Action research-driven professional development: Developing transformational health care managers and creating learning organisations

May and June were busy months in Europe for technology assessors. Following the International Society meeting in Rotterdam, many people went on to the quality assurance meeting at WHO in Copenhagen and the International Hospital Federation Congress in Helsinki. “Modern Technology—How Much and for Whom,” was one of the main themes of the congress; with an attendance of about 400 there was an opportunity to get the ideas about technology assessment across to a large group of health care managers and professionals. For those of us who spoke it was also a chance to meet members of the Finnish Society for Technology Assessment. This may be the only national society for health technology assessment, and with 70 members, it is clearly going to be influential.

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Towards systematic reviews that inform health care management and policy-making

Journal of Health Services Research & Policy ◽

10.1258/1355819054308549 ◽

2005 ◽

Vol 10 (1_suppl) ◽

pp. 35-48 ◽

Cited By ~ 331

Author(s):

John Lavis ◽

Huw Davies ◽

Andy Oxman ◽

Jean-Louis Denis ◽

Karen Golden-Biddle ◽

...

Keyword(s):

Health Care ◽

Systematic Reviews ◽

Policy Making ◽

Care Management ◽

Contextual Factors ◽

Health Care Management ◽

Health Care Managers ◽

Executive Summary ◽

Policy Makers ◽

Care Managers

Objectives To identify ways to improve the usefulness of systematic reviews for health care managers and policy-makers that could then be evaluated prospectively. Methods We systematically reviewed studies of decision-making by health care managers and policy-makers, conducted interviews with a purposive sample of them in Canada and the United Kingdom (n=29), and reviewed the websites of research funders, producers/purveyors of research, and journals that include them among their target audiences (n=45). Results Our systematic review identified that factors such as interactions between researchers and health care policy-makers and timing/timeliness appear to increase the prospects for research use among policy-makers. Our interviews with health care managers and policy-makers suggest that they would benefit from having information that is relevant for decisions highlighted for them (e.g. contextual factors that affect a review's local applicability and information about the benefits, harms/risks and costs of interventions) and having reviews presented in a way that allows for rapid scanning for relevance and then graded entry (such as one page of take-home messages, a three-page executive summary and a 25-page report). Managers and policy-makers have mixed views about the helpfulness of recommendations. Our analysis of websites found that contextual factors were rarely highlighted, recommendations were often provided and graded entry formats were rarely used. Conclusions Researchers could help to ensure that the future flow of systematic reviews will better inform health care management and policy-making by involving health care managers and policy-makers in their production and better highlighting information that is relevant for decisions. Research funders could help to ensure that the global stock of systematic reviews will better inform health care management and policy-making by supporting and evaluating local adaptation processes such as developing and making available online more user-friendly ‘front ends’ for potentially relevant systematic reviews.

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Inappropriate requests for tumor markers in patients aged 50 years and older: lessons not learned

Geriatrics Gerontology and Aging ◽

10.5327/z2447-212320212000113 ◽

2021 ◽

Vol 15 ◽

Author(s):

Valter Paz Nascimento-Júnior ◽

Einstein Francisco Camargos

Keyword(s):

Internal Medicine ◽

Health Care ◽

Health Insurance ◽

Medical Records ◽

Private Health Insurance ◽

Medical Specialty ◽

Health Care Managers ◽

Inappropriate Use ◽

Care Managers ◽

Previous Diagnosis

OBJECTIVE: To investigate, within a private health insurance, the ordering frequency and the costs related to inappropriate TM test orders. METHODS: This study analyzed data regarding TM requests within a private health insurance between 2010 and 2017. Patients included in this analysis were ≥ 50 years old, had available medical records, and had at least 1 TM tested within the study period. Tests were considered inappropriate when TMs were used in screening for neoplasms, ie, when there was no previous diagnosis. We evaluated data regarding age, sex, the ordering physician’s medical specialty, and test costs. RESULTS: Between 2010 and 2017, 1,112 TM tests were performed and increased from 52 to 262 per year. Our sample consisted mostly of women (69.50%) with a mean age of 59.40 (SD, 8.20) years. Most orders were inappropriate (87.80%) and represented 79.40% of all expenses with TM tests. Cardiology professionals were the medical specialty that requested the most TM tests (23.90%), followed by internal medicine specialists (22.70%) and gynecologists (19.20%). CONCLUSIONS: We observed a high percentage of inappropriate test orders in the study period, resulting in elevated costs. Studies of this nature deserve the attention of health care managers, and interventions should be performed in order to reduce the inappropriate use of TM tests in clinical practice.

