure specialist nurses have the potential to save significant sums of monies through reductions in readmissions this is estimated as pound1826 per patient seen over and above the cost of the heart failure nurse See p122 See attached Randomised controlled trial of specialist nurse intervention in heart failure BMJ 2001 September 29 323(7315) 715ndash718 Death or readmission from all causes was reduced by 28 (072 049 to 104) in the nurse intervention group compared with usual care (table (table3)3) The risk of admission to hospital for worsening heart failure was reduced by 62 (038 019 to 076) in the intervention group httpwwwncbinlmnihgovpmcarticlesPMC56888 Randomised controlled trial of specialist nurse intervention in heart failure Blue L Lang E McMurray JJ Davie AP McDonagh TA Murdoch DR et al BMJ 2001323(7315)715-8 httpeprintsglaacuk581BMJBlue2001pdf

A randomized trial of the addition of home-based exercise to specialist heart failure nurse care the Birmingham Rehabilitation Uptake Chronic heart failure (update) Jolly K Taylor RS Lip GY et al 220 httpeurjhfoxfordjournalsorgcontent112205fullpdf+html Latest evidence on effectiveness of heart failure service - especially home visits WHICH trial HF-nurse home visits cut in-hospital days vs clinic-based care httpwwwtheheartorgarticle1234889do Comparative Effectiveness and Heart Failure Readmissions PPT httpcmoremeduclaedupresentCMORE_Ong_Cleanpdf Evidence-based chronic heart-failure management programmes reality or myth httpqualitysafetybmjcomcontent20131fullpdf+htmlath_user=nhstrjbadcock1ampath_ttok=3CT6u7wKMj9iOXSjDGqA3E A randomized controlled trial of a community nurse supported hospital discharge programme in older patients with chronic heart failure httpjournalsohiolinkeduejcpdfcgiKwok_Timothypdfissn=09621067ampissue=v17i0001amparticle=109_arctoaopwchf Effects of a nurse-led clinic and home-based intervention on recurrent hospital use in chronic heart failure httponlinelibrarywileycomocochraneclcentralarticles075CN-00511075framehtml Nurse-led interventions in heart failure care patient and nurse perspectives httpjournalsohiolinkeduejcpdfcgiHoekstra_Tpdfissn=14745151ampissue=v09i0004amparticle=226_niihfcpanp Complexity of program and clinical outcomes of heart failure disease management incorporating specialist nurse-led heart failure clinics a meta-regression analysis httpwwwcrdyorkacukcrdwebShowRecordaspLinkFrom=OAIampID=12005003728

Anything that demonstrates heart failure service is well liked by patients Nurse-led interventions in heart failure care Patient and nurse perspectives httpjournalsohiolinkeduejcpdfcgiHoekstra_Tpdfissn=14745151ampissue=v09i0004amparticle=226_niihfcpanp Heart failure nurse services in England 5 Did the service affect the patientsrsquo health related quality of life How satisfied were they with the service Overview Overall the nurses appear to have had a significant positive impact on health related quality of life and patients and carers are highly satisfied with the care they provide Key Findings bull 10 of patients seen by nurses completed our survey but the sample of 954 patients and 342 carers exceeded our target The demographics were similar to those patients who did not complete the survey but when compared to those nonparticipants nurses gave us details for (297) non-participants were more likely to be older male and NYHA IV Survey patients were also more likely to have had more contacts with the nurses and have fewer co morbidities bull Looking at other studies using the Minnesota Living with Heart Failure (MLHF) questionnaire which measures the impact of heart failure on daily living our study patients had much higher baseline scores showing worse levels of health related quality of life There was significant improvement from baseline at 6 months and 12 months in both the disease specific (MLHF) and generic HRQoL measure (SF 12) used bull Self-care scores were good at baseline and did not improve overall It would appear that there were improvements in uptake of flu jab and increased exercise but a slight decrease in the score on other items in the questionnaire bull Anxiety and depression scores did not improve bull Patients were highly satisfied with the care from the HFSN But over the 12 month follow up satisfaction decreased slightly This may be linked to discharge from the service Conclusions There was significant improvement in patientsrsquo health related quality of life over a one year follow up period and patients werevery satisfied with the care they received An important role of HFSN services is to provide education and support to patients and their carers about the condition and its management which may need to be done more regularly to maintain high levels of self care behaviours Recommendation Anxiety and depression should be routinely assessed using recognised standardised measures When appropriate patients should be referred to their GP for onward referral to psychology services or medication 6 How does the caring role impact on family carers and is this role and their quality of life affected by the new service

Overview The majority of carers are spouses and female Carer age is about six years younger than the patientsrsquo age As we know caring can be exhausting for some carers We assessed the physical demands of caring the impact caring had on the carerrsquos perceived role and the financial demands of caring We also assessed general health-related quality of life and satisfaction with the care provided by the HFSN service Key findings bull Carersrsquo physical health score at baseline was better than that of the patients but poor compared with population norms and the score did get worse over the year (Figure 2) bull Carers SF12 mental health component score was similar to that of the person they werecaring for Request From LKRS Anything that demonstrates heart failure services are worthwhile commissioning and save monies Cost effectiveness of nurse led disease management for heart failure in an ethnically diverse urban community httpwwwannalsorgcontent1498540fullpdf+htmlNurse-led clinics can boost quality scores By Rachel Liddle 02 March 2007 GPs could improve their quality framework score if they commission specialist nurse clinics for patients with CHD or chronic heart failure (CHF) UK research suggests Add to CPD Organiser Tell us your views The scheme could boost the number of CHF patients who receive a proper diagnosis and help CHD patients meet BP cholesterol and therapeutic targets said lead researcher and Leicester GP Dr Kamlesh Khunti For the study 1316 patients with CHD or CHF were randomly assigned to attend clinics run by specialist nurses or standard care The weekly clinics were run by two specialist secondary care nurses who travelled between the 20 Leicester practices attended by the patients Nurse intervention included patient assessment confirmation of diagnosis management of medicines and home visits Nurses could refer patients to a secondary care cardiology clinic for echocardiography and assessment by a senior cardiologist At 12-month follow-up CHD patients assigned to the specialist clinics were 61 per cent more likely to have a BP of 14085mmHg and 58 per cent more likely to have total cholesterol levels below 5mmoll Under the quality framework meeting this target is worth 36 points Patients with a history of MI were 43 per cent more likely to receive a beta-blocker if they received nurse intervention rather than standard care

Additionally CHF patients were around four times more likely to have a diagnosis of left ventricular systolic dysfunction (LVD) confirmed or excluded if they attended the clinics Identifying and treating LVD is worth up to 20 points on the quality framework Although this study began in 2003 before introduction of the quality framework Dr Khunti said its findings were applicable to current practice For CHF management in particular GPs should commission specialist nurse clinics lsquoHeart failure is a very difficult area to manage and you need more training to help make the diagnosisrsquo he said In his area secondary care nurses run clinics for CHF while specialist practice nurses manage patients with CHD But Dr Terry McCormack chairman of the Primary Care Cardiovascular Society and a GP in Whitby Yorkshire said specialist practice nurses could achieve the same outcomes lsquoThe fact that itrsquos nurses doing it is not surprising because theyrsquore especially good at achieving targetsrsquo he said The introduction of the GMS contract has also led to an overall improvement in these targets he added httpwwwgponlinecomNewsarticle647910Nurse-led-clinics-boost-quality-scores If there is local information that would help a lot too Cardiovascular disease PCT health profile (2006 figures) Key messages PCT boundaries Lincolnshire httpwwwsephoorgukNationalCVDdocs5N9_CVD20Profilepdf Some General Guidance Documents Chronic Heart Failure National clinical guideline for diagnosis and management in primary and secondary care August 2010 httpwwwniceorguknicemedialive130995051450514pdf Management of chronic heart failure A national clinical guideline httpwwwsignacukpdfsign95pdf See Data base search below for more information

Online Resources Problems of Policy Implementation Implementation is the process of turning policy into practice However it is common to observe a lsquogaprsquo between what was planned and what actually occurred as a result of a policy There are three major theoretical models of policy implementation (Buse et al 2005) wwwhealthknowledgeorgukpublic-health-textbookmedical-sociology-policy-economics4c-equality-equity-policyproblems-policy-implementation Factors influencing policy formulation implementation and outcomes The literature identifies several key factors that influence the success of pro-poor health policies wwweldisorggotopicsdossiersmeeting-the-health-related-needs-of-the-very-poorpro-poor-health-policiesfactors-influencing-policy-formulation-implementation-and-outcomes Health sector reform There is widespread evidence of significant gaps between health policies as laid down on paper by governments or ministries of health and their implementation in practice As a result newly proposed and effective health interventions may fail to attain high coverage levels when implemented and may not fulfil their potential to reduce mortality and morbidity httpwwwcrehslshtmacukdownloadspublicationsCREHS_research_highlightspdf Implementation Matters A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation Joseph A Durlak and Emily P DuPre The first purpose of this review was to assess the impact of implementation on program outcomes and the second purpose was to identify factors affecting the implementation process Results from over quantitative 500 studies offered strong empirical support to the conclusion that the level of implementation affects the outcomes obtained in promotion and prevention programs Findings from 81 additional reports indicate there are at least 23 contextual factors that influence implementation The implementation process is affected by variables related to communities providers and innovations and aspects of the prevention delivery system (ie organizational functioning) and the prevention support system (ie training and technical assistance) The collection of implementation data is an essential feature of program evaluations and more information is needed on which and how various factors influence implementation in different community settings httpwwwspringerlinkcomcontentgm186205w580h57tfulltextpdf Influencing policy change the experience of health think tanks in low- and middle-income countries httpheapoloxfordjournalsorgcontentearly20110510heapolczr035fullpdf+html

