Clinical governance programme in patients with acute coronary syndrome: design and methodology of a quality improvement initiative.

INTRODUCTION: Despite the availability of diverse evidence-based diagnostic and treatment options, many patients with acute coronary syndrome (ACS) still fail to receive effective, safe and timely diagnoses and therapies. The Association of Acute CardioVascular Care of the European Society of Cardiology has proposed and retrospectively validated a set of ACS-specific quality indicators. Combining these indicators with the principles of clinical governance-a holistic, patient-centred approach intended to promote continuous quality improvement-we designed the clinical governance programme in patients with ACS. METHODS AND ANALYSIS: This is a multicentre quality improvement initiative exploring multiple dimensions of care, including diagnosis, therapy, patient satisfaction, centre organisation and efficiency in all comers patients with ACS.The study will enrol ≈ 5000 patients prospectively (ie, at the time of the first objective qualifying ACS criterion) with a 1-year follow-up. Consecutive inclusion will be promoted by a simplified informed consent process and quantified by the concordance with corresponding hospital administrative records using diagnosis-related group codes of ACS.Coprimary outcome measures are (1) timely reperfusion in patients with ST-elevation ACS and (2) optimal medical therapy at discharge in patients with confirmed acute myocardial infarction. Secondary outcomes broadly include multiple indicators of the process of care. Clinical endpoints (ie, death, myocardial infarction, stroke and bleeding) will be adjudicated by a clinical event committee according to predefined criteria. ETHICS AND DISSEMINATION: The study has been approved by local ethics committee of all study sites. As a quality improvement initiative and to promote consecutive inclusion of the population of interest, a written informed consent will be requested only to patients who are discharged alive. Dissemination will be actively promoted by (1) the registration site (ClinicalTrials.Gov ID NCT04255537), (2) collaborations with investigators through open data access and sharing.

Clinical governance breakdown: Australian cases of wilful blindness and whistleblowing.

BACKGROUND: After their attempts to have patient safety concerns addressed internally were ignored by wilfully blind managers, nurses from Bundaberg Base Hospital and Macarthur Health Service felt compelled to 'blow the whistle'. Wilful blindness is the human desire to prefer ignorance to knowledge; the responsibility to be informed is shirked. OBJECTIVE: To provide an account of instances of wilful blindness identified in two high-profile cases of nurse whistleblowing in Australia. RESEARCH DESIGN: Critical case study methodology using Fay's Critical Social Theory to examine, analyse and interpret existing data generated by the Commissions of Inquiry held into Bundaberg Base Hospital and Macarthur Health Service patient safety breaches. All data was publicly available and assessed according to the requirements of unobtrusive research methods and secondary data analysis. ETHICAL CONSIDERATIONS: Data collection for the case studies relied entirely on publicly available documentary sources recounting and detailing past events. FINDINGS: Data from both cases reveal managers demonstrating wilful blindness towards patient safety concerns. Concerns were unaddressed; nurses, instead, experienced retaliatory responses leading to a 'social crisis' in the organisation and to whistleblowing. CONCLUSION: Managers tasked with clinical governance must be aware of mechanisms with the potential to blind them. The human tendency to favour positive news and avoid conflict is powerful. Understanding wilful blindness can assist managers' awareness of the competing emotions occurring in response to ethical challenges, such as whistleblowing.

[EFQM Model in the hospitals of Madrid Regional Health Service: full self-assessment cycle]. / Modelo EFQM en los hospitales del Servicio Madrileño de Salud: ciclo completo de autoevaluación.

AIM: To analyse a complete cycle of self-assessment using the European Foundation for Quality Management (EFQM) Model in the hospitals of the Madrid Health Service as regards the fundamental concepts of excellence (FCE). METHOD: Descriptive study of the EFQM self-assessments of the entire public hospital sector identifying the methodology and the information on strengths, weaknesses, evidence, RADAR matrix (Results, Approach, Deployment, Assessment and Review), and the related FCEs in the enabling criteria and in the prioritised action plans. RESULTS: The self-assessment was carried out in 85% of the hospitals (29/34), 86% of them required specific training (25/29), with a total of 329 teaching hours and 833 people in training. Multidisciplinary working groups were required in 83% of the hospitals (24/29), with 123 groups and 857 people involved. There were 3,686 strengths and 3,197 weaknesses identified: strengths and weaknesses were 78% (2,869) and 74% (2,355), respectively, for the enabling criteria and 22% (817) and 26% (842), respectively, for the results criteria. The mean score was 404 points with a median of 399. The main FCEs were managing with agility, developing organisational capability, sustaining outstanding results, creating a sustainable future, succeeding through the talent of people, and adding value for customers, with harnessing creativity/innovation and leading with vision, inspiration and integrity being placed in lower positions. A total of 113 action plans were identified for all the hospitals. CONCLUSION: A complete EFQM self-assessment cycle of the entire public hospital sector of a Regional Health Service is provided, linking the analysis and action plans with the FCE of the EFQM Model.

