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Contracts are about much more than the simple purchasing of services. In an NHS context, they are also about working in partnership with patients, and about good employment practices, writes Judy Hargadon. Here she outlines how contracts can be used to improve health care services, and the health of those involved in both receiving and providing that care.
Health profiling is a central aspect of health visiting practice, writes Ian Bell. Here he describes the development of a profiling tool for use with all age groups to enable accurate assessment of clients' health needs.
OBJECTIVE: TO assess the maintenance of safe sexual practice. (We use the term 'safe' sex throughout the paper, since 'safe' is the term adopted by the Australian National Committee on AIDS). DESIGN: Maintenance was assessed by comparing sexual behaviour with both regular and casual partners reported in a 1986/1987 survey (time 1) with behaviour reported in a second survey in 1991 (time 2). METHOD: The 145 homosexually active participants were a non-clinical sample recruited in 1986/1987 by advertisement and followed-up in 1991. A structured questionnaire was administered at both times. Items included questions about the nature of the men's sexual relationships and their sexual practices. RESULTS: Our findings indicate that the majority of men had sustained safe sex practices. HIV prevention strategies adopted included condom use, avoidance of anal intercourse and negotiated safety (i.e., the negotiated practice of unprotected anal intercourse within regular partnerships of concordant serostatus). CONCLUSIONS: Negotiated safety is not the same as relapse.
OBJECTIVE: The publication of information about the performance of health-care providers is regarded as central to promoting greater accountability and empowering patients to exercise choice. The evidence suggests that the public is not very interested in accessing or using current sources of information. This study aimed to explore the information needs of patients in the context of UK primary care and to develop an information source about general practice services, designed to be usable by and useful to patients. DESIGN: An action research study making use of data from formal and informal interviews, focus groups, participant observation and document review. SETTING: The geographical areas covered by two Primary Care Trusts in the north of England and two Local Health Boards in south Wales. PARTICIPANTS: A partnership between 103 members of the public, general practice staff from 19 practices, NHS managers from four Primary Care Organizations and the research team. RESULTS: The public would like to know more about the quality and range of general practice services but current sources of information do not meet their needs. The public do not like league tables comparing the performance of practices and only a small number of people want to use comparative information to choose between practices. They seem to be more interested in the context and availability of services and the willingness of practices to improve, than in the practice's absolute or relative performance. They want to be clear about the source of the information so that they can make personal judgements about its veracity. Information is most likely to be useful if it adheres to the basic principles of cognitive science in terms of its structure, content and presentation format. Using these findings, paper and electronic prototype versions of a guide to general practice services have been developed. CONCLUSIONS: In order to maximize the potential use of performance information by the public it is necessary to move beyond provider-led and professionally constructed approaches to information provision and ensure that the public is actively involved in the development of information sources. Such involvement produces a different kind of information to that currently available to the public. The findings of this study have important implications for policy. Most importantly, it seems that the traditional consumerist model underlying a policy of making comparative performance information available to the public to enable them to exercise choice between primary care providers may not be appropriate. An alternative model of information provision, which recognizes the public's commitment to their practice and is integrated with 'soft' sources of knowledge is more likely to engage and be of use to the public.
Patients want doctors who are competent, respectful, honest and able to communicate with them. This is patient-centred professionalism. In the United Kingdom, it is being embedded into practice by the General Medical Council (GMC) through medical regulation in a partnership between the public and doctors. The foundation is a national code of professional standards - Good Medical Practice - that has been tied to medical licensure to secure doctors' continuing compliance whilst they are in active practice. The revalidation of a doctor's license to practise is the means of achieving such compliance. Revalidation requires that specialists and general practitioners must be able to demonstrate - on a regular basis - that they are keeping themselves up to date and remain fit to practise in their chosen field. It begins in April 2005. For revalidation, doctors' performance, conduct and health will be assessed against the headings of Good Medical Practice. Doctors will collect a folder of illustrative evidence that will form the basis of an annual appraisal carried out at the workplace by an appropriately trained colleague. The results of these annual appraisals will be submitted to the GMC for a revalidation decision every 5 years. Where doctors' performance or conduct gives cause for concern, they may have to undergo a further searching assessment under the GMC's Fitness to Practise Procedures. Under these procedures the GMC can order a doctor to retrain or, if circumstances warrant it, to stop practising.
