Background: Health Information Technology (HIT) has the potential to improve the quality and efficiency of healthcare delivery and reduce costs. However, the integration of HIT into healthcare workflows has experienced a range of issues during its implementation. It can adversely impact healthcare workflows, therefore reducing efficiency and safety in healthcare delivery. As healthcare settings are characterised by its own workflow, an in-depth understanding of the workflows of where the HIT to be implemented is crucial in order to avoid complexities that can arise. As there is a lack of research investigating an overall ED workflow, both clinical and non-clinical processes and practices, this research aims to gain an in-depth understanding of emergency care workflow which includes the work processes and practices of its clinicians and non-clinicians and its information artefacts. Methodology: This research employed a fieldwork case study approach analysing the work processes and practices of clinicians and non-clinicians in the delivery of emergency care. The approach was used in order to capture the situated nature of the ED workflow. The study was conducted in two emergency care settings located in the UK. Data were collected using semi-structured interviews, non-participant observations and documents. A multiple triangulation technique: data triangulation and within-methods triangulation were employed in order to gain an in-depth understanding of the topic. The data were analysed using thematic analysis. Findings: The emergency care workflow consisted of multidisciplinary ED team members’ work processes. These work processes were comprised of collaborative clinical and non-clinical tasks and activities in delivering care treatment governed and defined by time-related activities, organisational rules, exceptions and variability. The workflow was supported by both computerised systems and non-computerised information artefacts, such as non-electronic whiteboards and paper-based records and forms, which needed to be used in conjunction with each other. Additionally, the hybrid implementation had also been utilised to support collaborative work of the clinicians and non-clinicians, hence giving the implication that HIT systems should not be designed as purely technical system focusing on single users, but also as a collaborative work system. Conclusion: An ED workflow consists of interrelated care processes, clinical and non-clinical processes. These processes are executed semi-autonomously by clinicians and non-clinicians and governed by time-related organisational constraints, variable and exception-filled, relying on hybrid information architecture. The architecture presented workflow with a number of integration issues. However, its implementation does not only support the functionalities for the delivery of emergency care processes but also the collaborative practices of the clinicians and non-clinicians.

This study examined how GPs in Wiltshire understood sustainable development and its implications for the NHS, their role as GPs and the factors that influenced their engagement with sustainability through an online survey followed by one to one qualitative interviews. The objectives were to better understand how GPs in Wiltshire understood sustainability, to identify gaps between the literature and GPs and to determine the factors that influenced the engagement of GPs with sustainability. The NHS has committed to more sustainable practices, setting a target of an 80% reduction in greenhouse gas emissions by 2050, which will require radical change in how healthcare is delivered. Proposals on how to achieve the radical transition to more sustainable NHS are emerging in a developing literature on sustainability, health and healthcare. However there is a knowledge gap as to the extent that the analysis of sustainable development and the NHS and proposals for a more sustainable NHS are shared by a broad section of health professionals. The findings indicated that research participants had complex and nuanced views towards sustainability and the NHS. Findings suggested broad levels of support for some sustainability, activities such as building the resilience of individuals and local communities alongside reservations about others such as taking environmental impact into account when making clinical decisions. Findings also provide a potential explanation of why this broad support may not motivate change. Interview and survey data that suggested that sustainability was remote or an afterthought provide an indication of the leadership, resources and guidance necessary to change practices. The study contributes new knowledge about how this vital group of health professionals understand and engage with sustainability. The study suggests that sustainability should be communicated in terms of improvement in healthcare and the future viability of the NHS alongside clear commitments to sustainability in terms of leadership, strategic integration and organisational incentives.

