Health services tend to be over-managed and under-led and there is a need to harness the potential of front-line nurses by facilitating leadership development through appropriate organisational support.

Purpose Assessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as critical. Much patient experience research is quantitative and survey based. The purpose of this paper is to report a qualitative study gathering in-depth data in an emergency department (ED). Design/methodology/approach The authors used empirical data from seven focus groups to understand patient experience as participants progressed through a major teaching hospital in an Ireland ED. A convenience sampling technique was used, and 42 participants were invited to share their perceptions and outline key factors affecting their journey. A role-playing exercise was used to develop improvement themes. Data were analysed using thematic analysis and data analysis software (NVivo 10). Findings Capturing ED patient experience increases our understanding and process impact on the patient journey. Factors identified include information, access, assurance, responsiveness and empathy, reliability and tangibles such as surroundings, food and seating. Research limitations/implications Owing to the ED patient’s emergency nature, participants were recruited if triaged at levels 3–5 (Manchester Triage System). The study explored patients’ immediate rather than post hoc experiences where recollections may change over time. Originality/value To the authors’ knowledge, no study has examined in-depth, ED patient experience in Ireland using qualitative interviewing, obtaining critical process insights as it occurs. The potential to inform patient process improvements in Irish EDs is significant.

Background Increasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross‐disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two drivers: person‐centred care and health promotion; five critical enablers also need to be addressed: information technology, quality measures, infrastructure, incentive systems, and contracting strategies. Method In order to develop and test the roadmap, a COST Action project was initiated: COST−CARES, with 28 participating countries. This paper provides an overview of evidence about the effects of each of the identified enablers. Intersections between the drivers and the enablers are identified as critical for the success of future cost containment, in tandem with maintained or improved quality in healthcare. This will require further exploration through testing. Conclusion Cost containment of future healthcare, with maintained or improved quality, needs to be addressed through a concerted approach of testing key factors. We propose a framework for test lab design based on these drivers and enablers in different European countries.

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Politicians and national policy makers seek to encourage individuals to engage in a wide range of pro-environmental practices to address both discrete environmental problems and major global challenges such as climate change. Theoretically, the field of behavioural management in environmental consumption which seeks to change holarchic open human systems, is much contested. This paper proposes to develop a synthesized conceptual framework embracing a unified approach that addresses the systematic, structural, and institutional perspectives on how consumption, through public policy initiatives, can be developed and changed to reflect a deeper ecological foundation. This approach considers the debate regarding policy and behavioural change; as policies needed to enact large-scale change can often be seen as politically charged. The paper, in exploring the literature regarding the values that influence sustainable consumption behaviour in society, seeks to define the interplay of societal paradigms with regard to their influence on an individual"s motivations. The aim of this paper is to add to the debate on political governance in the context of enhancing sustainability in complex adaptive social systems, and guiding the development of sustainable consumption policy towards a new environmental paradigm.