MAKING A DIFFERENCE EFFECTIVE IMPLEMENTATION OF CROSS-CUTTING POLICY A Scottish Executive Policy Unit Review Kenneth Hogg June 2000 httpwwwscie-socialcareonlineorgukrepositoryfulltextcostcutpdf Turning policy into outcomes a report on the implementation of well-being strategies London Improvement and Development Agency 2007 48p Improving the quality of life for older people was one of seven shared priorities agreed between central government and the Local Government Association (LGA) Some 50 local authorities and their partners participated in the shared priority work through action learning sets The work ran from September 2004 to April 2006 The guide identifies the lessons learnt In them you will find valuable and timely examples tools and insights These will help to implement the vision for modernising older peoples services httpwwwideagovukidkaio5821111 Implementation of a health care policy An analysis of barriers and facilitators to practice change BMC Health Services Research 2005 553 doi1011861472-6963-5-53 The electronic version of this article is the complete one and can be found online at Governments often create policies that rely on implementation by arms length organizations and require practice changes on the part of different segments of the health care system without understanding the differences in and complexities of these agencies In 2000 in response to publicity about the shortening length of postpartum hospital stay the Ontario government created a universal program offering up to a 60-hour postpartum stay and a public health follow-up to mothers and newborn infants The purpose of this paper is to examine how a health policy initiative was implemented in two different parts of a health care system and to analyze the barriers and facilitators to achieving practice change httpwwwbiomedcentralcom1472-6963553 The impact of leadership factors in implementing change in complex health and social care environments NHS plan clinical priority for mental health crises resolution teams httpwwwnetsccacukhsdrfilesprojectSDO_FR_08-1201-022_V01pdf Creating a patient-led NHS some ethical and epistemological challenges This article responds to the Coalition governmentrsquos recent Open Public Service white paper and to proposals which call for the creation of a ldquopatient-led NHSrdquo which will wherever possible seek to give patients direct control over the services they receive through a greater degree of choice and participation Its central contention is that affording patients greater influence over the consultation and commissioning processes will require the NHS to accommodate and respond to the beliefs values and agendas of patients as well as those of medical professionals and policy makers Since it cannot be assumed that professionals and patients will share the same beliefs values and agendas the creation of a system of patient-led services has the potential to bring disagreement between professionals and patients to a head particularly within the consultation and commissioning processes Thus a set of complex epistemic and ethical challenges accompanies the proposed creation of a ldquopatient-led NHSrdquo greater awareness of which will be necessary for the successful implementation of such reforms httpwwwlondonjournalofprimarycareorgukarticles4543335pdf

Research Papers Implementing health and social care policy England and Scotland compared FORBES Tom EVANS Debbie SCOTT Niccola Policy Studies 31(6) November 2010 pp591-611 This paper compares the implementation of health and social care policies aimed at improving joint working between health care and social care provision sectors in Scotland and England The formerrsquos devolved government has developed policies in key areas different to those adopted in England These authors detail the backgrounds to the evolution of the differing policies focusing on the roles of the Joint Future Group and health-only and integrated Community Health Partnerships (CHPs) in Scotland Four health and social care partnerships were selected including one care trust and an alternative partnership model made of a combined Primary Care Trust from England and a non-integrated and integrated CHP from Scotland Sixteen interviews in total were conducted with senior NHS managers and senior social services managers in England and CHP chairs and directors NHS board senior managers and directors of council social services in Scotland Findings included overall dominance of NHS policy ldquoat the expense of local authority partnersrdquo with each example of joint working initiatives in both countries finding implementation of policy challenging often due to poor policy guidance and uneasy working relationships between social and health care sectors Devolution in Scotland had afforded greater freedom for experimentation with policy which appeared more readily influenced or challenged by front-line practitioners The authors consider potential implications for future policy in similar decentralised contexts Policy success and public health the case of public health in England Author(s) Baggott Rob Citation Journal of Social Policy 2012 volis 412(391-408) 0047-2794 on public health since the early 1990s Using concepts drawn from the policy success and failure literature this article concludes that recent governments in England achieved only precarious success in McConnells typology It demonstrates with wider significance that success or failure is not merely about policy achievement in programme terms but that policy processes and the political dimensions of policy must be included in any evaluation It also highlights the adversarial nature of public health policy the subjectivity of judgments about effectiveness and the political problems this creates for government The article pinpoints the relevance of public health policies for judgements about government competence trustworthiness and accountability It argues that failures of public health policy including poor evaluation and failures to learn from experience may be more comprehensible by adopting a political analysis of public policy making in this field [Abstract] Why the plans to reform the NHS may never be implemented Chris Ham Kingrsquos Fund BMJ Medical politics and party politics could yet frustrate the enactment of the governmentrsquos proposals Attached

NHS Evidence | librarynhsuk

Search ResultsTable of Contents1 What was the programme theory of New Labours Health System Reforms page 2

2 Implementing world class commissioning competencies page 2

3 Are NHS foundation trusts able and willing to exercise autonomy You can take a horse to water page 2

4 Plus ccedila change plus cest la mecircme chose senior NHS managers narratives of restructuring page 3

5 Policy entrepreneurship in the development of public sector strategy the case of London health reform page 4

6 English NHS embarks on controversial and risky market-style reforms in health care page 4

7 Opening the black box a study of the process of NICE guidelines implementation page 4

8 Reliability of a tool for measuring theory of planned behaviour constructs for use in evaluating research use inpolicymaking page 5

9 Local histories and local sensemaking a case of policy implementation in the English National Health Service page 5

10 Policy to tackle the social determinants of health using conceptual models to understand the policy process page 6

11 Is the metaphor of barriers to change useful in understanding implementation evidence from general medicalpractice page 6

12 Describing the impact of health services and policy research page 7

13 Window of opportunity for intersectoral health policy in Sweden - open half-open or half-shut page 7

14 Five years and billions of pounds later has anything changed page 8

15 Evidence into policy and practice measuring the Progress of US and UK policies to tackle disparities andinequalities in US and UK health and health care page 8

16 A new direction for NHS community services the white paper tackles the right issues but may be hard toimplement [Editorial] page 8

17 Implementation of a health care policy an analysis of barriers and facilitators to practice change page 9

18 Development of immunization policy and its implementation in the United Kingdom page 9

19 Implementing a national strategy for patient safety lessons from the National Health Service in England page 10

20 Addressing the implementation challenge Introducing primary care graduate mental health workers page 10

21 Transfer of Health for All policy what how and in which direction a two-case study page 10

22 Influencing sceptical staff to become supporters of service improvement a qualitative study of doctors andmanagers views page 11

23 The utilisation of health research in policy-making concepts examples and methods of assessment page 11

24 Policy effects on clinical work less change than envisaged page 12

25 Factors of the innovation organization environment and individual that predict the influence five systematicreviews had on public health decisions page 12

26 Meeting patient expectations healthcare professionals and service re-engineering page 13

27 How great expectations in Westminster may be dashed locally the local implementation of national policy onhealth inequalities page 13


Page 2

1 What was the programme theory of New Labours Health System Reforms

Citation Journal of Health Services Research and Policy 2012 volis 171(7-15) 1355-8196

Author(s) Millar Ross Powell Martin Dixon Anna

Language English

Abstract OBJECTIVES To examine whether the Health System Reforms delivered the promise ofbeing a coherent and mutually supporting reform programme to identify the underlyingprogramme theory of the reform programme to reflect on whether lessons have beenlearned METHODS Documentary analysis mapping the implicit and explicit programmetheories about how the reforms intended to achieve its goals and outcomesSemi-structured interviews with policy-makers to further understand the programmetheory RESULTS The Health System Reforms assumed a one size fits all approach topolicy implementation with little recognition that some contexts can be more receptivethan others There was evidence of some policy evolution and rebalancing between thereform streams as policy-makers became aware of some perverse incentives andunforeseen consequences Later elements aimed to restore balance to the systemCONCLUSIONS The Health System Reforms do not appear to comprise a coherent andmutually supportive set of levers and incentives They appear unbalanced with the centreof gravity favouring suppliers over commissioners However recent reform changes havesought to redress this imbalance to some extent suggesting that lessons have been learnedand policies have been adapted over time [Abstract]

