Deborah Davidson

Opportunity seized or missed? A case study of leadership and organizational change in the creation of a Care Trust.

This paper describes an action research study which focused on an exploration of the aspirations for and initial achievements of Stratham Mental Health NHS and Social Care Trust. Local leaders perceived that Stratham had a good history of health and social care partnership working and as such, adopted an integrationist view of culture to help shape the context of the new structural form. In doing so, consistency remained a key message to staff throughout this organizational transition and the change did not appear to cause the distraction to core business which the literature suggests it would do so. However, this continuity may have come at a cost, at least initially. In the process of formalizing the previous partnership into a Care Trust, Stratham may not have produced all the beneficial effects of synergy which are usually (albeit eventually) associated with mergers in the private sector. Certainly, local actors could see opportunities that had been missed. By focusing on the structural manifestation of the relationship, the opportunities to broaden informal horizontal linkages may have been underexploited. The study of Stratham serves to confirm that the integrationist conception of culture is limited and that the differentiation of professional groupings and the ambiguity of individual experience will always make contested the meanings that are attributed to organizational change.

The BLISS cluster randomised controlled trial of the effect of 'active dissemination of information' on standards of care for premature babies in England (BEADI) study protocol [ISRCTN89683698]

BackgroundGaps between research knowledge and practice have been consistently reported. Traditional ways of communicating information have limited impact on practice changes. Strategies to disseminate information need to be more interactive and based on techniques reported in systematic reviews of implementation of changes. There is a need for clarification as to which dissemination strategies work best to translate evidence into practice in neonatal units across England. The objective of this trial is to assess whether an innovative active strategy for the dissemination of neonatal research findings, recommendations, and national neonatal guidelines is more likely to lead to changes in policy and practice than the traditional (more passive) forms of dissemination in England.Methods/designCluster randomised controlled trial of all neonatal units in England (randomised by hospital, n = 182 and stratified by neonatal regional networks and neonatal units level of care) to assess the relative effectiveness of active dissemination strategies on changes in local policies and practices. Participants will be mainly consultant lead clinicians in each unit. The intervention will be multifaceted using: audit and feedback; educational meetings for local staff (evidence-based lectures on selected topics, interactive workshop to examine current practice and draw up plans for change); and quality improvement and organisational changes methods. Policies and practice outcomes for the babies involved will be collected before and after the intervention. Outcomes will assess all premature babies born in England during a three month period for timing of surfactant administration at birth, temperature control at birth, and resuscitation team (qualification and numbers) present at birth.Trial registrationCurrent controlled trials ISRCTN89683698

Beyond Involvement: Making Choices and Taking Control

he growth of the service user/survivor movement over the last 20 years has provided an opportunity for people to speak openly about their experiences of mental health services and to be involved in local health and social care organisations, regional and national initiatives, and to influence Government policy. The Government’s mental health strategy (Department of Health, 1998) and National Service Framework for Mental Health (Department of Health, 1999) emphasise a more user-centred service and state that their commitment to a modern, decent and inclusive society provides the context for mental health services. The first of the guiding values and principles of the National Service Framework states that: ‘People with mental health problems can expect that services will involve service users and their carers in planning and delivery of care.’ This principle is further echoed in the NHS Plan (Department of Health, 2000) and in the Mental Health Policy Implementation Guide (Department of Health, 2001, p6) which states that: ‘Above all, mental health services must place the needs of ... service users at the centre of their planning and their practice.’ Despite government intentions to put the service user at the centre, there is little evidence of this in the application of policy and practice at a local level. The IAHSP’s work with approximately 50 local implementation teams in the South East, North West, South West and Trent regions of England shows that 90% of their plans and actions do not include user involvement. There are pockets of good practice but T in the main this is limited to involvement on the local implementation teams in commissioning services and, in a few cases, on the boards of trusts. There has also been little action on other stated aims of the National Service Framework – promoting mental health, tackling stigma and discrimination, person-centred planning or promoting independence – and no targeted action in relation to a key issue that service users want; that is, involvement in care planning and treatment provision.