Important factors for effective patient safety governance auditing: a questionnaire survey.

BACKGROUND: Audits are increasingly used for patient safety governance purposes. However, there is little insight into the factors that hinder or stimulate effective governance based on auditing. The aim of this study is to quantify the factors that influence effective auditing for hospital boards and executives. METHODS: A questionnaire of 32 factors was developed using influencing factors found in a qualitative study on effective auditing. Factors were divided into four categories. The questionnaire was sent to the board of directors, chief of medical staff, nursing officer, medical department head and director of the quality and safety department of 89 acute care hospitals in the Netherlands. RESULTS: We approached 522 people, of whom 211 responded. Of the 32 factors in the questionnaire, 30 factors had an agreement percentage higher than 50%. Important factors per category were 'audit as an improvement tool as well as a control tool', 'department is aware of audit purpose', 'quality of auditors' and 'learning culture at department'. We found 14 factors with a significant difference in agreement between stakeholders of at least 20%. Amongst these were 'medical specialist on the audit team', 'soft signals in the audit report', 'patients as auditors' and 'post-audit support'. CONCLUSION: We found 30 factors for effective auditing, which we synthesised into eight recommendations to optimise audits. Hospitals can use these recommendations as a framework for audits that enable boards to become more in control of patient safety in their hospital.

Enhancing and Advancing Shared Governance Through a Targeted Decision-Making Redesign.

OBJECTIVE: The study aim was to determine if a targeted redesign of shared decision making improved shared governance (SG). BACKGROUND: Nursing SG is collaborative decision making between nurses at every level; it improves quality of care, empowers nurses, and enhances nurse satisfaction. METHODS: Using a quasi-experimental, pretest/posttest design, researchers electronically distributed the Index of Professional Nursing Governance (IPNG) to an inclusive, convenience sample of RNs in a Magnet®-designated 377-bed community medical center. Preintervention scores were used to tailor a redesign of shared decision making, and postintervention data were collected within 1 year to measure outcomes. RESULTS: IPNG overall score and 5 of 6 subscale scores significantly increased after the redesign. CONCLUSIONS: Changes to an SG structure can take 2 to 5 years to be realized. Our findings corroborate that the IPNG is a valuable tool in promoting setting-specific SG.

Utilidad del presupuesto y del cuadro de mando integral en la gestión de centros de atención primaria. Impacto sobre la motivación del personal / Usefulness of the budget and the balanced scorecard in managing Primary Care Centres. Impact on staff motivation

Objetivo: Analizar la utilidad percibida por los gestores de centros de atención primaria respecto a las herramientas utilizadas para su gestión (presupuesto y cuadro de mando integral [CMI]) y su impacto sobre la motivación del personal. Diseño: Estudio cualitativo de casos basado en teoría fundamentada, realizado entre enero y junio de 2014. Emplazamiento: Unidades de Gestión Clínica de Atención Primaria (UGCAP) del Área de Gestión Sanitaria metropolitana de Sevilla. Participantes: Directores de UGCAP y gestores del Área. Método: Los datos se recogieron en 8 entrevistas semiestructuradas mediante muestreo intencional no probabilístico con criterios de representatividad y suficiencia del discurso. Las entrevistas fueron grabadas, transcritas y analizadas mediante códigos in-vivo. Resultados: Ambas herramientas están implementadas en los centros de atención primaria, con usos diferentes. El presupuesto se percibe como una herramienta coercitiva, impuesta para el control del gasto, y poco útil para la gestión diaria. Aunque el CMI es más flexible y permite identificar los problemas financieros y asistenciales del centro, los límites presupuestarios reducen enormemente el margen para implementar soluciones. Además, la política de incentivos es insuficiente, generando problemas de motivación. Conclusiones: Este estudio muestra que las tensiones presupuestarias que afectan a la atención primaria han reducido al mínimo la autonomía de los centros de salud, imponiendo una toma de decisiones centralizada en la que prima el ahorro en costes sobre la calidad asistencial, generando tensiones con el personal. Se plantea la necesidad de incrementar la autonomía de los centros y mejorar el compromiso del personal mediante programas de formación y desarrollo profesional (AU)