Source HMIC

2 Implementing world class commissioning competencies


Author(s) McCafferty Sara Williams Lestyn Hunter David

Language English

Abstract BACKGROUND The world class commissioning (WCC) programme was introduced inthe English NHS in 2007 to develop primary care trust (PCT) commissioning of healthservices There has been limited evaluation of health commissioning initiatives over theyears and in particular little is known about how commissioners interpret and implementinitiatives and guidance intended to strengthen commissioning This research explores thedevelopment and implementation of WCC and draws implications for futurecommissioning arrangements METHODS This research draws on interviews with keyinformants (n = 6) and a literature review to analyse the aims of and stimulus for WCCIn-depth interviews (n = 38) were conducted in three PCTs in the north of England in2009 to analyse the interpretation and implementation of WCC RESULTS The aims andrationale of WCC in particular the specification of commissioning skills and theaspirations to improve health outcomes were largely welcomed and supported byinterviewees However the implementation of WCC posed a number of challengesincluding availability of resources and knowledge lack of a supportive organizationalculture and networks and the dominance of central government controlCONCLUSIONS The findings have implications for emerging clinical commissioninggroups (CCGs) in the English NHS Specifically the research highlights the need for asystem-wide approach to improving commissioning including appropriately alignedpolicy and objectives underpinned by a co-ordinated and supportive organizationalculture [Abstract]

Source HMIC

3 Are NHS foundation trusts able and willing to exercise autonomy You can take a horse to water

Citation Journal of Health Services Research amp Policy 2011 volis 164 1355-8196

Author(s) Exworthy Mark Frosini Francesca Jones Lorelei

Language English


Page 3

Abstract Foundation trusts (FTs) have been a central part of the governments National HealthService (NHS) reforms in England since 2004 They illustrate the governments claim todecentralisation by granting greater autonomy to high performing organisations Thenumber of FTs has grown steadily reaching 131 in September 2010 over 50 of eligibletrusts Despite this growth and notwithstanding the fact that organisations which initiallybecame FTs were previously high performing doubts remain about the implementation ofthe FT policy This article examines the implementation of FTs in the NHS and focuses onthe nature and exercise of autonomy by FTs It argues that the ability of FTs to exerciseautonomy is in place but the (relatively limited) extent of implementation may beexplained by trusts lack of willingness to exercise such autonomy Such unwillingnessmay be because of continued centralisation unclear policy and financial regimes fear ofnegative impacts on relations with other local organisations and awareness of greater riskto the FT among others Addressing the tension between FTs ability and willingness toexercise autonomy will largely explain the extent to which the governments provider sidereforms will be implemented Cites 28 references [Journal abstract]Although mostindividuals continue to use and trust their healthcare professional for health informationthey are increasingly bombarded with health information from other sources such as theInternet television and family or friends It is important to understand where variances inthe use and trust of health information by various demographic factors occur in order tomonitor these sources to make sure that information provided is accurate andunderstandable Therefore the purpose of this study was to use data from the AnnenbergNational Health Communication Survey (ANHCS) to determine the relationship ofdemographic variables of age raceethnicity educational level gender income level andhealth status to use and trust of health information sources (health provider televisionInternet and family or friends) Data were also analysed to determine how thesedemographic variables increase or decrease the likelihood of using the various sources forhealth information Results from the analysis showed that significant differences occur inuse of health information when examined by demographic variables Suggestions weremade on how to make these health information sources most user-friendly and cautionwas expressed regarding the accuracy of sources Cites 31 references [Journal abstract]

Notes doi 101258jhsrp20110177

Publication Type Article

Source HMIC

Full Text Available in fulltext at EBSCOhost

4 Plus ccedila change plus cest la mecircme chose senior NHS managers narratives of restructuring

Citation Sociology of Health and Illness 2011 volis 336(914-929) 0141-9889

Author(s) Macfarlane Fraser Exworthy Mark Wilmott Micky

Language English

Abstract The UK National Health Service (NHS) is regularly restructured Its smooth operationand organisational memory depends on the insights and capability of managers especiallythose with experience of previous transitions Narrative methods can illuminate complexchange from the perspective of key actors We used an adaptation of Wengrafsbiographical narrative life interview method to explore how 20 senior NHS managers(chief executives directors and assistant directors) had perceived and responded to majortransitions since 1974 Data were analysed thematically using insights fromphenomenology neo-institutional theory and critical management studies Findings werecontextualised within a literature review of NHS policy and management 1974-2009Managers described how experience in different NHS organisations helped buildresilience and tacit knowledge and how a strong commitment to the NHS brand allowedthem to weather a succession of policy changes and implement and embed such changeslocally By synthesising these personal and situated micro-narratives we built a widerpicture of macro-level institutional change in the NHS in which the various visiblerestructurings in recent years appear to have masked a deeper continuity in terms ofenduring values norms and ways of working We consider the implications of thesefindings for the future NHS [Summary]


Page 4

Source HMIC

5 Policy entrepreneurship in the development of public sector strategy the case of London health reform

Citation Public Administration 2011 volis 892(325-344) 1467-9299

Author(s) Oborn Eivor Barrett Michael Exworthy Mark

Language English

Abstract The development of health policy is recognized as complex however there has been littledevelopment of the role of agency in this process Kingdon developed the concept ofpolicy entrepreneur (PE) within his windows model He argued inter-related policystreams must coincide for important issues to become addressed The conjoining of thesestreams may be aided by a policy entrepreneur We contribute by clarifying the role of thepolicy entrepreneur and highlighting the translational processes of key actors in creatingand aligning policy windows We analyse the work in London of Professor Sir Ara Darzias a policy entrepreneur An important aspect of Darzis approach was to align a numberof important institutional networks to conjoin related problems Our findings highlighthow a policy entrepreneur not only opens policy windows but also yokes together anetwork to make policy agendas happen Our contribution reveals the role of clinicalleadership in health reform [Abstract]

Source HMIC


6 English NHS embarks on controversial and risky market-style reforms in health care

Citation New England Journal of Medicine 2011 volis 36414(1360-1366) 0028-4793

Author(s) Roland Martin Rosen Rebecca

Language English

Abstract The initiatives proposed for the English health system herald an immense change in theorganization of the NHS particularly the role of the general practitioner and thepromotion of a competitive market in health care Like all major policy initiatives beforeit the success of the initiative proposed in Equity and Excellence will depend on itsimplementation Perhaps the greatest concern is that the government may not have thepatience to see the implementation of change through before it decides to change thesystem again Major health service reforms cause years of disruption and English healthcare will go through a process of disorganization (a process that has also been termedre-disorganization) for 3 or 4 years before benefits can be expected from this new roundof changes Experience suggests that governments do not have the patience to see majorchanges through especially when general elections loom considerable political nervewill be required if politicians are to resist the urge to change the system again just asthings may be starting to improve [Abstract]

Source HMIC


7 Opening the black box a study of the process of NICE guidelines implementation

Citation Health Policy 2011 volis 1022-3(117-125) 0168-8510

Author(s) Spyridonidis Dimitrios Calnan Michael

Language English

Abstract OBJECTIVES This study informs evidence-based implementation by using aninnovative methodology to provide further understanding of the implementation processin the English NHS using two distinctly different NICE clinical guidelines as exemplarsMETHODS The implementation process was tracked retrospectively and prospectivelyusing a comparative case-study and longitudinal design 74 unstructured interviews werecarried out with 48 key informants (managers and clinicians) between 2007 and 2009RESULTS This study has shown that the NICE guidelines implementation process has


Page 5

both planned and emergent components which was well illustrated by the use of theprospective longitudinal design in this study The implementation process might becharacterised as strategic and planned to begin with but became uncontrolled and subjectto negotiation as it moved from the planning phase to adoption in everyday practice Thevariations in the implementation process could be best accounted for in terms ofdifferences in the structure and nature of the local organisational context The latterpointed to the importance of managers as well as clinicians in decision-making aboutimplementation CONCLUSION While national priorities determine the context forimplementation the shape of the process is influenced by the interactions between doctorsand managers which influence the way they respond to external policy initiatives such asNICE guidelines NICE and other national health policy-makers need to recognise that theintroduction of planned change initiatives in clinical practice are subject to social andpolitical influences at the micro level as well as the macro level [Abstract]

Source HMIC

8 Reliability of a tool for measuring theory of planned behaviour constructs for use in evaluating research use inpolicymaking

Citation Health Research Policy and Systems 2011 volis 929 1478-4505

Author(s) Boyko Jennifer A Lavis John N Dobbins Maureen

Language English

Abstract BACKGROUND Although measures of knowledge translation and exchange (KTE)effectiveness based on the theory of planned behavior (TPB) have been used amongpatients and providers no measure has been developed for use among health systempolicymakers and stakeholders A tool that measures the intention to use researchevidence in policymaking could assist researchers in evaluating the effectiveness of KTEstrategies that aim to support evidence-informed health system decision-makingTherefore we developed a 15-item tool to measure four TPB constructs (intentionattitude subjective norm and perceived control) and assessed its face validity through keyinformant interviews METHODS We carried out a reliability study to assess the toolsinternal consistency and test-retest reliability Our study sample consisted of 62policymakers and stakeholders that participated in deliberative dialogues We assessedinternal consistency using Cronbachs alpha and generalizability (G) coefficients and weassessed test-retest reliability by calculating Pearson correlation coefficients (r) and Gcoefficients for each construct and the tool overall RESULTS The internal consistencyof items within each construct was good with alpha ranging from 068 to alpha = 089G-coefficients were lower for a single administration (G = 034 to G = 073) than for theaverage of two administrations (G = 079 to G = 089) Test-retest reliability coefficientsfor the constructs ranged from r = 026 to r = 077 and from G = 031 to G = 062 for asingle administration and from G = 047 to G = 086 for the average of twoadministrations Test-retest reliability of the tool using G theory was moderate (G = 05)when we generalized across a single observation but became strong (G = 09) when weaveraged across both administrations CONCLUSION This study provides preliminaryevidence for the reliability of a tool that can be used to measure TPB constructs inrelation to research use in policymaking Our findings suggest that the tool should beadministered on more than one occasion when the intervention promotes an initial spikein enthusiasm for using research evidence (as it seemed to do in this case withdeliberative dialogues) The findings from this study will be used to modify the tool andinform further psychometric testing following different KTE interventions [Abstract]

