Simon Bishop

Understanding the occupational and organizational boundaries to safe hospital discharge

Objective Safe hospital discharge relies upon communication and coordination across multiple occupational and organizational boundaries. Our aim was to understand how these boundaries can exacerbate health system complexity and represent latent sociocultural threats to safe discharge. Methods An ethnographic study was conducted in two local health and social care systems (health economies) in England, focusing on two clinical areas: stroke and hip fracture patients. Data collection involved 345 hours of observations and 220 semi-structured interviews with health and social care professionals, patients and their lay carers. Results Hospital discharge involves a dynamic network of interactions between heterogeneous health and social care actors, each characterized by divergent ways of organizing discharge activities; cultures of collaboration and interaction and understanding of what discharge involves and how it contributes to patient recovery. These interrelated dimensions elaborate the occupational and organisational boundaries that can influence communication and coordination in hospital discharge. Conclusions Hospital discharge relies upon the coordination of multiple actors working across occupational and organizational boundaries. Attention to the sociocultural boundaries that influence communication and coordination can help inform interventions that might support enhanced discharge safety.

A qualitative study of professional and carer perceptions of the threats to safe hospital discharge for stroke and hip fracture patients in the English National Health Service.

BackgroundHospital discharge is a vulnerable transitional stage in patient care. This qualitative study investigated the views of healthcare professionals and patients about the threats to safe hospital discharge with aim of identifying contributory and latent factors. The study was undertaken in two regional health and social care systems in the English National Health Service, each comprising three acute hospitals, community and primary care providers and municipal social care services. The study focused on the threats to safe discharge for hip fracture and stroke patients as exemplars of complex care transitions.MethodsA qualitative study involving narrative interviews with 213 representative stakeholders and professionals involved in discharge planning and care transition activities. Narratives were analysed in line with ‘systems’ thinking to identify proximal (active) and distal (latent) factors, and the relationships between them.ResultsThree linked categories of commonly and consistently identified threat to safe discharge were identified: (1) ‘direct’ patient harms comprising falls, infection, sores and ulceration, medicines-related issues, and relapse; (2) proximal ‘contributing’ factors including completion of tests, assessment of patient, management of equipment and medicines, care plan, follow-up care and patient education; and distal ‘latent’ factors including discharge planning, referral processes, discharge timing, resources constraints, and organisational demands.ConclusionFrom the perspective of stakeholders, the study elaborates the relationship between patient harms and systemic factors in the context of hospital discharge. It supports the importance of communication and collaboration across occupational and organisational boundaries, but also the challenges to supporting such communication with the inherent complexity of the care system.

Becoming hybrid: The negotiated order on the front line of public–private partnerships

This article examines how tensions in institutional logics, created in the formation of hybrid organizations, are played out, and partially resolved, through micro-level interactions within everyday work. Drawing on the negotiated order perspective, our research examined how the ‘context’, ‘processes’ and ‘outcomes’ of micro-level negotiations reflect and mitigate tensions between institutional logics. Our ethnographic study of a public–private partnership within the English healthcare system identified tensions within the hybrid organization around organizational goals and values, work activities, hierarchies and the materials and technologies of work. We also identified processes of negotiation between actors, which contributed to negotiated settlements, at times combining elements of parent institutional logics, and at other times serving to keep parent logics distinct. The article demonstrates the relevance of negotiated order perspective to current institutional logics literature on hybrid organizations.

Mapping midwifery and obstetric units in England

OBJECTIVE to describe the configuration of midwifery units, both alongside&free-standing, and obstetric units in England. DESIGN national survey amongst Heads of Midwifery in English Maternity Services SETTING: National Health Service (NHS) in England PARTICIPANTS: English Maternity Services Measurements descriptive statistics of Alongside Midwifery Units and Free-standing Midwifery Units and Obstetric Units and their annual births/year in English Maternity Services FINDINGS: alongside midwifery units have nearly doubled since 2010 (n = 53-97); free-standing midwifery units have increased slightly (n = 58-61). There has been a significant reduction in maternity services without either an alongside or free-standing midwifery unit (75-32). The percentage of all births in midwifery units has trebled, now representing 14% of all births in England. This masks significant differences in percentage of all births in midwifery units between different maternity services with a spread of 4% to 31%. KEY CONCLUSIONS In some areas of England, women have no access to a local midwifery unit, despite the National Institute for Health&Clinical Excellence (NICE) recommending them as an important place of birth option for low risk women. The numbers of midwifery units have increased significantly in England since 2010 but this growth is almost exclusively in alongside midwifery units. The percentage of women giving birth in midwifery units varies significantly between maternity services suggesting that many midwifery units are underutilised. IMPLICATIONS FOR PRACTICE Both the availability and utilisation of midwifery units in England could be improved.