Objective: To analyse the utility perceived by managers of centers of primary care about management tools (budget and balanced scorecard), together their impact on human resources motivation. Design: Qualitative study (case study) based on grounded theory performed between January and June 2014. Location: Units of Clinical Management of Primary Health (UGCAP) in Metropolitan Health Area of Seville, Spain. Participants: UGCAP managers and Health Area (CEO) managers. Method: Data were collected through 8 semi-structured interviews using non-probabilistic intentional sampling with representation and sufficiency criteria of discourse. Interviews were recorded, literally transcripted and analysis through in-vivo codes. Results: Both tools are fully implemented but differently used in primary care centers. Budget is perceived as a coercive management tool, which has been imposed for cost saving; however, it is scarcely adequate for day-by-day management. While balanced scorecard is a more flexible tool that allows identifying financial and welfare problems, budgeting limits heavily reduce the possibility of implementing adequate solutions. The policy of incentives is not adequate either, leading on de-motivation. Conclusions: This study shows that budgeting restrictions have led to a significant reduction in autonomy of Spanish Primary Care centers. Management decision making is much centralised, also focused on cost saving over quality of healthcare. As a result, two needs emerge for the future: increasing centers' autonomy and improving staff commitment through training and professional development programs (AU)

La Gobernanza Enfermera y su impacto en la calidad en la organización sociosanitaria en Catalunya / Nursing governance and its impact on the quality of organization of health care services for older people in the Catalan region of Spain

Introducción: La Gobernanza enfermera consiste en la toma de decisiones de la líder de enfermería en la organización sanitaria y responde a las necesidades de los grupos de interés. Se estudiaron las líderes enfermeras del ámbito sociosanitario o de atención intermedia de Catalunya (España). Objetivo: Analizar las variables de Gobernanza en el ámbito sociosanitario y su relación con la calidad percibida por el paciente. Metodología: Se recogieron datos de Gobernanza mediante el Cuestionario de Gobernanza Enfermera (CGE) y Satisfacción de pacientes medidos con Plaensa(C) (Encuestas de satisfacción del paciente del CatSalut) 2013. Se obtuvieron los consentimientos y aprobación por el Comité de bioética. Se usaron los programas SPSS de IBM y Atlas- Ti para el análisis de los datos. Resultados: Respondieron 34 enfermeras (43,6%) al CGE y al Plaensa(C) 9 de ellas, edad, formación, sexo, años de experiencia y nº de camas, de septiembre 2014 a abril 2015. Los datos se analizaron con una significación del 5% y pruebas estadísticas no paramétricas. Se hallaron correlaciones con la Satisfacción del paciente (Spearman) y: "La calidad influye en las decisiones" (p=0,006), "Investigar y actualizar conocimientos" (p=0,043), y "Desarrollar comunicación estratégica" (p=0,043). Estos resultados se asemejaron a los obtenidos en estudios como el Magnet Model(R). Conclusiones: Es conveniente profundizar en la Gobernanza, la Calidad, el Conocimiento y la Comunicación mediante la investigación cualitativa. Para las enfermeras están interrelacionadas entre sí la experiencia en Tomar decisiones, Poder, Representatividad y Cuidados, a pesar de la participación (AU)