Source HMIC

Full Text Available in fulltext at BioMedCentralAvailable in fulltext at National Library of Medicine

9 Local histories and local sensemaking a case of policy implementation in the English National Health Service

Citation Policy and Politics 2010 volis 382 0305-5736

Author(s) Coleman Anna Checkland Kath Harrison Stephen Hiroeh Urara


Page 6

Language English

Abstract Record in progressCentral policies that are only loosely specified might be expected toresult in local variations in interpretation and implementation and practice-basedcommissioning in the English National Health Service (NHS) is no exception Theauthors show how local sensemaking in relation to this policy has been influenced bylocal histories and by conceptual schemata derived from earlier reorganisations of theNHS Changes to organisational formalities do not necessarily therefore result inreappraisals of sensemaking on the part of local actors The author also employ their datato address issues raised by commentators critical of the way the concept of sensemakinghas been previously employed Cites numerous references [Journal abstract]


Source HMIC

10 Policy to tackle the social determinants of health using conceptual models to understand the policy process

Citation Health Policy and Planning 2008 volis 235 0268-1080

Author(s) Exworthy Mark

Language English

Abstract Like health equity the social determinants of health (SHD) are becoming a key focus forpolicy-makers in many low and middle income countries Yet despite accumulatingevidence on the causes and manifestations of SDH there is relatively little understandingabout how public policy can address such complex and intractable issues This paper aimsto raise awareness of the ways in which the policy processes addressing SDH may bebetter described understood and explained It does so in three main sections First itsummarises the typical account of the policy-making process and then adapts this to thespecific character of SDH Second it examines alternative models of the policy-makingprocess with a specific application of the policy streams and networks model to theSDH policy process Third methodological consideration of the preceding two sectionsare assessed with a view to informing future research strategies The paper concludes thatconceptual models can help policy-makers understand and intervene better despitesignificant obstacles Cites numerous references [Journal abstract]


Source HMIC

Full Text Available in fulltext at Highwire Press

11 Is the metaphor of barriers to change useful in understanding implementation evidence from general medicalpractice


Author(s) Checkland Kath Harrison Stephen Marshall Martin

Language English

Abstract OBJECTIVES To investigate how general medical practices in the UK react tobureaucratic initiatives such as National Health Service (NHS) National ServiceFrameworks (NSFs) and to explore the value of the metaphor of barriers to change forunderstanding this METHODS Interviews non-participant observation and documentaryanalysis within case studies of four practices in northern England RESULTS Thepractices had not actively implemented NSFs At interview various barriers that hadprevented implementation were listed including the complexity of the documents andlack of time Observation suggested that these barriers were constructions used by theparticipants to make sense of the situation in which they found themselvesCONCLUSION The metaphor of removing barriers to change was of limited use in acontext where non-implementation of policy was an emergent property of underlyingorganizational realities likely to be modifiable only if these realities were addressed 20refs [Abstract]

Source HMIC


Page 7


12 Describing the impact of health services and policy research

Citation Journal of Health Services Research and Policy 2007 volis 12 1355-8196

Author(s) Kuruvilla Shyama Mays Nicholas Walt Gill

Language English

Abstract OBJECTIVES In an essentially applied area of research there are particular pressures onhealth services and policy researchers to describe the impact of their work Howeverspecialized research impact assessments often require skills and resources beyond thoseavailable to individual researchers and ad hoc accounts impose a considerable burden togenerate Further these idiosyncratic accounts may not facilitate comparative analysis toinform research management practice and assessment This paper describes an initialattempt to develop a methodical approach to identify and describe research impactMETHODS A Research Impact Framework was developed drawing on the literature andinterviews with researchers at the London School of Hygiene and Tropical Medicine andwas used to structure impact narratives of selected research projects These narrativeswere based on semi-structured interviews with principal investigators and documentaryanalysis of the projects RESULTS Using the framework as a guide researchers wererelatively easily and methodically able to identify and present impacts of their workResearchers narratives contained verifiable evidence and highlighted a wide range ofareas in which health services and policy research has impact The standardized structureof the narratives also facilitated analysis across projects Factors thought to positivelyinfluence the impact of research included researchers continued involvement in researchand policy networks established track records in the field and the ability to identify anduse key influencing events such as policy windows CONCLUSIONS The frameworkhelped develop research impact narratives and facilitated comparisons across projectshighlighting issues for research management and assessment 2 tables 33 refs [Abstract]

Source HMIC


13 Window of opportunity for intersectoral health policy in Sweden - open half-open or half-shut

Citation Health Promotion International 2007 volis 224 0957-4824

Author(s) Nilunger Mannheimer Louise Lehto Juhani Ostlin Piroska

Language English

Abstract Health in All Policies (HiAP) is defined as a horizontal complementary policy-relatedstrategy with a high potential for contributing to population health To ensure that healthimpacts are highlighted across sectors the support of actors in different sectors not justthe health sector is needed Public health here defined as a universally important but alow prioritised politics areas needs to involve high politics areas to fulfil the HiAPstrategy This study aimed to analyse the agenda setting formulation initiation andimplementation of the intersectoral public health policy and one tool of HiAP healthimpact assessment (HIA) at the national and local level (exemplified by StockholmCounty) in Sweden A literature search was carried out of scientific and grey literature onintersectoral health policy and HIA in Sweden The study was a policy analysis using acontent analysis method and the theoretical framework of Kingdon where the resultswere examined through problem identification (why a window of opportunity opens foran intersectoral health policy and HIA) the factors and impact of politics (support for theformulation and implementation of policy) and policy (how best to solve the problem)The results showed that actors perceived the problems (the rationale) differentlydepending on their agenda and interest Politicians and experts had a high impact on theformulation of the policy agreeing on the policy goals However there was a little focuson implementation plans implying that the political actors were not in agreement and theexperts sometimes showing conflicting evidence-based opinions on how to best ensurethe policy Without this in place it is difficult to involve high politics areas and viceversa without the involvement of high politics it is difficult to achieve the policy


Page 8

However this is a long-term process where small steps need to be taken leaving thepolicy window half-shut Cites numerous references [Journal abstract]


Source HMIC


14 Five years and billions of pounds later has anything changed

Citation Health Service Journal 2006 volis 1166028(16-17) 0952-2271

Author(s) Martin Daniel

Language English

Abstract Sir Derek Wanlesss 2002 report prompted the chancellor to pump billions into the healthservice - but called for reform too Now he is back to pack another punch by examininghow wisely the money was spent and set out lessons for the future Daniel Martin reports[Introduction]

Source HMIC

15 Evidence into policy and practice measuring the Progress of US and UK policies to tackle disparities andinequalities in US and UK health and health care

Citation Milbank Quarterly 2006 volis 841(75-109)


Language English

Abstract Health policy in both the United States and the United Kingdom has recently shiftedtoward a much greater concern with disparities and inequalities in health and health careAs evidence for these disparities and inequalities mounts the different approaches in eachcountry present specific challenges for policy and practice These differences are mostapparent in the mechanisms by which the progress of such policies is measured Thisarticle compares the United States and United Kingdoms strategies to gauge thechallenges for policymakers in order to inform policy and practice A cross-nationalcomparison of selected measurement mechanisms identifies lessons for policy andpractice in both countries 7 tables 120 refs [Abstract]

Source HMIC

Full Text Available in fulltext at EBSCOhostAvailable in fulltext at EBSCOhost

16 A new direction for NHS community services the white paper tackles the right issues but may be hard toimplement [Editorial]

Citation BMJ 2006 volis 7537(315-316)

Author(s) Lewis Richard Q

Language English

Abstract The governments new white paper on the future of primary community and social care[Our health our care our say a new direction for community services] heralds moreemphasis on preventive care a greater choice of services from general practitionersreduced health inequalities and better support for people who need long term care Theplan also promises more convenient access to general practices together with anexpanded range of other sources of primary care such as walk-in centres The NHS willseek new providers from the independent sector to tackle longstanding problems of pooraccess to health care in deprived areas and perhaps elsewhere In addition many services- including up to half of all outpatient care for some specialties - will be shifted out ofhospitals and into community settings 12 refs [Introduction]