Background: The information exchange between healthcare practitioners in South Korea and the UK has so far been limited and cross-cultural comparisons of Relaxation techniques (RTs) and Mindfulness meditation (MM) and Relaxation music (RM) within the healthcare context of Korea and the UK have previously been unexplored. This has been the inspiration for this qualitative case study focussing on understanding and use of RTs/MM and RM within the respective healthcare contexts. Methods: Data were collected through qualitative semi-structured interviews with six Korean and six UK healthcare practitioners in three professional areas: medical practice, meditation, and music therapy. The interviews were transcribed and a thematic analysis was undertaken. The topics explored include: a) the value and use of RTs/MM and RM; b) approaches and methods; c) practitioners’ concerns; d) responses of interventions; e) cultural similarities and differences; and f) the integration of RTs/MM and RM within healthcare. Underlying cultural factors have been considered, including education systems and approaches, practitioner-client relationships and religious influences alongside the background of cultural change and changing perspectives within healthcare in the UK and Korea. Findings: A great variety of approaches to RTs/MM and RM were discussed among the sample group. Across a wide client spectrum common therapeutic purposes included stress reduction, emotional support and regulation, rehabilitation, personal transformation and spiritual development. The participants were both discerning and creative in terms of mind-body interventions they use. Practitioners’ training, personal experience and insights gained through practice inform their professional work and they were keen to share knowledge among colleagues. Nevertheless, practitioners’ level of competency and abilities with respect to the use of RTs/MM and RM were a common concern; training opportunities exist to varying degrees in both countries, however, and growth in the use of mind-body interventions is a significant trend. Nation-specific and cultural factors can affect the use of interventions, settings and client group. Similarities (focus on individual and subjective factors, client acceptance and practical concerns) and differences (related to historical background, educational culture, prevailing religious outlooks and the respective health services) were found between Korea and the UK. Conclusion: The value of cross-cultural and multidisciplinary research and integrated health is increasingly recognised and the use of RTs/MM and RM as mind-body interventions considered to be useful integrated treatment within healthcare context. This study shows the difference in range of RTs/MM and RM resources and the approaches in integrating practice and these may lead to cross-fertilisation within therapeutic practice. The value of knowledge sharing and integrated medicine is increasingly recognised across the globe and this study opens up a number of themes that might be taken up again and built on by future researchers. More generally, the study contributes to cross-cultural qualitative research between Korea and UK and integrating theory and practice with respect to RTs/MM and RM.

Observational health data are a rich resource that present modelling challenges due to data complexity. If inappropriate analytical methods are used to make comparisons amongst either patients or healthcare providers, inaccurate results may generate misleading interpretations that may affect patient care. Traditional approaches cannot fully accommodate the complexity of the data; untenable assumptions may be made, bias may be introduced, or modelling techniques may be crude and lack generality. Latent variable methodologies are proposed to address the data challenges, while answering a range of research questions within a single, overarching framework. Precise model configurations and parameterisations are constructed for each question, and features are utilised that may minimise bias and ensure that covariate relationships are appropriately modelled for correct inference. Fundamental to the approach is the ability to exploit the heterogeneity of the data by partitioning modelling approaches across a hierarchy, thus separating modelling for causal inference and for prediction. In research question (1), data are modelled to determine the association between a health exposure and outcome at the patient level. The latent variable approach provides a better interpretation of the data, while appropriately modelling complex covariate relationships at the patient level. In research questions (2) and (3), data are modelled in order to permit performance comparison at the provider level. Differences in patient characteristics are constrained to be balanced across provider-level latent classes, thus accommodating the ‘casemix’ of patients and ensuring that any differences in patient outcome are instead due to organisational factors that may influence provider performance. Latent variable techniques are thus successfully applied, and can be extended to incorporate patient pathways through the healthcare system, although observational health datasets may not be the most appropriate context within which to develop these methods.

Local authorities and their partners are increasingly required to involve communities within decision making (DETR, 1998; 2000a). Community involvement, and the subsequent creation of networks, has been presented within national policy documentation as a means to tackle social exclusion and associated multiple deprivation (DETR, 2000a; SEU, 2001). Similarly, increased levels of societal integration have long been associated with improved health outcomes (e.g. Durkheim, 1952; Egolf et al, 1992). More recently, social capital, in its various interpretations, has been portrayed as an important resource for public health (Kawachi et al, 1997). Here, the relationship between community involvement and health has been explored and the value of social capital in advancing understanding of this relationship determined. Theories of social capital and well being interpretations of health informed the development of a qualitative methodology. In the first stage of research, a local authority case study was selected to examine the translation of policies into a new strategic framework for community involvement. Qualitative interviews and analysis of key documentation determined interpretations of community involvement. In the second stage, observations and interviews were conducted with a newly formed community group to explore experiences of involvement and their potential influence upon health. This approach enabled the investigation of bonding, bridging and linking forms of social capital (Szreter and Woolcock, 2002). Reflecting the extensive changes taking place within the local authority, the new strategic approach to involvement centred upon a model of engagement, yet the value attached to community development perspectives diverged across the sectors. Investigation of the involvement activities of the community group revealed that their limited capacity inhibited interaction with the newly created involvement structures. Capacity, in turn, determined the perceived levels of control and influence held by communities. In the absence of the capacity to respond to the challenges presented by involvement, community group membership yielded predominantly negative health related outcomes. It is concluded that community involvement can potentially influence health through two primary mechanisms; the development of resources and the facilitation of collective action. Therefore uncritical acceptance of community involvement as a positive resource for public health does not reflect the complexity of the relationship. Instead, the relationship is shaped by the heterogeneous nature of bonding, bridging and linking forms of social capital. Reflecting this, it is concluded here that Bourdieu's (1997) interpretation of social capital as interdependent with cultural and economic resources presents a valuable framework for the implementation of involvement.