Inconsistency in health care professional work: Employment in independent sector treatment centres.

PURPOSE The purpose of this paper is to investigate the impact of recent outsourcing and public-private partnership (PPPs) arrangements on the consistency of professional employment in health care. DESIGN/METHODOLOGY/APPROACH A case study methodology is applied. FINDINGS The paper finds that multiple arrangements for employment within the ISTC creates numerous sources for inconsistency in employment: across the workplace, within professional groups and with national frameworks for health care employment. These are identified as having implications for organisational outcomes, threatening the stability of current partnerships, and partially stymieing intended behavioural change. RESEARCH LIMITATIONS/IMPLICATIONS The study is a single case study of an independent sector treatment centre. Future research is required to investigate wider trends of employment in heterogeneous outsourcing and PPP arrangements. PRACTICAL IMPLICATIONS The paper informs both managers and clinical professionals of the unanticipated complexities and practical challenges that can arise in partnerships and outsourcing arrangements. ORIGINALITY/VALUE The paper presents a unique in-depth investigation of employment within recently established ISTCs, and highlights important employment changes for the core health care workforce and high-status professionals in the evolving health care organisational landscape.

Discovering healthcare professional‐practice networks

Purpose – The aim of this paper is to examine the benefits of undertaking mixed methods social network analysis (SNA) to investigate patterns of interpersonal relationships in healthcare delivery. Although SNA has roots in anthropological and ethnographic research, recent emphasis has been on the mathematical properties of social networks utilising graph theory and statistical analysis. While such studies may present interesting data on the structure of ties, this paper argues that they sidestep other important elements of patterns of social relationships; their meaning and their implications for network members. The paper identifies how SNA survey can be employed alongside ethnographic data within a qualitative framework.Design/methodology/approach – The paper reports on a study that investigated how knowledge sharing in social networks can contribute to patient safety in surgical care involving a social network survey, qualitative interviews and ethnographic observations.Findings – Results describe how ...

George Ritzer: Rationalisation, Consumerism and the McDonaldisation of Surgery

This chapter introduces and explores the continuing relevance of George Ritzer’s McDonaldisation thesis to contemporary healthcare reforms. In general terms, Ritzer’s work revisits and extends Max Weber’s analysis of modernity, especially the idea that social action is increasingly ‘rational’ or driven to determine the most efficient and practical means of achieving a desired end. For Weber, this type of ‘instrumental rationality’ was best exemplified by the growth of bureaucracy, which institutionalised the roles, rules and regulations of achieving efficient and effective modes of social action. In revisiting these ideas, Ritzer’s work offers a counter-argument to more recent social theories that describe a late- or post-modern era characterised by more diverse and fluid types of action, including post-bureaucratic modes of social organisation. At its foundations, his McDonaldisation thesis, therefore, aims to demonstrate the continuing relevance of Weberian concepts of rationality and bureaucracy to contemporary society by showing how they have evolved to reflect additional social changes, especially individualisation, consumerisation and globalisation. In particular, Ritzer’s work focuses on the mode of social organisation associated with fast-food chains, such as McDonalds, as exemplifying the hyper-rationalisation of everyday life. This includes rationalising the production of goods and services, and also transforming the material and symbolic modes of consumption. Importantly, he also reveals the inherent contradictions and irrationalities of this type of social action, especially latent risk and the illusion of choice.

Public policies on healthcare-associated infections: a Brazil and UK case study

ABSTRACT To summarize the historical events and drivers underlying public policy for the prevention and control of healthcare-associated infections in Brazil and in the United Kingdom. In doing so, the article aims to identify lessons and recommendations for future development of public policy. The analysis is based on a historical overview of national healthcare-associated infections programs taken from previously published sources. Findings highlight how the development of healthcare-associated infections prevention and control policies followed similar trajectories in Brazil and the United Kingdom. This can be conceptualized around four sequential phases: Formation, Consolidation, Standardization, and Monitoring and Evaluation. However, while we identified similar phases of development in Brazil and the United Kingdom, it can be seen that the former entered each stage around 20 years after the latter.

The Knowledge Brokering Situations of Care Transitions

Bishop and Waring look at the relationship between the context of care transitions and the nature of knowledge brokering activities. In common usage, knowledge brokers are intermediaries that help to share or transfer knowledge between otherwise separate networks or communities. Analysis has mainly focused on knowledge brokers themselves, but this chapter takes an alternative approach. Bishop and Waring seek to understand the performance of knowledge brokering within the social interactions and workplace settings in which it takes place. Based on data from a trauma orthopaedic unit, Bishop and Waring identify the ways in which the production of safe care transitions is dependent on knowledge being shared across boundaries; it describes several roles by study participants and highlights how the performance of knowledge brokering can be seen as a collective endeavour.