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Martin Marshall

Publications and source records attributed to Martin Marshall.

10 recordsLinked to original sources
PubMed2003

The quantitative measurement of organizational culture in health care: a review of the available instruments.

OBJECTIVE: To review the quantitative instruments available to health service researchers who want to measure culture and cultural change. DATA SOURCES: A literature search was conducted using Medline, Cinahl, Helmis, Psychlit, Dhdata, and the database of the King's Fund in London for articles published up to June 2001, using the phrase "organizational culture." In addition, all citations and the gray literature were reviewed and advice was sought from experts in the field to identify instruments not found on the electronic databases. The search focused on instruments used to quantify culture with a track record, or potential for use, in health care settings. DATA EXTRACTION: For each instrument we examined the cultural dimensions addressed, the number of items for each questionnaire, the measurement scale adopted, examples of studies that had used the tool, the scientific properties of the instrument, and its strengths and limitations. PRINCIPAL FINDINGS: Thirteen instruments were found that satisfied our inclusion criteria, of which nine have a track record in studies involving health care organizations. The instruments varied considerably in terms of their grounding in theory, format, length, scope, and scientific properties. CONCLUSIONS: A range of instruments with differing characteristics are available to researchers interested in organizational culture, all of which have limitations in terms of their scope, ease of use, or scientific properties. The choice of instrument should be determined by how organizational culture is conceptualized by the research team, the purpose of the investigation, intended use of the results, and availability of resources.

Health Services Research↗
PubMed2003

Does organisational culture influence health care performance? A review of the evidence.

OBJECTIVE: To review the evidence for a relationship between organisational culture and health care performance. METHODS: Qualitative comprehensive review: all empirical studies exploring a relationship between organisational culture (broadly defined) and health care performance (broadly defined) were identified by a comprehensive search of the literature. Study methods and results were analysed qualitatively to provide a narrative review with integrative discussion. RESULTS: Ten studies met the inclusion criteria. There was considerable variation in the design, study setting, quality of reporting and aspects of culture/performance considered. Four of the ten studies reviewed in detail claimed to have uncovered supportive evidence for the hypothesis that culture and performance are linked. All the other studies failed to find a link, though none provided strong evidence against the hypothesis. CONCLUSIONS: There is some evidence to suggest that organisational culture may be a relevant factor in health care performance, yet articulating the nature of that relationship proves difficult. Simple relationships such as 'strong culture leads to good performance' are not supported by this review. Instead, the evidence suggests a more contingent relationship, in that those aspects of performance valued within different cultures may be enhanced within organisations that exhibit those cultural traits. A striking finding is the difficulty in defining and operationalising both 'culture' and 'performance' as variables that are conceptually and practically distinct. Considerably greater methodological ingenuity will be required to unravel the relationship(s) between organisational culture(s) and performance(s). Current policy prescriptions, which seek service improvements through cultural transformation, are in need of a more secure evidential base.

Efficiency, Organizational↗
PubMed2002

User involvement in clinical governance.

OBJECTIVES: To investigate the involvement of users in clinical governance activities within Primary Care Groups (PCGs) and Trusts (PCTs). Drawing on policy and guidance published since 1997, the paper sets out a framework for how users are involved in this agenda, evaluates practice against this standard and suggests why current practice for user involvement in clinical governance is flawed and why this reflects a flaw in the policy design as much as its implementation. DESIGN: Qualitative data comprising semi-structured interviews, reviews of documentary evidence and relevant literature. SETTING: Twelve PCGs/PCTs in England purposively selected to provide variation in size, rurality and group or trust status. PARTICIPANTS: Key stakeholders including Lay Board members (n = 12), Chief Executives (CEs) (n = 12), Clinical Governance Leads (CG leads) (n = 14), Mental Health Leads (MH leads) (n = 9), Board Chairs (n = 2) and one Executive Committee Lead. RESULTS: Despite an acknowledgement of an organizational commitment to lay involvement, in practice very little has occurred. The role of lay Board members in setting priorities and implementing and monitoring clinical governance remains low. Beyond Board level, involvement of users, patients of GP practices and the general public is patchy and superficial. The PCGs/PCTs continue to rely heavily on Community Health Councils (CHCs) as a conduit or substitute for user involvement; although their abolition is planned, their role to be fulfilled by new organizations called Voices, which will have an expanded remit in addition to replacing CHCs. CONCLUSIONS: Clarity is required about the role of lay members in the committees and subcommittees of PCGs and PCTs. Involvement of the wider public should spring naturally from the questions under consideration, rather than be regarded as an end in itself.