Introduction: I aimed to evaluate the performance of the National Health Service (NHS) Health Check in the first four years since April 2009. The programme offers all English adults aged 40-74 years, and without known vascular disease, a cardiovascular disease (CVD) risk assessment and management Health Check every five years. Methods: Electronic medical records of 300,000 random sample of patients who were aged 40-74 years old but not filtered by other Health Check eligibility criteria were obtained from a nationally representative UK primary care database. Multilevel logistic regression was performed to examine variations in programme coverage. Programme impact on the management of CVD risks and early detection of selected vascular conditions was examined using a difference-in-differences matching analysis. A model-based cost-utility analysis was conducted to estimate the relative long-term costs and benefits of the NHS Health Check with a lifetime time horizon. Results: National coverage of the programme was low in the first four years and varied between general practices and English regions although no significant differences were observed between areas of different levels of deprivation. The programme had contributed to a statistically significant but clinically modest reduction in global CVD risk and individual risk factors among attendees but smoking prevalence stayed unchanged. The prescribing of statins increased significantly but the absolute statin prescribing remained low after Health Checks. The programme appears to be cost-effective long-term, based on the benefits of medical and lifestyle interventions being realised. Conclusions: The NHS Health Check needs to be improved substantially via better planning, implementation, monitoring, and management before any anticipated public health benefit are achieved. High-quality research is required to identify the most effective strategies such as a combination of CVD risk assessment programme and other population-wide programmes for the prevention of CVD.

No description available.

No description available.

Background: Over the last three decades, men's health has emerged as an area of research interest. The relationship between male socialization, the performance of masculinity and health behaviour has been well established. Within the Caribbean, however, there is a gap in the literature on how masculinity affects health beliefs and behaviour. Aim: This study explored men's accounts of "doing" masculinity and the implications for health beliefs and behaviours in order to make recommendations for developing male sensitive health services. Methodology: Men between the ages of 19-60 years in Trinidad and Tobago participated in this study during the period August 2011 to January 2012. Fourteen focus group discussions were conducted among men from various socio-demographic groups and twelve semi structured interviews with men involved in clinical and social programs targeting males. Data were coded thematically using inductive and deductive analysis. Findings: This study is a contribution to the literature on masculinity, in general, and masculinity and health in the Caribbean, in particular. Men reported three core elements for performing masculinity: being a provider, being a leader and being heterosexually promiscuous. However, these expectations could not be realized fully in their personal experiences. Men were expected to take risks and show disregard for their own health and yet perceived being healthy as essential for 'being a man'. Views about prostate cancer screening were an example of this tension: men wanted to be healthy, were positive about screening in principle but unwilling to access services. Implications for policy/practice: Men were willing to talk openly about their health risks, suggesting that they might be willing to access services perceived as sensitive to their needs. Health information and services must be developed and implemented with men in mind to encourage greater participation in health service delivery.

The aim of the study is to capture informal carers’ perceptions of effective interprofessional working. The theoretical background of this research is founded in the existing knowledge base of interprofessional working and the experiences of informal carers in their role of caring. A naturalistic approach is used in this exploratory study which involves informal carers in the North of England. Stories are developed from two carers’ experiences. These stories are subsequently used in interviews with eleven other carers. The interviews are audio-recorded and transcripts are produced. Three subjective meanings of caring emerged from the analysis: ‘It’s all a battle’, ‘That’s how it is’ and ‘I know how it should be’. Three main themes were identified, namely individual attributes, shared philosophy of care and information communication. A synergistic relationship exists between these three themes. Implications from the findings are that professionals need to understand the realities of caring and actively listen to the patient and their families in order to communicate effectively with other professionals. Professionals need to be aware of the impact of their attitudes and behaviours on effective collaboration with other professionals. The routinisation of care, whilst being an important component of efficiency, can override decisions based on need. There needs to be an awareness of how some rules and routines, whether local or organisational, can prevent the achievement of successful care outcomes. There needs to be a cultural shift away from the notion of team to an increased focus on working with others to deliver effective care. To achieve the policy directive of providing person centred care, professionals need to be willing to open up their minds to others’ perspectives. This may require a change in mind set and a change in practice This study provides an alternative perspective of effective interprofessional working.