Demonstrating Excellence in Practice-based Teaching for Public Health is a report intended to provide a resource for practice-based teaching of public health and includes a brief explanation of terms and practices, as well as suggestions on methodologies for implementation. No comparable resource currently exists that assists faculty and practice partners to recognize, implement, and promote practice-based teaching. This article summarizes findings from the report, including an explanation of practice-based teaching, its guiding principles, practical approaches, and recommendations on sustaining and advancing partnerships for professional public health education and training.
Based on a 6-year, learn and earn curriculum, the authors report on a year-old project that assists licensed practical nurses (LPNs) to obtain a baccalaureate degree in nursing (BSN). Partnerships with 4 area healthcare agencies employing LPNs were developed to support students with full or partial tuition reimbursement and work schedules to accommodate classes. Key university staff in the offices of admissions, financial aid, adult programs and services, and nursing advisement are assigned to this student group to provide individualized assistance. The authors discuss unique components of the project including regularly scheduled role transition seminars, faculty mentors, BSN and nurse practitioner clinical mentors, and clinical experiences in nurse-managed clinics.
Biological threats to health are challenging governments worldwide. National strategies for preventing and managing existing and emerging threats require significant collaboration across borders, sectors, services, agencies and professions. Perhaps most important are the partnerships of key national health leaders who can develop and foster these relationships. Government Chief Nursing Officers (CNOs) and Chief Medical Officers (CMOs), providing leadership in more than 100 countries worldwide, play crucial roles in addressing biological threats to health. However, much of this leadership is exercised without the benefit of strong collaborative relationships between these two key national leaders. Unfortunately, without functional partnerships between nurses and physicians at all levels, national and global capacity to address biological and other threats will be greatly compromised. For these reasons, the first ever global forum for CNOs and CMOs teams was hosted by the Lillian Carter Center for International Nursing in Atlanta, in June 2004. Representatives from 70 countries focused on biological threats in relation to three key purposes: (1) gaining shared scientific and practical knowledge; (2) developing and strengthening collaboration and partnerships among CNOs and CMOs; and, (3) creating a joint plan for advancing national preparedness. This article describes the content, process and outcomes of this historic meeting.
Advanced practice nurses (APNs) in the community are in a prime position to respond to the changing health care environment stimulated by health care reform. An emerging practice model for APNs is parish nursing, community-based nursing practice set in communities of faith. Parish nursing stimulates shared public-private partnerships and is a consumer-oriented delivery system. The article describes the models, context, and practice of parish nursing, emphasizing the problem of evaluating outcomes. It also discusses implications for research and education. Parish nursing is a significant practice model affording APNs the opportunity to contribute to healthier communities.
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Iron fortification of food is a methodology utilized worldwide to address iron deficiency. A critical problem in some food fortification programs is the lack of bioavailability of iron compounds. This article reviews presentations on iron fortification programs in the Americas and the technical and practical barriers faced by the programs. Effective programmatic strategies will incorporate systematic consideration of sound program management, ensure consumption of fortified foods, and promote advocacy and supportive legislation. However, these factors are often overlooked or are not addressed coherently. Key components to consider in implementation of iron fortification programs include: utilization of foods and condiments containing fortificants that are bioavailable; program development and its implementation coordinated with targeted communications; utilizing resources from public/private sector partnerships; and operational research on how to overcome practical barriers for successful implementation of fortification.
More and more physician groups are considering taking a capital partner, whether a physician practice management company, a hospital or other organization. But physicians have questions about how partnership will affect their salary in the short and long run, whether it will affect practice overhead, quality of care and physician control. They also want to know what to do if the relationship doesn't work out. This article answers those questions and recommends that groups do a careful self-evaluation and scrutinize any potential partners before making a move.
