Since 1990, market mechanisms have occurred in the predominantly hierarchical National Health Service (NHS). The Health and Social Care Act 2012 led to concerns that market principles had been irrevocably embedded in the NHS and that the regulators would acquire unwarranted power compared with politicians (known as ‘juridification’). To assess this concern, we analysed regulatory activity in the period from 2015 to 2018. We explored how economic regulation of the NHS had changed in light of the policy turn back to hierarchy in 2014 and the changes in the legislative framework under Public Contracts Regulations 2015. We found the continuing dominance of hierarchical modes of control was reflected in the relative dominance and behaviour of the sector economic regulator. But there had also been a limited degree of juridification involving the courts. Generally, the regulatory decisions were consistent with the 2014 policy shift away from market principles and with the enduring role of hierarchy in the NHS, but the existing legislative regime did allow the incursion of pro market regulatory decision making, and instances of such decisions were identified.

Given the rapidly expanding older adult population, finding health care approaches that support older adults to age in their choice of place, with an accompanying philosophical re-orientation of health services, is becoming more urgent. We studied the Home Care Home First – Quick Response Project to understand how clients over age 75 and their family caregivers perceived the enhanced community-based services delivered through Home First. Using interpretive description as the methodological design, we explored the experiences of eight older adults and 11 family caregivers; all older adults were enrolled in Home First due to a significant change in their health status. We identified four themes: growing older in chosen places with support, philosophy of care, processes of Home First, and the significance of Home First for clients. Overall, clients and family caregivers responded positively to the Home First services. Clients valued their independence and growing older in places they had specifically chosen.

This study evaluates the emergence and persistence of the racial divide on health reform in public opinion using survey data from 2008 through 2017. The findings support existing work showing a consistent relationship between racial resentment and attitudes on the Affordable Care Act among White adults. However, the study also builds on existing work by evaluating the relationship between strength of racial identity among Black adults and health care opinion during President Barack Obama's Administration. The paper investigates the implications of the findings for future health policy in the post-Obama era using survey data on the Republicans’ attempt to pass the American Health Care Act in 2017. The results underscore the conditions that make the “spillover” of racial attitudes into seemingly non-racial policy areas more or less likely to occur. The findings also provide suggestive evidence for how future health reforms may receive different levels of support from both White and Black adults.

Health care facilities are always seen as places of haven and protection for managing external incidents, but situations become difficult and challenging when such facilities themselves are affected by internal hazards. Such incidents are arguably more disruptive than external incidents, because patients are dependent on supportive measures and are neither in position to respond to such crisis situation nor do they know how to respond. Operating room fires are rare but potentially catastrophic, involving loss of costly resources and possibly lives. This case report details a true operating room fire incident in an emergency operating room and details the real-life challenges encountered by operating room staff in preserving both life and property. As a result of this work, precautionary measures may be implemented to mitigate such incidents. Careful coordination, continuous training, and fire drill exercises can improve the overall outcomes and minimize the possibility of these potentially fatal problems, thereby making a safer health care environment for every worker and patient.

To better understand and improve the rehabilitation process of older adults with sensory losses in both hearing and vision or dual sensory impairment (DSI), this study explored the perspectives of health care professionals who work with this population. Thirteen individuals, with varied professional backgrounds, were interviewed about their experiences in working with older adults with DSI. We transcribed and coded the interviews, then conducted content analysis. Regardless of their professional backgrounds, the participants reported additional roles that they perceived they fulfilled: (a) counsellor, (b) navigator, and (c) trainer and re-trainer. These roles involved helping individuals with DSI, and their family, with depression, acceptance, repeat consultations, and way-finding through the health system. From the professionals’ perspective, these additional roles increase workload and place them in situations they were not trained for. They suggest education for all professionals and for family members working with people with DSI; moreover, they suggest a multidisciplinary team rehabilitation approach.