Introduction: Nursing governance consists of decisions made by nursing leaders in health organizations that respond to the needs of interest groups. Nursing leaders in the realm of social-health or intermediate care in Catalonia (Spain) were studied. Objective: Analyze the governance variables in the social-health realm and their relationship with the quality perceived by patients. Methodology: Governance data was collected through a nursing governance questionnaire and patient satisfaction measured through Plaensa(C) (CatSalut 2013 patient satisfaction surveys). The consent of participants and approval by a bioethics committee were obtained. The statistical programs SPSS (from IBM) and Atlas.ti were used for data analysis. Results: Thirty-four (43.6%) nurses responded to the nursing governance questionnaire and nine to the Plaensa(C). Information was collected about age, education, gender, years of experience and number of beds. The data collection took place between September 2014 and April 2015. The data was analyzed with a significance level of 5% and through nonparametric statistical tests. Correlations were found between patient satisfaction (Spearman) and: "Quality influences decisions" (p=0.006), "Research and update knowledge" (p=0.043), and "Develop strategic communication" (p=0.043). These results were similar to those obtained in studies such as Magnet Model(R). Conclusions: It would be worth delving deeper into the topics of governance, quality, knowledge, and communication through qualitative research. In the view of nurses, decision-making experience, power, representativeness, and care are inter-related, despite participation (AU)

Eficiencia y sostenibilidad en la gestión clínica / Efficiency and sustainability in clinical management

No disponible

Desarrollo y evolución de un cuadro de mando integral en atención primaria: lecciones aprendidas / Development and evolution of a balanced scorecard in primary health care: lessons learned

Objetivos. Describir el diseño, implantación y seguimiento del cuadro de mando integral de atención primaria (eSOAP) y su papel en el despliegue de los objetivos estratégicos y en la gestión clínica. Mostrar las lecciones aprendidas en los 6 años de seguimiento. Método. Estudio descriptivo en esferas: metodológica (marco conceptual, matriz estratégica, mapa estratégico y de procesos), tecnológica y de normalización. Resultados. En diciembre de 2014 9.046 (78%) profesionales estaban registrados en eSOAP. Se midieron 381 indicadores de 16 fuentes de datos, de los cuales, el 36% era de resultados (modelo EFQM), el 39,1% de gestión clínica y el 20% estaba incluido en el contrato programa de centro. El eSOAP ha permitido desplegar todas las líneas estratégicas de atención primaria, y ha hecho posible que los asistenciales evalúen la evolución de indicadores resultados a lo largo del tiempo y en el ámbito del paciente (por ejemplo incremento del 16% en el control de pacientes diabéticos). Se generaron 295.779 informes y se valoró por objetivos a 13.080 profesionales. Conclusiones. Se ha hecho un elevado uso de la aplicación eSOAP por parte de los profesionales. Fue clave el papel del cuadro de mando integral en el despliegue de las estrategias de atención primaria. Ha permitido la gestión clínica y la mejora de los indicadores relevantes (salud, experiencia del paciente y costes) tal y como promueven los modelos de gestión que hemos utilizado como referentes (EFQM y Kaplan y Norton) y los nuevos escenarios emergentes (triple meta) (AU)

Objectives. To describe the design, implementation, and monitoring of eSOAP (Primary Health Care Balanced Scorecard) and its role in the deployment of strategic objectives and clinical management, as well as to show the lessons learned during six years of follow-up. Method. Descriptive study areas: methodology (conceptual framework, strategic matrix, strategic map, and processes map), technology and standardisation. Results. As of December 2014, 9,046 (78%) professionals are registered in eSOAP. A total of 381 indicators were measured from 16 data sources, of which 36% were of results (EFQM model), 39.1% of clinical management, and 20% were included in the Program Centre Contract. The Balanced Scorecard has enabled to deploy all strategic lines of Primary Health Care, and has enabled the healthcare professionals to evaluate the evolution of results over time, and at patient level (e.g. 16% increase in control of diabetic patients). A total of 295,779 reports were generated and 13,080 professionals were evaluated by goals. Conclusions. There was an increased use of the eSOAP application by the professionals. The Balanced Scorecard was the key in deploying Primary Health Care strategies. It has helped clinical management and improved relevant indicators (health, patient experience, and costs), such as the management models that we used as references (EFQM Kaplan and Norton), and new emerging scenarios (Triple aim) (AU)

Sección de Neumología Pediátrica del Hospital General Universitario Gregorio Marañón / Pediatric Pneumology section of the Hospital General Universitario Gregorio Marañón