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Evidence-Based Practice in Primary Health Care From The Managerial Point of View: – A National Survey

10.21203/rs.3.rs-62937/v1 ◽

2020 ◽

Author(s):

Tobias Abelsson ◽

Helena Morténius ◽

Ann-Kristin Karlsson ◽

Stefan Bergman ◽

Amir Baigi

Keyword(s):

Health Care ◽

Primary Health Care ◽

National Survey ◽

Evidence Based Practice ◽

Direct Result ◽

Evidence Based ◽

Care Organization ◽

Health Care Managers ◽

Care Managers ◽

Primary Health

Abstract Background: The vast availability of and demand for evidence in modern primary health care forces clinical decisions to be made based on condensed evidence in the form of policies and guidelines. Primary health care managers play a key role in implementing these governing documents. Thus, the aim of this article was to investigate the use and availability of evidence-based practice resources from the perspective of first-line primary health care managers.Methods: The study utilized a quantitative method based on a national survey of primary health care managers. The study population was recruited nationally from Sweden and consisted of 186 respondents. The data were analysed using empirically constructed themes and validated using factor analysis. To determine the statistical significance in making comparisons, the chi-square test was utilized. Associations between variables were calculated using Spearman’s correlation. All tests were two-sided, and the significance level was set to 0.05.Results: A majority (97%) of managers stated there was an impact of guidelines and policy documents on primary health care; 84% of managers could see a direct influence in daily practices. Most of the managers (70%) stated that some adaptation had to be made when new evidence was introduced. The managers emphasised the importance of keeping themselves updated and open to new information about work routines (96%). Conclusions: Evidence-based practice has a fundamental impact on Swedish primary health care. The study illustrated a nearly unanimous response about evidence influencing daily practice. The emphasis on the importance of all staff members keeping their professional knowledge up to date can be seen as a direct result of this. An information-dense organization such as a primary health care organization would have much to gain from cooperation with regional information resources such as clinical libraries.Trial registration: Not applicable.

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Being a manager, becoming a professional? A case study and interview-based exploration of the use of management knowledge across communities of practice in health-care organisations

Health Services and Delivery Research ◽

10.3310/hsdr02140 ◽

2014 ◽

Vol 2 (14) ◽

pp. 1-138 ◽

Cited By ~ 4

Author(s):

Mike Bresnen ◽

Damian Hodgson ◽

Simon Bailey ◽

Paula Hyde ◽

John Hassard

Keyword(s):

Health Care ◽

Communities Of Practice ◽

Knowledge Sharing ◽

Health Care Managers ◽

Health Care Settings ◽

General Managers ◽

Care Managers ◽

Management Knowledge ◽

Observation Methods ◽

Managerial Knowledge

BackgroundUnderstanding how managers in the NHS access and use management knowledge to help improve organisational processes and promote better service delivery is of pressing importance in health-care research. While past research has examined in some depth how managers in the NHS perform their roles, we have only limited understanding of how they access management knowledge, interpret it and adapt and apply it to their own health-care settings.ObjectivesThis study aims to investigate how NHS middle managers encounter, adapt and apply management knowledge in their working practices and to examine the factors [particularly organisational context, career background and networks of practice (NoPs)/communities of practice (CoPs)] which may facilitate or impede the acceptance of new management knowledge and its integration with practice in health-care settings. Our research was structured around three questions: (1) How do occupational background and careers influence knowledge receptivity, knowledge sharing and learning among health-care managers? (2) How do relevant CoPs enable/obstruct knowledge sharing and learning? (3) What mechanisms are effective in supporting knowledge receptivity, knowledge sharing and learning/unlearning within and across such communities?Design and settingThree types of NHS trust were selected to provide variation in organisational context and the diversity of services provided: acute, care and specialist foundation trusts (FTs). It was expected that this variation would affect the knowledge requirements faced by managers and the networks likely to be available to them. To capture variation amongst managerial groups in each trust, a selection framework was developed that differentiated between three main cohorts of managers: clinical, general and functional.ParticipantsAfter initial interviews with selected key informants and Advisory Group members, the main empirical phase consisted of semistructured interviews combined with ethnographic observation methods. A purposive, non-random sample of managers (68 in total) was generated for interview, drawn from across the three trusts and representing the three cohorts of managers. Interviews were semistructured and data was collated and analysed using NVivo 9 software (QSR International, Warrington, UK).Main outcome measuresThe analysis was structured around four thematic areas: context (institutional and trust), management (including leadership), knowledge and networks. The research underlines the challenges of overcoming fragmentation across a diffuse managerial CoP in health care, exacerbated by the effects of organisational complexity and differentiation. The research highlights the importance of specific training and development initiatives, and also the value of NoPs for knowledge sharing and support of managers.ResultsThe main findings of the research stress the heterogeneity of management and the highly diverse sources of knowledge, learning, experience and networks drawn upon by distinct management groups (clinical, general and functional); the particular challenges facing general managers in establishing a distinct professional identity based around a coherent managerial knowledge base; the strong tendency for managerial knowledge – particularly that harnessed by general managers – to be more ‘home grown’ (localised) and experiential (as opposed to abstract and codified); and the tendency for this to be reinforced through the difficulties facing general managers in accessing and being actively engaged in wider networks of professionals for knowledge sharing, learning and support.ConclusionsManagement in health care is a complex and variegated activity that does not map onto a clear, unitary and distinct CoP. Improving flows of knowledge and learning among health-care managers involves taking account not just of the distinctiveness of managerial groups, but also of a number of other features. These include the complex relationship between management and leadership, alternative ways of bridging the clinical–managerial interface, the importance of opportunities for managers to learn through reflection and not mainly through experience and the need to support managers – especially general managers – in developing their networks for knowledge sharing and support. Building on the model developed in this research to select managerial cohorts, future work might usefully extend the research to other types of trust and health-care organisation and to larger samples of health-care managers, which can be further stratified according to their distinct occupational groups and CoPs. There is also scope for further ethnographic research that broadens and deepens the investigation of management using a range of observation methods.FundingThe National Institute for Health Research Health Service and Delivery Research programme.

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