Canadian older adults with complex health problems are often considered ineligible for traditional rehabilitation programs but may benefit from slow stream rehabilitation (SSR). This scoping review summarizes the literature related to SSR for older adults, within single-payer health care systems. Methods: Peer-reviewed and grey-literature documents relevant to older adults in SSR were systematically reviewed. Results: 1,445 documents were screened independently by two reviewers [Cohen Kappa value of 0.78 (CI = 0.73, 0.83)], and included 18 documents. SSR programs were found to be multidisciplinary with a mean duration ranging from 30 to 141.2 days. SSR participants were more likely to be female, with a mean age range of 72–82 years, multiple co-morbidities and mild-to-moderate cognitive impairments. SSR participants demonstrated improvements in physical and functional measures. Discussion: SSR programs have the potential to be an integral part of the continuum of care for older adults with complex medical histories.

Health research is generally undertaken to resolve existing health problems or enhance existing solutions. Research ethics committees have been the main governance tool for research for more than half a century. Their role is to ensure that research is undertaken ethically. To close the increasing gap between science and society, other governance tools are required. The European Commission recommends and actively promotes the policy of responsible research and innovation (RRI). In addition to sound research ethics, a key feature of RRI is the involvement of different societal stakeholders throughout the research process.

But how accepted is the involvement of societal stakeholders in the research of small- and medium-sized enterprises (SMEs) in the health care sector? This question is examined based on 18 in-depth interviews with private health care industry representatives from across Europe in companies focusing on developing medical device technology. Findings suggest that SMEs are reluctant to undertake research involving patients, especially in the early stages of the research and innovation process. For some SMEs this is due to concerns about the dangers of raising expectations they cannot meet, while for others the main concerns are increasing costs and producing less competitive products. Implications of the research findings are discussed.

International research has generated strong evidence that healthcare providers (HCPs) play a key role in the return to work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. Aim: Our study sought to understand how HCPs interact with workers compensation boards (WCBs), manage the treatment of workers compensation patients and navigate the RTW process. Method: The study involved in-depth interviews with 97 HCPs in British Columbia, Manitoba, Ontario and Newfoundland and Labrador and interviews with 34 case managers (CMs). An inductive, constant comparative analysis was employed to develop key themes. Findings: Most HCPs did not encounter significant problems with the workers compensation system or the RTW process when they treated patients who had visible, acute, physical injuries, but faced challenges when they encountered patients with multiple injuries, gradual-onset or complex illnesses, chronic pain and mental health conditions. In these circumstances, many experienced the workers compensation system as opaque and confusing. A number of systemic, process and administrative hurdles, disagreements about medical decisions and lack of role clarity impeded the meaningful engagement of HCPs in RTW. In turn, this has resulted in challenges for injured workers (IWs), as well as inefficiencies in the workers compensation system. Conclusion: This study raises questions about the appropriate role of HCPs in the RTW process. We offer suggestions about practices and policies that can clarify the role of HCPs and make workers compensation systems easier to navigate for all stakeholders.

Purpose: The aim of this study was to identify and analyze the characteristics of leadership and management associated with a successful Lean thinking adaptation in healthcare.

Design: A systematic literature review was undertaken using electronic databases: PubMed, PubMed Systematic Review, ABI/INFORM, Business Source Complete, Emerald, JBI, and Cinahl. Inclusion criteria were: (i) a description of Lean management or leadership in health care, (ii) a reference to Lean thinking, (iii) a peer-reviewed original research article or a literature review, and (iv) a full text article available in English. Among the 1,754 peer-reviewed articles identified, nine original articles and three systematic reviews met the inclusion criteria. Data on informants, methods, and settings were extracted and collated. Content analysis was used to conduct a review of the nine original studies describing and analyzing the success factors of Lean adaptation. The characteristics of leadership and management were analyzed by using the concept of a managerial windshield that divides leadership and management into four ontological dimensions: activities, style, focus, and purpose, each with typical developmental stages of skills and capabilities. The current study has some limitations: some papers from the journals not indexed in the searched databases may have been overlooked and the literature searches were carried out only for a 5-year period.

Findings: Considering the results using the windshield concept emphasizes the philosophy, principles, and tools of Lean thinking. Lean leadership and management factors in health care were mainly conceptualized as skills and capabilities such as problem solving, making changes occur, empowering, communicating, coaching, supporting, facilitating, being democratic, organizational learning, and organizational success, all of which represented middle-stage or advanced managerial skills and capabilities.