En este documento resumimos cómo entendemos que debe ser la atención sanitaria a la población pediátrica con patología respiratoria, liderada por un servicio altamente especializado que atienda adecuadamente la vertiente asistencial, y de respuesta a la demanda docente (pre y postgrado) e investigadora—innovadora propias de un centro de tercer nivel y alta complejidad; todo ello bajo estándares de calidad y controles externos como es el caso del laboratorio de función pulmonar acreditado según Norma ISO 9001 y de las Consultas externas a las que se va a ampliar el alcance de dicha certificación. Se describen la Misión, Visión y Valores; los objetivos asistenciales, sociales y de docencia e investigación y las líneas estratégicas de Gestión Clínica de la Sección de Neumología Pediátrica (Pacientes/Profesionales/Procesos/Alianzas Estratégicas/Calidad Asistencial). A continuación, se describe la Cartera de Servicios, la Estructura y los Recursos (humanos y materiales) con los que cuenta nuestra Sección, para desarrollar una actividad orientada a la humanización de todo el proceso asistencial del paciente pediátrico con patología respiratoria, siguiendo la línea estratégica del Servicio Madrileño de Salud. Por último, hacemos referencia a los Programas Específicos de Gestión — Áreas de Mejora, a medio y largo plazo, que permitan consolidarnos como una Sección de Neumología Pediátrica referente en nuestro ámbito (AU)

With this document we aim to show what we believe health care for the pediatric population who suffer respiratory pathology should be like; it should be led by highly specialized personnel Who can attend to the patients, and should be able to handle the demand for educational health-oriented work placements (pre and post—graduate) as well as the demand for investigation and innovation which are part and parcel of a highly complex and third level centre. All of this should be enveloped in high level of quality and external controls as is the case of the lung function laboratory accredited by Norma ISO 9001 and the Outpatient Clinics which will also be included by the same certificate. We outline our mission, our vision our values; the objectives for patient attendance, and as social, teaching and investigative objectives and the strategies for Clinical management within the Pediatric Pneumology Unit (Patients/Professionals/Processes/ Strategic Allíances/Healthcare Quality management). We continue by describing the full list of services we offer, in order to develop an activity which is oriented to the humanization of the attendance process for the pediatric patient with respiratory problem, in line with the Madrid Health Service Strategies. Finally, we make reference to specific Management Programmes - areas in which we can improve, in the medium to long-term, which will allow us to consolidate our position as the Pediatric Pneumology Unit of reference in our field (AU)

Mothercraft: Birth work and the making of neoliberal mothers.

The literature on neoliberal health governance explores how macro-economic neoliberal policies as well as individual attitudes and behaviors reflect an increasingly individualized construction of health and citizens' responsibility over it. This study contributes to this literature and expands it in important ways. Drawing on qualitative interviews from 22 midwives and birth workers (doulas, childbirth educators, lactation consultants) practicing in the US, this study explores how midwives and birth workers act as "experts of conduct" who promote certain neoliberal values in their logics of care and interactions with clientele. The findings reveal that midwives and birth workers promote a form of maternal neoliberal health governance by: 1) making distinctions between their clientele that signal differences in health competence and resources, 2) encouraging autonomy and responsibility over birth experiences, and 3) promoting an empowerment discourse that hinges implicitly on an exclusionary consumer choice rhetoric. Midwives and birth workers are crucially implicated in shaping maternal subjectivities through pedagogical interactions I refer to as "mothercraft." This study illustrates how the promotion of certain health identities by experts further stratifies patient populations, exacerbating differences between women based on their socioeconomic status, racial-ethnic, and cultural positions.

Análisis y evaluación de resultados tras la implantación de un programa de prescripción electrónica asistida en un hospital de tercer nivel / Analysis and evaluation of results following the implementation of a programme of e-prescribing in a tertiary hospital

Introducción: la Prescripción Electrónica Asistida (PEA), constituye en la actualidad una herramienta útil en el proceso de hospitalización. La supresión de la prescripción y/o transcripción manuscrita, ha conseguido minimizar los errores relacionados con la medicación, mitigando la constante preocupación que supone la seguridad del paciente. Objetivo: analizar los datos de intervención farmacéutica registrados tras la implantación de un software de prescripción electrónica y la seguridad que confiere al usuario. Material y método: estudio retrospectivo de cinco meses de duración, en el que se revisaron las historias clínicas electrónicas de prescripción, describiendo los errores de medicación detectados y el número de intervenciones farmacéuticas realizadas. Resultados: sobre un total de 27.533 validaciones, fueron realizadas 4.917 intervenciones farmacéuticas (IF), lo que supone 32,78 errores de medicación/día y 0,95 errores/paciente