Community Participation↗
PubMed2002

Lumbar artery pseudoaneurysm following renal biopsy: treatment with ultrasound-guided thrombin injection.

latrogenic pseudoaneurysms are usually seen following arterial catheterization. However, we describe a case of a 23-year-old woman who developed a pseudoaneurysm of a lumbar artery following renal biopsy. In view of her progressing renal failure, arterial embolization was felt to be inappropriate, and although the pseudoaneurysm could be seen ultrasonically, guided compression could not be applied because of the location of the aneurysm deep to the lumbar musculature. Hence, the pseudoaneurysm was thrombosed by percutaneous ultrasound-guided injection of thrombin directly into the pseudoaneurysm sac. This resulted in immediate thrombosis of the aneurysm and no recurrence on follow-up imaging. Thrombin injection for femoral artery pseudoaneurysms following catheterization is becoming more widely accepted, and our case demonstrates that this technique might be applied to pseudoaneurysms elsewhere in the body.

Adult↗
PubMed2002

Treatment of iatrogenic femoral artery false aneurysms with ultrasound-guided thrombin injection.

The aim of this paper is to review our results of treating iatrogenic pseudoaneurysms of the femoral artery with ultrasound-guided thrombin injection. A retrospective review was carried out of all patients referred for this procedure over a 1-year period from December 1999 to December 2000. Forty-five patients were referred and, of these, 44 were eligible for this treatment, with 300-2500 units of thrombin being injected directly into the false aneurysms under ultrasound guidance. The procedure was well tolerated with no patients requiring sedation or analgesia. There was a primary success rate of 95%, although in four of the patients, there was recurrence on repeat ultrasound performed 2-5 days post-procedure and a second injection of thrombin was required for permanent thrombosis to be achieved. No complications relating to the procedure occurred. Our results confirm increasing evidence in the published research that thrombin injection of femoral artery false aneurysms is a safe and effective treatment.

Aneurysm, False↗
PubMed2002

A qualitative study of the cultural changes in primary care organisations needed to implement clinical governance.

BACKGROUND: It is commony claimed that changing the culture of health organisations is a fundamental prerequisite for improving the National Health Service (NHS). Little is currently known about the nature or importance of culture and cultural change in primary care groups and trusts (PCG/Ts) or their constituent general practices. AIMS: To investigate the importance of culture and cultural change for the implementation of clinical governance in general practice by PCG/Ts, to identify perceived desirable and undesirable cultural attributes of general practice, and to describe potential facilitators and barriers to changing culture. DESIGN: Qualitative: case studies using data derived from semi-structured interviews and review of documentary evidence. SETTING: Fifty senior non-clinical and clinical managers from 12 purposely sampled PCGs or trusts in England. RESULTS: Senior primary care managers regard culture and cultural change as fundamental aspects of clinical governance. The most important desirable cultural traits were the value placed on a commitment to public accountability by the practices, their willingness to work together and learn from each other, and the ability to be self-critical and learn from mistakes. The main barriers to cultural change were the high level of autonomy of practices and the perceived pressure to deliver rapid measurable changes in general practice. CONCLUSIONS: The culture of general practice is perceived to be an important component of health system reform and quality improvement. This study develops our understanding of a changing organisational culture in primary care; however, further work is required to determine whether culture is a useful practical lever for initiating or managing improvement.

Attitude of Health Personnel↗