Practical Implications: A conceptual analysis of systematically reviewed studies of Lean leadership and management point to certain traits as being typical when adapting Lean thinking to health care. The concept of a managerial windshield is useful when categorizing and analyzing essential managerial skills and capabilities for Lean implementation. Findings are beneficial when learning and educating the skills required for Lean transformation in healthcare organizations.

The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.

There is little existing in the literature that provides a definition of readiness for a jurisdiction’s whole health care system. As defining readiness at the system level has proven to be challenging, an approach that provides a framework for planning and measuring health care readiness with broad utility is needed. The New York City Department of Health and Mental Hygiene (DOHMH) devised the Readiness Target Project. Nine areas or dimensions of readiness emerged from this work. Through focus groups and feedback from hospital stakeholders DOHMH developed a matrix of readiness areas outlining current state, target state, gaps, and recommendations to achieve readiness. The matrix is in use as a systematic approach to discover and close gaps in the readiness of the whole health care system and to provide that system a locally valid framework to drive continuous improvement. This paper describes a framework for planning and determining the status of health care readiness at the system level for the jurisdiction. (Disaster Med Public Health Preparedness. 2018;12:759-764))

The use of after-action reviews (AARs) following major emergency events, such as a disaster, is common and mandated for hospitals and similar organizations. There is a recurrent challenge of identified problems not being resolved and repeated in subsequent events. A process improvement technique called a rapid improvement event (RIE) was used to conduct an AAR following a complete information technology (IT) outage at a large urban hospital. Using RIE methodology to conduct the AAR allowed for the rapid development and implementation of major process improvements to prepare for future IT downtime events. Thus, process improvement methodology, particularly the RIE, is suited for conducting AARs following disasters and holds promise for improving outcomes in emergency management.

Little CM , McStay C , Oeth J , Koehler A , Bookman K . Using Rapid Improvement Events for Disaster After-Action Reviews: Experience in a Hospital Information Technology Outage and Response. Prehosp Disaster Med. 2018;33(1):98–100.

This mini-theme contains six stories of health technology assessment (HTA) impact from member agencies of The International Network of Agencies for Health Technology Assessment (INAHTA), which were originally shared at the 2015 and 2016 INAHTA Congresses. The INAHTA impact story sharing is an innovative network activity where member agency representatives share experiences of HTA impact in a loosely structured story format. Through this process, members gain insights from other agencies on new ways of thinking about and approaching HTA impact assessment. A guide is provided to members to prepare their story, and the best story receives the David Hailey Award for Best Impact Story. This mini-theme contains stories of HTA impact from six member agencies in different parts of the world: the Health Assessment Division of the Ministry of Public Health (Uruguay), the Institute of Quality and Efficiency in Health Care (Germany), the Health Information and Quality Authority (Ireland), the Finnish Office for Health Technology Assessment (Finland), the Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (Australia), and the Institut national d'excellence en santé et en services sociaux (Canada). Across the papers, common themes emerge about the importance of appropriate engagement of stakeholders and the broadening scope of HTA beyond reimbursement decision making.

The importance of teamwork is being increasingly recognised in healthcare. Nonetheless, it is equally recognised that teamwork is difficult. In this article, I explore whether we can learn lessons from musicians, orchestras, and conductors as we build our teams. The evolution of the role of the conductor provides useful lessons on leadership and the evolving role of the members of the orchestra on how team members can contribute to a shared outcome. The uncertainty of jazz provides useful lessons for innovation in an increasingly turbulent healthcare environment.

Over the last decades, rationing of medical treatment in the National Health Service (NHS) has moved from implicit to being increasingly explicit about what is being denied and about the procedures and reasons for such decisions. This article argues that the courts have had an important role in this process. By applying a heightened scrutiny of rationing decisions, courts have forced health authorities to make better-informed decisions and to take procedural justice more seriously to comply with, respond to and avoid judicial review. The analysis in this article reveals that litigation has contributed to incremental, but significant and enduring, changes in a social policy. It also offers insights to the paradoxes of judicial accountability in health care policies.

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the 'QALY trap': we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination.