Alan Gillies

Managing change in process and people: Combining a maturity model with a competency-based approach

This study is concerned with an integrated approach to the management of change. The approach described combines a process improvement approach derived from the Capability Maturity Model with a model of competency derived from Benners work in health care. The paper describes the original models and how they have been adapted for use. It then describes how they have been integrated and encapsulated within a software tool. A case study application is described together with some of the initial findings from its deployment. The paper concludes with some comments about future developments.

An international comparison of information in adverse events

PURPOSE Aims to describe the growing importance of information and its governance within public services. The paper starts by considering how scandals in three national public health systems have focused public attention on information issues. It describes a theoretical framework for improving information governance, and its practical implementation as a management tool. The paper concludes with a discussion of the benefits of the approach, and the consequences of not improving information governance. DESIGN/METHODOLOGY/APPROACH The framework brings together a number of existing methodological approaches, principally the maturity model approach to process improvement, first described in the Software Engineering Institutes capability maturity model, and the novice-to-expert approach to competency. FINDINGS The paper describes how these approaches can be synthesised into an integrated framework to manage organisational change and how that can be used to improve information governance within public sector organisations. RESEARCH IMPLICATIONS The paper compares the framework and its practical implementation with existing solutions, arguing that existing solutions provide only partial solutions. ORIGINALITY/VALUE Considers how plans for future service improvements will be restricted unless information governance issues can be addressed.

Current practice in software quality and the impact of certification schemes

The paper presents the findings of a survey that investigated the level of quality management practice within some 150 UK companies from a sample of 500. It provides a snapshot of practice at the time of the survey, and assesses the impact of government quality initiatives particularly, the TickIT scheme at that time. The survey methodology is described, together with the results and conclusions. The sample has been graded by size of company, which the authors consider to have a significant effect upon the adoption of quality practices. The survey highlights the need to encourage small companies to adopt quality practices and to assist them with the short-term costs incurred.

Neglected user perspectives in the design of an online hospital bed-state system: implications for the National Programme for IT in the NHS

Technical aspects of the National Programme for IT in the National Health Service have run ahead of genuine engagement with front-line users. We have explored with front-line NHS staff the factors which limit their contribution to management information from operational systems. Staff place psychological distance between ‘the real job’ and the reporting of information. Even where accurate reporting is heavily incentivized, and operational control is shared between staff and shift leader, the reporting of information to the computer represents a division between caregiving and computer input, and between information openly declared and that waiting to be disclosed. The Programme needs to reconsider how clinicians are to be engaged. Equally, information systems designers, if they expect to obtain management information and want to understand the limitations of that process, need to be socialized into the fields where systems are to be deployed.

BS 11000 for health commissioning: Lessons from history for managing the commissioning relationship

Purpose – The purpose of this paper is to consider how BS 11000 may be usefully deployed within a commissioning situation in the light of the Department of Healths suggestion that it represents “best practice”.Design/methodology/approach – The study uses case studies from other sectors (criminal justice) and IT outsourcing to consider the nature of the commissioning relationship at the heart of the English NHS post‐2013. It looks at how BS 11000 is intended to support business relationships and how this can address potential problems identified in the case studies.Findings – The study finds that business relationships are often regarded in a reductionist manner based on a simple contractual relationship. The case studies suggest that a richer more collaborative business relationship is required for effective provision of services. The authors suggest that BS 11000 can help organisations put in place the foundations of such relationships.Research limitations/implications – The Clinical Commissioning Group...

On the computerization of general practice in the UK: the IT perspective

This paper is concerned with the computerization of the primary health care sector in the United Kingdom. This care is provided by family doctors, known as general practitioners (GPs). The sector has been transformed in the years since 1986 by a series of legislative changes. These changes have had profound implications for the information requirements of GPs. They have led to the widespread adoption of computerized patient record systems by GPs rising from less than 25% before 1988, to greater than 75% by 1993. The paper considers evidence from a variety of historical surveys and combines this with first-hand experience drawn from working to implement information technology (IT) in the National Health Service (NHS) and through a set of interviews carried out for this study. It seeks to evaluate the process up to the present and to identify critical factors relevant to both practitioners and IT professionals who are increasingly involved with the NHS in the UK. Finally, it makes recommendations for both health and IT professionals on the future IT needs of general practice.

Information as Change Agent or Barrier in Health Care Reform

Health care systems across the world are in a state of flux. If the experience of the early 1990s can be used as a model, the recent global economic downturn will lead to very significant pressures to reduce spending and achieve better value. Systems have provided a range of approaches to modeling and evaluating these more complex organizations, from simple process models to complex adaptive systems. This paper considers the pros and cons of such approaches and proposes a new modeling approach that combines the best elements of other techniques. This paper also describes a case study, where the approach has been deployed by the authors. The case study comes from health care services in Ontario, Canada, who are shifting from the traditionally hospital-based system to one that recognizes a greater role for community and primary care services.

Using healthcare system archetypes to help hospitals become learning organisations

Purpose – Internationally, change in healthcare is often a result of a knee jerk reaction to high‐profile adverse events. Alternatively, change is driven by a reductionist set of targets and indicators, which do not reflect the complexity of hospitals. This paper posits that hospitals would benefit from promoting organisational learning, and that system archetypes offer a mechanism for achieving this. It seeks to examine the application of healthcare system archetypes in an Australian hospital.Design/methodology/approach – Archetypes do not describe any one problem specifically. They describe families of problems generically. Their value comes from the insights they offer into the dynamic interaction of complex systems. As part of a suite of tools, they are extremely valuable in developing broad understandings about the hospital and its environment.Findings – Diagnostically, archetypes helped the hospital managers recognize patterns of behaviour that are already present in their organizations. They served...

Computers and the NHS: an analysis of their contribution to the past, present and future delivery of the National Health Service

This paper looks at the contribution that computers have made to the delivery of the National Health Service through a period of major reform that began in 1986, and is still ongoing. The paper starts with a retrospective analysis of the first generation of NHS Reforms and the role played by computer systems. The major empirical component is a case study looking at the impact of computers on health promotion activities among over 1 million patients in Lancashire. Finally, the paper looks forward to the latest NHS reforms, as outlined in the 1997 White Paper The New DHS (Department of Health, 1997, HMSO, London) and outlines the information implications and a strategic framework to deliver changes required if the reforms are to succeed.

Competency in healthcare : a practical guide to competency frameworks

Competence and competency. Clinical governance and competent practitioners. The model. Case Study 1: Developing competency-based frameworks for nurses within Blackburn, Hyndburn and Ribble Valley Healthcare NHS Trust. Case Study 2: Staff development amongst staff assessing and treating personality disorder. Case Study 3: Competency profiling in health informatics. Linking competency to organisational development. Case Study 4: Electronic health records in primary care. Linking competency to e-learning.