Considers the impact of recent government policy on the organization of primary care in England and Wales. Discusses the notion and practice of "teamworking" currently in vogue, and analyses implications for doctors, nurses and managers working in/attached to general practices. Draws on the findings of a study of primary care team building which took place in a UK health authority (here referred to as "Weston"), and focuses on the experience of four general practices as they have attempted to develop as multidisciplinary partnerships. Gives consideration to the "new managerialism" evident in the NHS and its attempt to redefine professionalism and professional autonomy.
This article outlines an action research study developed to facilitate nurse teachers returning to clinical practice. The article explores how the teachers established partnerships with clinicians through which they were able to share the experience of returning to an area of nursing that they had previously only visited. It discusses four categories: expectations of self and others; entering someone else's world; more awareness of student needs; and teaching theory and practising nursing. These categories emerged following the analysis of journals, focus group interviews and individual interviews and led to a number of recommendations concerning the implications for other teachers wishing to return to clinical practice.
OBJECTIVE: LCME has recently required that all graduating medical students learn about end-of-life care. This program describes the design and integration into an existing geriatrics clerkship of a palliative care module that teaches the foundations of end-of-life and palliative care to medical students. DESCRIPTION: Faculty experts in geriatrics met during a series of weekly meetings in 1999 to design a mandatory four-week-long clinical clerkship in geriatrics. Since the palliative care program is based within the geriatrics department, faculty members with interest and expertise in both geriatrics and palliative care were invited to design a palliative care module that can be integrated into the clerkship. Since LCME does not specify details of what students must learn about end-of-life care, and our goal is to educate and prepare students for any chosen specialty, we wanted to design a basic core curriculum in palliative care that would be useful to any graduating student. After reviewing potential palliative care topics, and given limited curriculum time, we condensed the medical student core curriculum to the following sessions: (1) Systematic Pain Assessment Management, (2) Management of Distressing Symptoms, (3) Communicating Bad News, and (4) Advance Directives. We developed PowerPoint presentations, teaching case vignettes, and a set of reference articles, which can be distributed to students as well as to help faculty teachers prepare for the sessions. Teaching sessions occur in small groups, using case discussions and interactive lectures. Sessions 3 and 4 are co-facilitated by palliative care physicians and ethicists, who use role-plays, reflections, and discussions to teach the topics. At the end of the clerkship, students practice these communication skills with videotaped standardized patient encounters, and debrief with faculty members about their performances and ways to improve their communication skills. DISCUSSION: Palliative care sessions are welcomed by the students, who traditionally have not received much teaching in this area. Even though students have learned about mechanisms regulating pain and other symptoms in the past, they have not learned to assess or treat symptoms in a systematic way. Students often have good questions about the decision-making, legal, and ethical issues that emerge for patients near the end of life. Thus, co-facilitation of physicians with ethicists presents both the practical clinical and the theoretical perspectives, and provides a good model for team teaching. In terms of teaching style, students are more involved and participatory when teachers use case vignettes as compared with slide presentations, even if they are case-based. When using role-plays to teach students how to communicate bad news, we found that students need to feel safe in that environment, need to know they can call for time out when necessary, and want to have seen one done before they are asked to do one.
The ideas in this article arose from discussions between two nurse educators brought together from different professional backgrounds to teach on a new Project 2000 course. It is a frank and honest account of a partnership involving two teachers--a nurse and a sociologist. It is also an illustration of theory-in-use; of an attempt in the workplace to move away from the split between theories in sociology, nursing and education and their practical application. The authors discuss how they worked in partnership--planning, delivering and evaluating their contribution to the course's 18 month long common foundation programme.
Traditional "one-patient-at-a-time," doctor-centered primary care practice models do not achieve optimal immunization rates for pneumonia and influenza, in part because of time pressures and competing demands from a burgeoning list of clinical guidelines. Some widely used quality improvement methods (physician education, provider feedback, academic detailing, etc.) have only a modest and short-lived impact on improving immunization rates. Evidence is mounting that practices can substantially improve immunization rates by changing practice systems and processes with standing orders and algorithms, expanded nurse decision-making, patient education and incentives, and partnerships with community-based pharmacies. Quality-focused, constantly-learning practices that cultivate a culture of excellence will be most effective in adopting such changes.