Source HMIC


Page 9


17 Implementation of a health care policy an analysis of barriers and facilitators to practice change

Citation BMC Health Services Research 2005 volis 553

Author(s) Kreuger Paul Sword Wendy Watt Susan

Language English

Abstract BACKGROUND Governments often create policies that rely on implementation by armslength organizations and require practice changes on the part of different segments of thehealth care system without understanding the differences in and complexities of theseagencies In 2000 in response to publicity about the shortening length of postpartumhospital stay the Ontario government created a universal program offering up to a60-hour postpartum stay and a public health follow-up to mothers and newborn infantsThe purpose of this paper is to examine how a health policy initiative was implemented intwo different parts of a health care system and to analyze the barriers and facilitators toachieving practice change METHODS The data reported came from two studies ofpostpartum health and service use in Ontario Canada Data were collected from newlydelivered mothers who had uncomplicated vaginal deliveries The study samples weredrawn from the same five purposefully selected hospitals for both studies Questionnairesprior to discharge and structured telephone interviews at 4-weeks post discharge wereused to collect data before and after policy implementation Qualitative data werecollected using focus groups with hospital and community-based health care practitionersand administrators at each site RESULTS In both studies the respondents reflected apopulation of women who experienced an average or non-eventful hospital-basedsingleton vaginal delivery The findings of the second study demonstrated wide variancein implementation of the offer of a 60-hour stay among the sites and focus groupsrevealed that none of the hospitals acknowledged the 60-hour stay as an official policyThe uptake of the offer of a 60-hour stay was unrelated to the rate of offer The percentageof women with a hospital stay of less than 25 hours and the number with the guidelinethat the call be within 48 hours of hospital discharge Public health telephone contact washigh although variable in relation to compliance the guideline that the call be within 48hours of hospital discharge Home visits were offered at consistently high ratesCONCLUSION Policy enactment is sometimes inadequate to stimulate practice changesin health care Policy as a tool for practice change must thoughtfully address theorganizational professional and social contexts within which the policy is to beimplemented These contexts can either facilitate or block implementation Ourexamination of Ontarios universal postpartum program provides an example ofdifferential implementation of a common policy intended to change post-natal carepractices that reflects the differential influence of context on implementation [Abstract]

Source HMIC

Full Text Available in fulltext at EBSCOhostAvailable in fulltext at BioMedCentralAvailable in fulltext at National Library of Medicine

18 Development of immunization policy and its implementation in the United Kingdom

Citation Health Affairs 2005 volis 243 0278-2715

Author(s) Salisbury David M

Language English

Abstract The UK immunisation program is managed through a tightly connected process thatlinks the ways policy is developed submitted to independent expert review andrecommendation adopted into strategy and implemented into practice There is oneadvisory body for immunisation its recommendations once accepted by government arecentrally funded and vaccines are provided at no cost to recipients Although the presentsystem has worked well changes in health care management at the peripheral level meanthat the immunisation program will need to adapt to retain the health gains achieved


Page 10

Rates of vaccine-preventable disease are at historically low levels although challengesrelated to costs and effectiveness remain Cites 26 references [Journal abstract]


Source HMIC

Full Text Available in fulltext at Highwire PressAvailable in fulltext at EBSCOhostAvailable in fulltext at EBSCOhost

19 Implementing a national strategy for patient safety lessons from the National Health Service in England

Citation Quality and Safety in Health Care 2005 volis 142 1478-9957

Author(s) Lewis R Q Fletcher M

Language English

Abstract Improving patient safety has become a core issue for many modern healthcare systemsHowever knowledge of the best ways for government initiated efforts to improve patientsafety is still evolving although there is considerable commonality in the challengesfaced by countries Actions to improve patient safety must operate at multiple levels ofthe healthcare system simultaneously Using the example of the NHS in England thisarticle highlights the importance of a strategic analysis of the policy process and theprevailing policy context in the design of the national patient safety strategy The paperidentifies a range of policy levers (forces for change) that can be used to support theimplementation of the national safety initiative and in particular discusses the strengthsand limitations of the business case approach that has attracted recent interest The paperoffers insights into the implementation of national patient safety goals that should providelearning for other countries Cites 38 references [Journal abstract]


Source HMIC

Full Text Available in fulltext at National Library of MedicineAvailable in print at Lincolnshire Knowledge amp Resource ServiceAvailable in print at Lincolnshire Knowledge amp Resource ServiceAvailable in print at Lincolnshire Knowledge amp Resource Service

20 Addressing the implementation challenge Introducing primary care graduate mental health workers

Citation Mental Health Review 2005 volis 101 1361-9322

Author(s) Newbigging Karen Nixon Debbie Playle John Lyons Christina Harrison Nigel

Language English

Abstract The introduction of primary care graduate mental health workers (PCGMHWs) is acentral element of a national strategy to support the capacity in primary care to respondeffectively and appropriately to people presenting with mental health problems Thecommittment in the NHS Plan to recruit 1000 workers across England by 2004(Department of Health 2000) has not been easy to deliver This paper describes theexperience and process of introducing these workers in the North West region of Englandwithin the context of the challenges of implementing national policy it identifieselements of the approach which have facilitated implementation and provides a case studywhich might have broader relevance Cites 10 references [Journal abstract]


Source HMIC


21 Transfer of Health for All policy what how and in which direction a two-case study

Citation Health Research Policy and Systems 2004 volis 28

Author(s) Tervonen-Goncalves Leena Lehto Juhani


Page 11

Language English

Abstract BACKGROUND This article explores the transfer of World Health Organizations(WHO) policy initiative Health for all by the year 2000 (HFA2000) into nationalcontexts by using the changes in the public health policies of Finland and Portugal fromthe 1970s onward and the relationship of these changes to WHO policy development astest cases Finland and Portugal were chosen to be compared as they represent differentwelfare state types and as the paradigmatic transition from the old to new public health isassumed to be related to the wider welfare state development METHODS The policytransfer approach is used as a conceptual tool to analyze the possible policy changesrelated to the adaptation of HFA into the national context To be able to analyze not onlythe content but also the contextual conditions of policy transfer Kingdons analyticalframework of policy analysis is applied CONCLUSIONS Our analysis suggests that nosignificant change of health promotion policy resulted from the launch of HFA programneither in Finland nor in Portugal Instead the changes that occurred in both countrieswere of incremental nature in accordance with the earlier policy choices and theadaptation of HFA program was mainly applied to the areas where there were nationaltraditions 1 fig 84 refs [Abstract]

Source HMIC


22 Influencing sceptical staff to become supporters of service improvement a qualitative study of doctors andmanagers views

Citation Quality and Safety in Health Care 2004 volis 132(108-114) 1475-3898

Author(s) Gollop R

Language English

Abstract OBJECTIVE To explore scepticism and resistance towards changes in working practicedesigned to achieve service improvement Two principal questions were studied (1) whysome people are sceptical or resistant towards improvement programmes and (2) whatinfluences them to change their minds METHODS Semi-structured qualitativeinterviews were conducted with 19 clinicians and 19 managers who held national andregional roles in two national programmes of service improvement within the NHSinvolving systematic organisational changes in working practices the National BookingProgramme and the Cancer Services Collaborative (now the Cancer ServicesCollaborative Improvement Partnership) RESULTS Scepticism and resistance exist inall staff groups especially among medical staff Reasons include personal reluctance tochange misunderstanding of the aims of improvement programmes and a dislike of themethods by which programmes have been promoted Sceptical staff can be influenced tobecome involved in improvement but this usually takes time Newly won support may befragile requiring ongoing evidence of benefits to be maintained CONCLUSIONS Thesupport of health service staff particularly doctors is crucial to the spread andsustainability of the modernisation agenda Scepticism and resistance are seen to hamperprogress Leaders of improvement initiatives need to recognise the impact of scepticismand resistance and to consider ways in which staff can become positively engaged inchange 27 refs [Abstract]

Source HMIC


23 The utilisation of health research in policy-making concepts examples and methods of assessment


Author(s) Hanney Stephen R


Page 12

Language English

Abstract The importance of health research utilisation in policy-making and of understanding themechanisms involved is increasingly recognised Recent reports calling for moreresources to improve health in developing countries and global pressures foraccountability draw greater attention to research-informed policy-making Key utilisationissues have been described for at least twenty years but the growing focus on healthresearch systems creates additional dimensions The utilisation of health research inpolicy-making should contribute to policies that may eventually lead to desired outcomesincluding health gains In this article exploration of these issues is combined with areview of various forms of policy-making When this is linked to analysis of differenttypes of health research it assists in building a comprehensive account of the diversemeanings of research utilisation Previous studies report methods and conceptualframeworks that have been applied if with varying degrees of success to recordutilisation in policy-making These studies reveal various examples of research impactwithin a general picture of underutilisation Factors potentially enhancing utilisation canbe identified by exploration of priority setting activities of the health research system atthe interface between research and policy-making and the role of the recipients orreceptors of health research An interfaces and receptors model provides a frameworkfor analysis Recommendations about possible methods for assessing health researchutilisation follow identification of the purposes of such assessments Our conclusion isthat research utilisation can be better understood and enhanced by developingassessment methods informed by conceptual analysis and review of previous studies 2figs 145 refs [Abstract]

