Search PubMed⌕ Search

Biomedical subjects

S Dopson

Publications and source records attributed to S Dopson.

14 recordsLinked to original sources
PubMed2001

Commissioning. When push comes to shove.

A study of four HAs in three regions found that they had little influence on encouraging trusts to implement the recommendations of the Changing Childbirth report over the period 1993-98. Where changes had been introduced this was often through the influence of an opinion leader in the trust, such as directors of midwifery. The results suggest healthcare professionals providing services have substantial influence over the fate of strategic change initiatives.

Attitude of Health Personnel↗
PubMed2001

Understanding the role of opinion leaders in improving clinical effectiveness.

We present findings from evaluations of two government-funded initiatives exploring the transfer of research evidence into clinical practice--the PACE Programme (Promoting Action on Clinical Effectiveness), and the Welsh Clinical Effectiveness Initiative National Demonstration Projects. We situate the findings within the context of available research evidence from healthcare and other settings on the role of opinion leaders or product champions in innovation and change--evidence which leaves a number of problems and unanswered questions. A major concern is the difficulty of achieving a single replicable description of what opinion leaders are and what they do--subjective understandings of their role differ from one setting to another, and we identify a range of very different types of opinion leadership. What makes someone a credible and influential authority is derived not just from their own personality and skills and the dynamic of their relationship with other individuals, but also from other context-specific factors. We examine the question of expert versus peer opinion leaders, and the potential for these different categories to be more or less influential at different stages in the innovation process. An often neglected area is the impact of opinion leaders who are ambivalent or hostile to an innovation. Finally, we note that the interaction between individual opinion leaders and the collective process of negotiating a change and reorienting professional norms remains poorly understood. This raises a number of methodological concerns which need to be considered in further research in this area.

Evidence-Based Medicine↗
PubMed2001

Implementation of evidence-based medicine: evaluation of the Promoting Action on Clinical Effectiveness programme.

OBJECTIVES: To evaluate the Promoting Action on Clinical Effectiveness (PACE) programme, which sought to implement clinically effective practice in 16 local sites. METHODS: 182 semi-structured interviews, usually by telephone, with project team members, clinicians, and senior managers and representatives from the Department of Health and the King's Fund. RESULTS: The most influential factors were strong evidence, supportive opinion leaders and integration within a committed organization; without these factors, projects had little chance of success. Other factors (context analysis, professional involvement and good project management) emerged as important, supporting processes; their presence might be an additional help, but on their own they would not be enough to initiate change. A serious problem with any of them could have a strong adverse impact. CONCLUSIONS: Although there is no simple formula for the factors that ensure successful implementation of research-based improvements to clinical practice, certain principles do seem to help. Time and resource need to be devoted to a period of local negotiation and adaptation of good research evidence based on a careful understanding of the local context, in which opinion leader influence is an important component of a well managed and preferably well integrated process of change.

Diffusion of Innovation↗
PubMed1999

Influences on clinical practice: the case of glue ear.

A case study of clinical practice in children with glue ear is presented. The case is part of a larger project, funded by the North Thames Research and Development Programme, that sought to explore the part played by clinicians in the implementation of research and development into practice in two areas: adult asthma and glue ear in children. What is striking about this case is the differences found in every area of the analysis. That is, diversity was found in views about diagnosis and treatment of glue ear; the organisation of related services; and in the reported practice of our interviewees, both between particular groupings of clinical staff and within these groupings. The challenge inherent in the case is to go beyond describing the complexity and differences that were found, and look for patterns in the accounts of practice and tease out why such patterns may occur.

Attitude of Health Personnel↗
PubMed1999

Changing clinical practice: views about the management of adult asthma.

A case study of clinical practice in adult asthma is presented. The case is part of a larger project, funded by the North Thames NHS Executive Research and Development Programme, that sought to explore the part played by clinicians in the implementation of research and development into practice in two areas: adult asthma and glue ear in children. The first case of glue ear in children was reported in a previous issue of this journal (Quality in Health Care 1999;8:99-107). Background information from secondary sources on the condition, treatment, and organisation and location of care is followed by an account of the results of semistructured interviews with 159 clinicians. The findings are reported in two sections: clinical management and the organisation of care, and clinicians' accounts of what, why, and how they introduce changes into their practice. The way clinicians talk about their learning, their expressed views on acceptable practice, and their willingness to change were shown to be informed by construction of legitimate and sufficient evidence, respected colleagues, and accumulated individual experience. There was little open acknowledgment of the influence of organisational factors in influencing practice. To investigate whether relationships between task performance and organisational arrangements found in other sectors apply to UK health, more robust measures by which performance can be evaluated are needed.

Adult↗
PubMed1998

The changing role of the regional tier of the NHS.

Reviews the past role of regional health authorities in the the British NHS and gives details of the recent changes to regions associated with the functions and responsibilities paper. Goes on to give details of the research project in which we are currently involved and reports on our interim findings (as of April 1996). In a final discussion section, reflects on those findings in terms of the evolving problems of influence and control in a national service operating in a devolved quasi-market.

Decision Making, Organizational↗
PubMed1994

Management: the one disease consultants did not think existed.

Considers progress made in involving doctors in management, drawing on available ethnographies of local health-care systems and a small-scale study of consultants who have moved into clinical director roles or the equivalent. Specifically considers the extent to which the sample believes consultant roles have changed as a result of the recent reorganization of the NHS and general concerns about the involvement of doctors in management.

Anthropology, Cultural↗
PubMed1994

Getting research into practice: facing the issues.

The translation of research into practice is currently a high-profile issue in the NHS. A number of regions have undertaken work in this area. Reports on a project that is part of the Anglia and Oxford Regions's "getting Research into Practice" (GRiP) initiative. The work focuses on the use of steroids in pre-term delivery, a procedure that medical evidence suggests can reduce neo-natal mortality and morbidity. Presents a number of findings which suggest that getting research into practice does not merely rest on the availability of well-researched evidence.

Attitude of Health Personnel↗
PubMed1988

Griffiths in theory and practice: a research assessment.

This paper focuses upon one of the major recommendations of the Griffiths Report: the appointment of general managers at each level in the NHS. It is based on a study of a sample of 20 district general managers (DGMs) who had been followed for a year to 18 months at the time this paper was written. Their first major task was to restructure their districts; some of the variations in these structures are described, together with what happened to officers from different professional backgrounds, and the reactions of the doctors, nurses, and paramedics. The ways in which the DGMs sought to change the culture of the NHS are outline. A number of major ongoing dilemmas are identified. The study suggests what the learning needs are of present and future general managers.

Administrative Personnel↗