Introduction: the Electronically Assisted Prescription (EAP) is now a useful tool in the process of hospitalization. The removal of the prescription or transcript handwritten, has managed to minimize errors related to medication, mitigating the constant concern involving the safety of the patient. Objective: to analyze data pharmaceutical intervention reported following implementation of a software for e-prescribing and the security that gives the user. Materials and methods: retrospective study of five months duration, which reviewed the electronic medical records of prescription, describing medication errors that are detected and the number of pharmaceutical interventions carried out. Results: out of a total of 27.533 validations, were performed 4.917 pharmaceutical interventions (IF), which represents 32.78 medication errors per day and 0.95 errors per patient

Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal.

BACKGROUND: The need of improving the governance of healthcare services has brought health professionals into management positions. However, both the processes and outcomes of this policy change highlight differences among the European countries. This article provides in-depth evidence that neither quantitative data nor cross-country comparisons have been able to provide regarding the influence of hybrids in the functioning of hospital organizations and impact on clinicians' autonomy and exposure to hybridization. METHODS: The study was designed to witness the process of institutional change from the inside and while that process was underway. It reports a case study carried out in a public hospital in Portugal when the establishment of a clinical directorate was being negotiated. Data collection comprises semi-structured interviews with general managers and surgeons complemented with observations. RESULTS: The clinical directorate under study illustrates a divisionalized professional bureaucracy model that combines features of professional bureaucracies and divisionalized forms. The hybrid manager is key to understand the extent to which practising clinicians are more accountable and to whom given that managerial tools of control have not been strengthened, and trust-based relations allow them to keep professional autonomy untouched. In sum, clinicians are allowed to profit from their activity and to perform autonomously from the hospital's board of directors. The advantageous conditions enjoyed by the clinical directorate intensify internal re-stratification in medicine, thus suggesting forms of divisionalized medical professionalism grounded in organizational dynamics. CONCLUSION: It is discussed the extent to which policy change to the governance of health organizations regarding the relationship between medicine and management is subject to specific constraints at the workplace level, thus conditioning the expected outcomes of policy setting. The study also highlights the role of hybrid managers in determining the extent to which practising professionals are more accountable to managerial criteria. The overall conclusion is that although medical and managerial values link to each other, clinicians reconfigure managerial criteria according to specific interests. Ultimately, medical autonomy and authority may be reinforced in organizational settings subject to NPM-driven reforms.

Uncomfortable realities: the challenge of creating real change in Europe's consolidating hospital sector.

BACKGROUND: This article examines uncomfortable realities that the European hospital sector currently faces and the potential impact of wide-spread rationalization policies such as (hospital) payment reform and privatization. METHODS: Review of relevant international literature. RESULTS: Based on the evidence we present, rationalization policies such as (hospital) payment reform and privatization will probably fall short in delivering better quality of care and lower growth in health expenses. Reasons can be sought in a mix of evidence on the effectiveness of these rationalization policies. Nevertheless, pressures for different business models will gradually continue to increase and it seems safe to assume that more value-added process business and facilitated network models will eventually emerge. CONCLUSIONS: The overall argument of this article holds important implications for future research: how can policymakers generate adequate leverage to introduce such changes without destroying necessary hospital capacity and the ability to produce quality healthcare.

Unidades de gestión clínica en Neurociencias / Clinical management departments for the neurosciences

Introducción: Las unidades de gestión clínica de Neurociencias (UGC) representan una fórmula de organización de los hospitales basadas en la atención centrada en el pacientes y las fórmulas de gestión clínica y administración. Desarrollo: Los autores revisan la puesta en marcha y los distintos modelos de UGC en España, así como sus problemas de desarrollo, con especial mención a aquellas que tratan al paciente neurológico. Conclusiones: Las neurociencias, por la propia variabilidad y el coste del paciente neurológico, por la necesaria coordinación que debe existir en los servicios que lo asisten y, probablemente, por el propio dinamismo que tiene esta área de conocimiento, posiblemente ofrecen un marco conveniente para unidades que los integren. Las dificultades de implantación como de aceptación del nuevo modelo lo han limitado hasta la actualidad

Introduction: Neuroscience-related clinical management departments (UGC in Spanish) represent a means of organising hospitals to deliver patient-centred care as well as specific clinical and administrative management models. Development: The authors review the different UGC models in Spain and their implementation processes as well as any functional problems. We pay special attention to departments treating neurological patients. Conclusions: Neuroscience-related specialties may offer a good framework for the units that they contain. This may be due to the inherent variability and costs associated with neurological patients, the vital level of coordination that must be present between units providing care, and probably to the dynamic nature of the neurosciences as well. Difficulties associated with implementing and gaining acceptance for the new model have limited such UGCs until now

Quality and impact of appraisal for revalidation: the perceptions of London's responsible officers and their appraisers.