Source HMIC


24 Policy effects on clinical work less change than envisaged

Citation Clinical Governance Bulletin 2003 volis 36(11-12)

Author(s) Braithwaite Jeffrey Black Deborah Westbrook Johanna I

Language English

Abstract Many people view policy as a top-down phenomenon imagining that policy makersdevise it while staff at lower levels implement it In fact clinicians have considerablediscretion over whether and how particular policies are adopted We analysed nineemergent key policy drivers in Medline (the health and biomedical database) and thenasked 25 clinicians in focus groups whether from their experience these drivers wereaffecting their practice Participants reported that their practices were not changing to theextent one might have expected from the rapid growth in the citation of papers on thesepolicy drivers The study suggests that change sponsored by clinical governanceinitiatives may be harder to realise and is more generational in scope than many peoplethink 1 table 5 refs [Summary]

Source HMIC

Full Text Available in print at Lincolnshire Knowledge amp Resource ServiceAvailable in print at Lincolnshire Knowledge amp Resource Service

25 Factors of the innovation organization environment and individual that predict the influence five systematicreviews had on public health decisions

Citation International Journal of Technology Assessment in Health Care 2002 volis174(467-478) 0266-4623

Author(s) Dobbins Maureen

Language English

Abstract OBJECTIVE To determine the extent to which systematic reviews of public healthinterventions influenced public health decisions and which factors were associated with


Page 13

influencing these decisions METHODS This cross-sectional follow-up survey evaluatedthe use of five systematic reviews in public health decision making Independent variablesincluded characteristics of the innovation organisation environment and individualPrimary data were collected using a telephone survey and a self-administeredorganisational demographics questionnaire Public health decision makers in all 41 publichealth units in Ontario were invited to participate in the study Multiple linear regressionanalyses on the five program decisions were conducted RESULTS The systematicreviews were perceived as having the greatest amount of influence on decisions related toprogram justification and program planning and the least influence on programevaluation decisions The greater the perception that ones organisation valued the use ofresearch evidence for decision making and that ongoing training in the critical appraisalof research literature was provided the greater the perception of the influence thesystematic review had on public health decisions CONCLUSIONS Organisationalcharacteristics are important predictors of the use of systematic reviews in public healthdecision making Future dissemination strategies need to promote the value of usingsystematic reviews for program decision making as well as promote ongoing training incritical appraisal among intended users in Ontario 2 tables 62 refs [Abstract]

Source HMIC

26 Meeting patient expectations healthcare professionals and service re-engineering

Citation Health Services Management Research 2002 volis 153(165-172) 0951-4848

Author(s) Laing Angus

Language English

Abstract A central theme underpinning the reform of healthcare systems in western economiessince the 1980s has been the emphasis on reorienting service provision around the patientHealthcare organisations have been forced to reappraise the design of the service deliveryprocess specifically the service encounter to take account of these changing patientexpectations This reorientation of healthcare services around the patient has fundamentalimplications for healthcare professionals specifically challenging the dominance ofservice professionals in the design and delivery of health services Utilising a qualitativemethodological framework this paper explores the responses of healthcare professionalsto service redesign initiatives implemented in acute NHS hospitals in Scotland andconsiders the implications of such professional responses for the development ofpatient-focused service delivery Within this it specifically examines evolvingprofessional perspectives on the place of a service user focus in a publicly fundedhealthcare system professional attitudes towards private sector managerial practices andthe dynamics of changing professional behaviour 37 refs [Abstract]]

Source HMIC


27 How great expectations in Westminster may be dashed locally the local implementation of national policy onhealth inequalities


Author(s) Exworthy Mark Berney Lee Powell Martin

Language English

Abstract Tackling health inequalities is a policy priority for the Labour government in the UK Theauthors use Kingdons model of policy streams to explain how the issue of healthinequalities gets onto the policy agenda nationally and locally and how it is beingimplemented Using empirical evidence from local agencies they suggest that the issue ofhealth inequalities is on the agenda nationally and locally but implementation is hamperedby deficiencies in performance management insufficient integration between policysectors and contradictions between health inequalities and other policy imperativesThus the governments expectations are not only dashed locally but also localexpectations are being dashed at the centre Cites numerous references [Journal abstract]


Page 14


Source HMIC


Page 1

Search ResultsTable of Contents1 The NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchestercombining empirical theoretical and experiential evidence to design and evaluate a large-scale implementation strategy page 2

2 Mind the gap Understanding utilisation of evidence and policy in health care management practice page 3

3 Implementation of Evidence-Based Practice and Organizational Performance page 3

4 Privacy As An Enabler Not An Impediment Building Trust Into Health Information Exchange page 4

5 Understanding the challenges of service change - learning from acute pain services in the UK page 4

6 Recognizing rhetoric in health care policy analysis page 5

7 The determinants of policy effectiveness page 6

8 Lost in Translation A Multi-Level Case Study of the Metamorphosis of Meanings and Action in Public SectorOrganizational Innovation page 7

9 Dissemination of Health Technology Assessments Identifying the Visions Guiding an Evolving Policy Innovation inCanada page 7

10 Implementation deficit and street-level bureaucracy policy practice and change in the development of communitynursing issues page 8

11 Case Report Nurse prescribing a case study in policy influence page 9

12 Implementation of community care policy in the United Kingdom will it be achieved page 9


Page 2

1 The NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for GreaterManchester combining empirical theoretical and experiential evidence to design and evaluate a large-scaleimplementation strategy

Citation Implementation Science 2011 volis 6(96) 1748-59081748-5908 (2011)

Author(s) Harvey G Fitzgerald L Fielden S McBride A Waterman H Bamford D Kislov RBoaden R

Institution Manchester Business School University of Manchester Booth Street West ManchesterM156PB UK gillharveymbsacuk

Language English

Abstract BACKGROUND In response to policy recommendations nine National Institute forHealth Research (NIHR) Collaborations for Leadership in Applied Health Research andCare (CLAHRCs) were established in England in 2008 aiming to create closer workingbetween the health service and higher education and narrow the gap between research andits implementation in practice The Greater Manchester (GM) CLAHRC is a partnershipbetween the University of Manchester and twenty National Health Service (NHS) trustswith a five-year mission to improve healthcare and reduce health inequalities for peoplewith cardiovascular conditions This paper outlines the GM CLAHRC approach todesigning and evaluating a large-scale evidence- and theory-informed context-sensitiveimplementation programmeDISCUSSION The paper makes a case for embeddingevaluation within the design of the implementation strategy Empirical theoretical andexperiential evidence relating to implementation science and methods has beensynthesised to formulate eight core principles of the GM CLAHRC implementationstrategy recognising the multi-faceted nature of evidence the complexity of theimplementation process and the corresponding need to apply approaches that aresituationally relevant responsive flexible and collaborative In turn these core principlesinform the selection of four interrelated building blocks upon which the GM CLAHRCapproach to implementation is founded These determine the organizational processesstructures and roles utilised by specific GM CLAHRC implementation projects as wellas the approach to researching implementation and comprise the Promoting Action onResearch Implementation in Health Services (PARIHS) framework a modified version ofthe Model for Improvement multiprofessional teams with designated roles to leadfacilitate and support the implementation process and embedded evaluation andlearningSUMMARY Designing and evaluating a large-scale implementation strategythat can cope with and respond to the local complexities of implementing researchevidence into practice is itself complex and challenging We present an argument foradopting an integrative co-production approach to planning and evaluating theimplementation of research into practice drawing on an eclectic range of evidencesources

Country of Publication England

Publication Type Journal Article Research Support Non-US Govt

Subject Headings Cooperative BehaviorEmpirical ResearchEvidence-Based Practicemt [Methods]Great BritainHealth PolicyHealth Services Researchmt [Methods]HumansLeadershipModels TheoreticalProgram DevelopmentProgram EvaluationResearch Design

Source MEDLINE



Page 3

2 Mind the gap Understanding utilisation of evidence and policy in health care management practice

Citation Journal of Health Organization amp Management 2011 volis 253(298-314)1477-72661477-7266 (2011)

Author(s) Gkeredakis E Swan J Powell J Nicolini D Scarbrough H Roginski C Taylor-PhillipsS Clarke A

Institution Warwick Business School University of Warwick Coventry UKemmanouilgkeredakiswbsacuk

Language English

Abstract PURPOSE The paper aims to take a reflective stance on the relationship betweenpolicyevidence and practice which the authors argue is conceptually under-developedThe paper aims to show that current research perspectives fail to frame evidence andpolicy in relation to practiceDESIGNMETHODOLOGYAPPROACH A qualitativestudy was conducted in the English NHS in four Primary Care Trusts (PCTs)Seventy-five observations of meetings and 52 semi-structured interviews were completedThe approach to data analysis was to explore and reconstruct narratives of PCT managersreal practicesFINDINGS The exploratory findings are presented through two kinds ofnarratives The first narrative vividly illustrates the significance of the active involvementskills and creativity of health care practitioners for policy implementation The secondnarrative elucidates how problems of collaboration among different experts in PCTsmight emerge and affect evidence utilisation in practicePRACTICAL IMPLICATIONSThe findings exemplify that policies are made workable in practice and hence policymakers may also need to be mindful of practical intricacies and conceive policyimplementation as an iterative processORIGINALITYVALUE The contribution of thispaper lies in offering an alternative and important perspective to the debate of utilisationof policyevidence in health care management and in advancing existing understanding ofhealth care management practice The papers rich empirical examples demonstrate someimportant dimensions of the complexity of practice



