Professional autonomy and surveillance: the case of public reporting in cardiac surgery

Exworthy, Mark; Gabe, Jonathan; Jones, Ian Rees; Smith, Glenn

doi:10.1111/1467-9566.12883

Cited by 12 publications

(11 citation statements)

References 53 publications

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“…On a general level, such limited influence might have implications for the contents of work schedules that are developed for medical work. As such our finding does not confirm recent suggestions about an assimilation of the managerial logic into a professional logic (Exworthy et al, 2019).…”

Section: Discussioncontrasting

confidence: 99%

Implementing New Practice: The Roles of Translation, Progression and Reflection

Nilsen

Sandaunet

2020

Journal of Change Management

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The aim of this article is to assess the contribution provided by the instrumental theory of translation when conceptualizing micro processes of change. A core assumption of this framework is that the translation of management ideas is characterized by regularities, or translation rules, and that performance of translation rules depends on translation competence. The assessment is based on an exploration of how the process of providing contents to a new model of manpower planning among doctors in a Norwegian health trust unfolded. Participant observation and documents represent the main sources of data. The analysis demonstrates that project methodology competence emerges as a key factor of influence on the performance of translation rules, leading to the interpretation that there is a 'taken-for-grantedness' in change implementation which suggests additional competences at play. We propose that the instrumental theory of translation would benefit from extending the framework for contextualizing the performance of translation rules. MAD statement Empirical insights from this article relate to the increasing number of change agents that are assigned the task of translating management ideas into organizations. Traditionally, research on change management does not combine a focus on the translation of ideas and the design of change processes. Empirical data from this study, however, demonstrate that change design competences are part of a 'taken-for-grantedness' in change implementation, which might impact how new management ideas are being translated. We suggest that change agents will benefit from both raising the awareness of conducting translations, and of the impact of change design when translating management ideas.

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Section: Discussioncontrasting

confidence: 99%

Implementing New Practice: The Roles of Translation, Progression and Reflection

Nilsen

Sandaunet

2020

Journal of Change Management

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“…Others have also reported that the registration burden is perceived as taking time away from patient care 24,45 and found resistance to quality registrations. 46 This reasoning might also explain the reluctance to register observed in our study. In addition, our findings suggest that external regulations (in our case mandatory quality registrations perceived as unreasonable) reduces the intrinsic motivation of healthcare professionals.…”

Section: Discussionmentioning

confidence: 68%

Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study

Zegers¹,

Veenstra

Gerritsen

et al. 2020

Int J Health Policy Manag

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Background: Quality indicators are registered to monitor and improve the quality of care. However, the number and effectiveness of quality indicators is under debate, and may influence the joy in work of physicians and nurses. Empirical data on the nature and consequences of the registration burden are lacking. The aim of this study was to identify and explore healthcare professionals’ perceived burden due to quality registrations in hospitals, and the effect of this burden on their joy in work. Methods: A mixed methods observational study, including participative observations, a survey and semi-structured interviews in two academic hospitals and one teaching hospital in the Netherlands. Study participants were 371 healthcare professionals from an intensive care unit (ICU), a haematology department and others involved in the care of elderly patients and patients with prostate or gastrointestinal cancer. Results: On average, healthcare professionals spend 52.3 minutes per working day on quality registrations. The average number of quality measures per department is 91, with 1380 underlying variables. Overall, 57% are primarily registered for accountability purposes, 19% for institutional governance and 25% for quality improvement objectives. Only 36% were perceived as useful for improving quality in everyday practice. Eight types of registration burden were identified, such as an excessive number of quality registrations, and the lack of usefulness for improving quality and inefficiencies in the registration process. The time healthcare professionals spent on quality registrations was not correlated with any measure of joy in work. Perceived unreasonable registrations were negatively associated with healthcare professionals’ joy in work (intrinsic motivation and autonomy). Healthcare professionals experienced quality registrations as diverting time from patient care and from actually improving quality. Conclusion: Registering fewer quality indicators, but more of what really matters to healthcare professionals, is key to increasing the effectiveness of registrations for quality improvement and governance. Also the efficiency of quality registrations should be increased through staffing and information and communications technology solutions to reduce the registration burden experienced by nurses and physicians.

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“…17 If compliance in gathering patient outcomes is poor, there is a risk that a registry could be used as surgeon surveillance instead which in turn may lead to higher-risk cases being avoided. 18 …”

Section: Discussionmentioning

confidence: 99%

The impact of a spinal best practice tariff on compliance with the British Spine Registry

et al. 2021

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Aims The British Spine Registry (BSR) was introduced in May 2012 to be used as a web-based database for spinal surgeries carried out across the UK. Use of this database has been encouraged but not compulsory, which has led to a variable level of engagement in the UK. In 2019 NHS England and NHS Improvement introduced a new Best Practice Tariff (BPT) to encourage input of spinal surgical data on the BSR. The aim of our study was to assess the impact of the spinal BPT on compliance with the recording of surgical data on the BSR. Methods A retrospective review of data was performed at a tertiary spinal centre between 2018 to 2020. Data were collated from electronic patient records, theatre operating lists, and trust-specific BSR data. Information from the BSR included operative procedures (mandatory), patient consent, email addresses, and demographic details. We also identified Healthcare Resource Groups (HRGs) which qualified for BPT. Results A total of 3,587 patients were included in our study. Of these, 1,684 patients were eligible for BPT. Between 2018 and 2019 269/974 (28%) records were complete on the BSR for those that would be eligible for BPT. Following introduction of BPT in 2019, 671/710 (95%) records were complete having filled in the mandatory data (p < 0.001). Patient consent to data collection also improved from 62% to 93%. Email details were present in 43% of patients compared with 68% following BPT introduction. Conclusion Our study found that following the introduction of a BPT, there was a statistically significant improvement in BSR record completion compliance in our unit. The BPT offers a financial incentive which can help generate further income for trusts. National data input into the BSR is important to assess patient outcome following spinal surgery. The BSR can also aid future research in spinal surgery. Cite this article: Bone Jt Open 2021;2-3:198–201.

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Professional autonomy and surveillance: the case of public reporting in cardiac surgery

Cited by 12 publications

References 53 publications

Implementing New Practice: The Roles of Translation, Progression and Reflection

Implementing New Practice: The Roles of Translation, Progression and Reflection

Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study

The impact of a spinal best practice tariff on compliance with the British Spine Registry

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