BACKGROUND: To evaluate NHS England London region's approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice. METHODS: A pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation. RESULTS: The central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer's practice by providing an 'outsider perspective'. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement. CONCLUSIONS: Responsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective.

Evaluación e impacto del uso de las tecnologías de la información y comunicación para la gestión clínica y seguimiento compartido y consensuado de las úlceras por presión / Evaluation and impact on the use of information and communication technology in the clinical management and agreed shared monitoring of pressure ulcers

Objetivo. Afrontar el grave problema de las úlceras por presión (UPP) implica buscar nuevos métodos y estrategias de registro, valoración y una estandarización de los criterios de intervención. La aplicación de las nuevas tecnologías de la información y las comunicaciones (TIC) constituye alternativa prometedora, a la vez que surge la necesidad de realizar estudios que corroboren su impacto. En este escenario, se presenta una aplicación informática específica de gestión de UPP, y se plantea valorar su aceptabilidad, utilidad y aplicabilidad por parte de profesionales enfermeros de 3 residencias de mayores, durante un año. Material y métodos. Se diseña y evalúa una aplicación informática que permite, partiendo de una recogida de datos completa, y un exhaustivo tratamiento e interpretación: 1) la gestión y seguimiento de las UPP; 2) la valoración del riesgo de padecer UPP; 3) el cribado del estado nutricional y, 4) el intercambio de datos entre profesionales y niveles asistenciales. Esto, que podría constituir un nuevo enfoque basado en el uso de TIC, como herramienta de cuidado compartido y consenso, tiene por delante un importante recorrido en términos de evaluación, al que se pretende contribuir mediante este artículo. Resultados. Los 3 centros han participado con 69 residentes. Se han realizado 27 cribados del estado nutricional, 22 valoraciones del riesgo de UPP y 230 monitorizaciones de lesiones. Conclusiones. Los profesionales enfermeros consideran que el sistema es útil, de fácil uso, perciben que mejora el seguimiento del paciente, no así la interrelación profesional. Acelerarían los procesos y potenciarían la parte web (AU)

Objective. Tackling the huge problem of Pressure Ulcers (PU), involves looking for new recording methods and strategies, as well as the standardization of the assessment and intervention criteria. In this context, a specific software application for PU management has been developed and was used for assessing its acceptability, usefulness and applicability by professional nurses from three residential homes for the elderly over a period of one year. Material and methods. A software application is designed and evaluated. This software application allows health professionals to: Manage and monitor PUs.; to determine the risk of PUs; and perform a nutritional status screen, based on a comprehensive data collection, processing and interpretation. It also allows health professionals to exchange data between themselves and at different care levels, which could provide a new approach based on the use of ICT as a tool for an agreement to shared care. This approach has an important journey ahead in terms of its assessment, to which we attempt to contribute through this article. Results. Three centres and 69 residents are taking part in this project. During these processes, 27 nutritional status screens and 22 PU risk assessments, as well as the monitoring of 230 PUs have been performed. Conclusions. Nurses professionals think that the system is useful, easy to use, and perceive that it improves patient monitoring, but not relationship between professionals. Moreover, they would like to makethe web a more powerful part of the application and to speed up the procedures (AU)

The Francis Report--implications for the regulator.

The professional regulators were identified in the Francis Report as having a central role in maintaining fundamental standards of care. This paper describes the key themes in the Report and the importance of regulatory powers to ensure that the serious failings in patient care highlighted by the Mid-Staffs Inquiry cannot be repeated. The central role of the GDC Standards in the profession's response to the Francis Report is stressed. Clinical Relevance: The importance of our professional regulator in ensuring adherence to fundamental standards of care is a central tenet of clinical dentistry.