Subject Headings Attitude of Health PersonnelEnglandEvidence-Based Medicinest [Standards]Health Knowledge Attitudes PracticeHealth PolicyHealth Services Researchog [Organization and Administration]Health Services Researchst [Standards]HumansInformation DisseminationInterviews as TopicPrimary Health Carema [Manpower]Primary Health Careog [Organization and Administration]Primary Health Carest [Standards]Qualitative ResearchState Medicineog [Organization and Administration]State Medicinest [Standards]

Source MEDLINE

3 Implementation of Evidence-Based Practice and Organizational Performance

Citation Journal of Behavioral Health Services amp Research 01 January 2010 volis 371(79-94)10943412

Author(s) Hovmand Peter Gillespie David

Language English


Page 4

Abstract Administrators of mental health services may expect evidence-based practice (EBP) tooffer strategic benefits Existing theory suggests that the benefits of implementing EBPvary by organizational characteristics This paper presents a conceptual framework forconsidering how implementation impacts organizational performance The framework isdeveloped as a system dynamics simulation model based on existing literatureorganizational theory and key informant interviews with mental health servicesadministrators and clinical directors Results from the simulations show how gains inperformance depended on organizationsrsquo initial inertia and initial efficiency and that onlythe most efficient organizations may see benefits in organizational performance fromimplementing EBP Implications for administrators policy makers and servicesresearchers are discussed

Publication Type Academic Journal

Subject Headings MENTAL health servicesSIMULATION methodsHEALTH services administratorsPSYCHIATRYMEDICAL care

Source HEALTH BUSINESS ELITE


4 Privacy As An Enabler Not An Impediment Building Trust Into Health Information Exchange

Citation Health Affairs 01 March 2009 volis 282(416-427) 02782715

Author(s) McGraw Deven Dempsey James X Harris Leslie Goldman Janlori

Language English

Abstract Building privacy and security protections into health information technology systems willbolster trust in such systems and promote their adoption The privacy issue too long seenas a barrier to electronic health information exchange can be resolved through acomprehensive framework that implements core privacy principles adopts trustednetwork design characteristics and establishes oversight and accountability mechanismsThe public policy challenges of implementing this framework in a complex and evolvingenvironment will require improvements to existing law new rules for entities outside thetraditional health care sector a more nuanced approach to the role of consent andstronger enforcement mechanisms


Subject Headings MEDICAL informaticsINFORMATION technologyRIGHT of privacyPATIENTS -- Civil rightsELECTRONIC systemsMEDICAL care -- United StatesPOLITICAL planningMEDICAL policyAMERICANS


Full Text Available in fulltext at Highwire PressAvailable in fulltext at EBSCOhost

5 Understanding the challenges of service change - learning from acute pain services in the UK

Citation Journal of the Royal Society of Medicine February 2009 volis 1022(62-8)0141-07681758-1095 (2009 Feb)

Author(s) Powell AE Davies HT Bannister J Macrae WA


Page 5

Institution Social Dimensions of Health Institute at the University of Dundee UKaep2st-andacuk

Language English

Abstract OBJECTIVES To explore organizational difficulties faced when implementing nationalpolicy recommendations in local contextsDESIGN Qualitative case study involvingsemi-structured interviews with health professionals and managers working in and aroundacute pain servicesSETTING Three UK acute hospital organizationsMAIN OUTCOMEMEASURES Identification of the content context and process factors impacting on theimplementation of the national policy recommendations on acute pain services insightsinto and deeper understanding of the generic obstacles to change facing serviceimprovementsRESULTS The process of implementing policy recommendations andimproving services in each of the three organizations was undermined by multiple factorsrelating to doubts and disagreements about the nature of the change challenging localorganizational contexts and the beliefs attitudes and responses of health professionalsand managers The impact of these factors was compounded by the interaction betweenthemCONCLUSIONS Local implementation of national policies aimed at serviceimprovement can be undermined by multiple interacting factors Particularly importantare the pre-existing local organizational contexts and histories and the deeply-ingrainedattitudes beliefs and assumptions of diverse staff groups Without close attention to all ofthese underlying issues and how they interact in individual organizations against thebackground of local and national contexts more resources or further structural change areunlikely to deliver the intended improvements in patient care


Publication Type Journal Article Multicenter Study Research Support Non-US Govt

Subject Headings Great BritainHealth Policytd [Trends]HumansOrganizational InnovationOutcome and Process Assessment (Health Care)Pain Clinicsog [Organization and Administration]Pain Clinicstd [Trends]Pain ManagementQuality of Health CareState Medicineog [Organization and Administration]State Medicinetd [Trends]

Source MEDLINE

Full Text Available in fulltext at Highwire PressAvailable in fulltext at EBSCOhostAvailable in fulltext at National Library of Medicine

6 Recognizing rhetoric in health care policy analysis

Citation Journal of Health Services amp Research Policy January 2008 volis 131(40-6)1355-81961355-8196 (2008 Jan)

Author(s) Russell J Greenhalgh T Byrne E McDonnell J

Institution Open Learning Unit Department of Primary Care and Population Sciences UniversityCollege London London UK jrussellpcpsuclacuk

Language English

Abstract Critiques of the naive rationalist model of policy-making abound in the sociological andpolitical science literature Yet academic debate on health care policy-making continues tobe couched in the dominant discourse of evidence-based medicine whose underlyingassumptions--that policies are driven by facts rather than values and these can be clearlyseparated that evidence is context-free can be objectively weighed up and placedunproblematically in a hierarchy and that policy-making is essentially an exercise indecision science--have constrained both thinking and practice In this paper drawing on


Page 6

theoretical work from political science and philosophy and innovative empirical work inthe health care sector we argue that health care is well overdue for a re-defining of whatpolicy-making is Policy-making is the formal struggle over ideas and values played outby the rhetorical use of language and the enactment of social situations While theselection evaluation and implementation of research evidence are important in thepolicy-making process they do not equate to that process The study of argument in theconstruction of policy has the potential to illuminate dimensions of the process that aresystematically occluded when policy-making is studied through a naive rationalist lens Inparticular a rhetorical perspective highlights the struggle over ideas the naming andframing of policy problems the centrality of audience and the rhetorical use of languagein discussion to increase the audiences adherence to particular framings and proposalsRhetorical theory requires us to redefine what counts as rationality--which must extendfrom what is provably true (by logic) and probably true (by Bayesian reasoning) toembrace in addition that which is plausibly true (ie can convince a reasonableaudience) Future research into health care policy-making needs to move beyond thestudy of getting evidence into practice and address the language arguments anddiscourse through which policy is constructed and enacted



Subject Headings CommunicationGreat BritainHealth PolicyHumansModels TheoreticalPolicy MakingResearchState Medicineog [Organization and Administration]Terminology as Topic

Source MEDLINE


7 The determinants of policy effectiveness

Citation Bulletin of the World Health Organization 01 November 2006 volis 8411(843-843)00429686

Author(s) Potter Christopher C Harries Jennifer

Language English

Abstract The article focuses on the article by S Siddiqi T I Masud and B Sabri regarding thepractical limitations of implementing strategy for health care sector reform Siddiqi andcolleagues states that contracting out requires tendering arrangements and the capacity tooperate them In addition they illustrate the determinants of policy effectiveness and thelimiting factors to successful enforcement of policy initiatives In addition Siddiqi andcolleagues enumerates the issues that need to be considered for the implementation of thehealth care program such as the realities of public administration system and the localtraining of professionals


Subject Headings CONTRACTING outMEDICAL care -- Contracting outPUBLIC contractsHUMAN services -- Contracting outPUBLIC welfare -- Contracting outPUBLIC-private sector cooperationHEALTH services administrationMEDICAL policyMEDICAL economics



Page 7

Full Text Available in fulltext at EBSCOhostAvailable in fulltext at EBSCOhostAvailable in fulltext at EBSCOhostAvailable in fulltext at National Library of Medicine

8 Lost in Translation A Multi-Level Case Study of the Metamorphosis of Meanings and Action in Public SectorOrganizational Innovation

Citation Public Administration 01 March 2006 volis 841(59-79) 00333298

Author(s) Pope Catherine Robert Glenn Bate Paul Le May Andreacutee Gabbay John

Language English

Abstract This paper explores the early implementation of an organizational innovation in the UKNational Health Service (NHS) ndash Treatment Centres (TCs) ndash designed to dramaticallyreduce waiting lists for elective care The paper draws on case studies of 8 TCs (each atvarying stages of their development) and aims to explore how meanings about TCs arecreated and evolve and how these meanings impact upon the development of theorganizational innovation Research on organizational meanings needs to take greateraccount of the fact that modern organizations like the NHS are complex multi-levelphenomena comprising layers of interlacing networks To understand the pace directionand impact of organizational innovation and change we need to study the interconnectionsbetween meanings across different organizational levels The data presented in this papershow how the apparently simple relatively unformed concept of a TC framed by centralgovernment is translated and transmuted by subsequent layers in the health serviceadministration and by players in local health economies and ultimately in the TCsthemselves picking up new rationales meanings and significance as it goes along Thedevelopmental histories of TCs reveal a range of significant re-workings of macro policywith the result that there is considerable diversity and variation between local TCschemes The picture is of important disconnections between meanings that in manyways mirror Weicks (1976) rsquoloosely coupled systemsrsquo The emergent meanings and thedirection of micro-level development of TCs appear more strongly determined byinteractions within the local TC environment notably between what we identify as groupsof rsquoidealistsrsquo rsquopragmatistsrsquo rsquoopportunistsrsquo and rsquoscepticsrsquo than by the framing (Goffman1974) provided by macro and meso organizational levels While this illustrates thelimitations of top down and policy-driven attempts at change and highlights the crucialimportance of the front-line local rsquomicro-systemsrsquo (Donaldson and Mohr 2000) in theoverall scheme of implementing organizational innovations the space or headroomprovided by frames at the macro and meso levels can enable local change albeit atvariable speed and with uncertain outcomes


Subject Headings ORGANIZATIONAL changeGREAT Britain National Health ServiceCASE studiesRESEARCHGREAT Britain



9 Dissemination of Health Technology Assessments Identifying the Visions Guiding an Evolving Policy Innovation inCanada

Citation Journal of Health Politics Policy amp Law 01 August 2005 volis 304(603-641)03616878

Author(s) Lehoux Pascale Denis Jean-Louis Tailliez Steacutephanie Hivon Myriam

Language English

Abstract Health technology assessment (HTA) has received increasing support over the past twentyyears in both North America and Europe The justification for this field of policy-oriented


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research is that evidence about the efficacy safety and cost-effectiveness of technologyshould contribute to decision and policy making However concerns about the ability ofHTA producers to increase the use of their findings by decision makers have beenexpressed Although HTA practitioners have recognized that dissemination activities needto be intensified why and how particular approaches should be adopted is still underdebate Using an institutional theory perspective this article examines HTA as a means ofimplementing knowledge-based change within health care systems It presents the resultsof a case study on the dissemination strategies of six Canadian HTA agencies Chiefexecutive officers and executives (n = 11) evaluators (n = 19) and communications staff(n = 10) from these agencies were interviewed Our results indicate that the targetaudience of HTA is frequently limited to policy makers that three conflicting visions ofHTA dissemination coexist that active dissemination strategies have only occasionallybeen applied and that little attention has been paid to the management of diverging viewsabout the value of health technology Our discussion explores the strengths limitationsand trade-offs associated with the three visions Further efforts should be deployed withinagencies to better articulate a shared vision and to devise dissemination strategies that areconsistent with this vision


Subject Headings MEDICAL technologyMEDICAL innovationsMEDICAL policyMEDICAL careCONJOINT analysis (Marketing)CANADA


Full Text Available in fulltext at EBSCOhostAvailable in fulltext at EBSCOhostAvailable in fulltext at EBSCOhost

10 Implementation deficit and street-level bureaucracy policy practice and change in the development ofcommunity nursing issues

Citation Health amp Social Care in the Community January 2005 volis 131(1-10)0966-04100966-0410 (2005 Jan)

Author(s) Bergen A While A

Institution Department of Health and Social Welfare Canterbury Christ Church University CollegeCanterbury Kent CT1 1QU UK chrisannfishcouk

Language English

Abstract The present paper examines the mechanisms by which health and social care policies putforward by the Government may be translated into community nursing practice Datafrom a research project on community nurse case managers were re-examined in the lightof two classic theories often cited by policy analysts (ie implementation theory andstreet-level bureaucracy) It was found that the extent to which nurses adopted the casemanagement role and the model of choice depended on four major interrelated variablesnamely (1) the clarity of policy guidance (2) the extent to which it coincided withprofessional (nursing) values (3) local practices and policies and (4) the personal visionof the community nurse It is argued that this framework may have wider relevance andthis was tested out in two ways First major change in one of these variables(Government policy) over time was analysed for its effect on case management practicevia the remaining variables Secondly an unrelated but policy-initiated nursing issue(nurse prescribing) was briefly examined in the light of the framework It is suggestedthat this framework may be of some use when considering the likely practice response topolicy-related changes in community nursing


Publication Type Journal Article

Subject Headings Attitude of Health Personnel


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Case Managementog [Organization and Administration]Community Health Nursingog [Organization and Administration]Drug PrescriptionsEntrepreneurshipGreat BritainHealth Care SurveysHealth Plan ImplementationHealth PolicyHumansInterprofessional RelationsModels OrganizationalNurses RoleState Medicineog [Organization and Administration]

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11 Case Report Nurse prescribing a case study in policy influence

Citation Journal of Nursing Management July 2004 volis 124(266-72) 0966-04290966-0429(2004 Jul)

Author(s) Jones M

Institution Community Practitioners and Health Visitors Association 40 Bermondsey StreetLondon SE1 7UD UK markjonesamicustheunionorg

Language English

Abstract The implementation of nurse prescribing is characterized by political machination theneed to construct an effective case and deft manoevering within the corridors of powerThis paper illustrates the approach taken by the Royal College of Nursing and its keymembers in policy formulation and influence as this key nursing tool was brought to theattention of government and achieved passing of the legislation required to make it areality


Publication Type Journal Article Review

Subject Headings Drug PrescriptionsGreat BritainHealth PolicyHumansNurses RolePolicy MakingPoliticsPower (Psychology)Professional AutonomySocieties Nursingog [Organization and Administration]State Medicineog [Organization and Administration]

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12 Implementation of community care policy in the United Kingdom will it be achieved

Citation Journal of Advanced Nursing May 1995 volis 215(988-95) 0309-24020309-2402(1995 May)

Author(s) Trnobranski PH

Institution North Staffordshire College of Nursing and Midwifery Stoke-on-Trent England

Language English


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Abstract In the United Kingdom the provision of health and social care within the community isthe subject of major reform This reform is aimed at reducing the dominance of the stateas provider of welfare services whilst encouraging the independent sector to provide thebulk of services through competition and market forces The purpose of this paper is todiscuss the implementation of government policy with respect to health and social care inthe community The policy recommended in the 1989 White Paper Caring for Peoplewhich is sanctioned in the National Health Service (NHS) and Community Care Act(1990) is the focus for discussion Implementation theory is used as a framework toexplore the modification and reshaping which inevitably accompanies the translation ofgovernment policy into reality The nature of any actual or potential deficit between statedpolicy and community care reform in practice is examined against this theoreticalbackground An historical stance is taken in order to place current policy into the widercontext and consider what determinants may have led to the radical proposals forcommunity care and indeed other sectors of public service A consideration ofpredominating philosophies is prudent to an analysis of government policy-making andtherefore the values and beliefs of new public management are employed as a conceptualframework underpinning current reform The feasibility of a quasi-market in the deliveryof health and social care is considered and some of the main issues which may result inimplementation deficit with respect to the implementation of Caring for People areexamined

Country of Publication ENGLAND


Subject Headings CommunicationCommunity Health Servicestd [Trends]CultureGreat BritainHealth Policytd [Trends]HumansMarketing of Health Servicestd [Trends]Organizational InnovationPoliticsState Medicinetd [Trends]

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Date 11th May 2012 By Jan Badcock

Latest figures on how heart failure nursing service reduces hospital admissions middot What causes heart failure patients to be re-admitted middot Poor discharges for heart failure - what stats are there - why does it happen middot latest evidence on effectiveness of heart failure service - especially home visits middot anything that demonstrates heart failure service is welled liked by patients middot Anything that demonstrates heart failure services are worthwhile commissioning and save monies middot If there is local information that would help a lot too middot Is there any evidence to show that it reduces burden of GP consultations Latest figures on how heart failure nursing service reduces hospital admissions Heart failure nurse services in England Heart failure nurses saw 34 of all patients discharged from hospital with a diagnosis of heart failure in the 12 month period bull The number of all cause readmissions during this period was 35 less than in the 12 months prior to the nurses coming into post bull Patients seen by heart failure specialist nurses were less likely to be readmitted but when they were they tended to be admitted for a longer duration (116 nights compared to 86 nights before the nurses were in post) bull Heart failure specialist nurses have the potential to save significant sums of monies through reductions in readmissions this is estimated as pound1826 per patient seen over and above the cost of the heart failure nurse See p122 See attached Randomised controlled trial of specialist nurse intervention in heart failure BMJ 2001 September 29 323(7315) 715ndash718 Death or readmission from all causes was reduced by 28 (072 049 to 104) in the nurse intervention group compared with usual care (table (table3)3) The risk of admission to hospital for worsening heart failure was reduced by 62 (038 019 to 076) in the intervention group httpwwwncbinlmnihgovpmcarticlesPMC56888 Randomised controlled trial of specialist nurse intervention in heart failure Blue L Lang E McMurray JJ Davie AP McDonagh TA Murdoch DR et al BMJ 2001323(7315)715-8 httpeprintsglaacuk581BMJBlue2001pdf









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