Impact of entrepreneurship training on clinician engagement in innovation creation: an evaluation of the Johns Hopkins Hexcite programme.

BACKGROUND: Academic health science centres are an ideal location to translate innovative discoveries into clinical practice. However, increased cost, decreased time and encroaching technology are few of the challenges that academic clinicians face in an increasingly digitised healthcare industry. Academic health science centres have begun creating training to involve clinicians in developing and deploying innovative solutions. Few of these programmes engage clinicians in interactive and interdisciplinary activities. APPROACH: Hexcite is a 16-week entrepreneurship training programme at Johns Hopkins. During the programme, clinicians with innovative clinical software ideas learn how to launch start-ups. Clinicians accepted into the programme team up with a business expert, design expert and technical expert. Teams participate in 15 expert-led interactive 3-hour workshops, interview potential customers, regularly pitch their ideas to industry experts and iteratively refine their products. METHODS: This report examined anonymous participant feedback, quantitative data from team productivity reports, and interview responses between 2015 and 2019. Outcomes were assessed using the Kirkpatrick Model. RESULTS AND CONCLUSION: Many clinicians reported improved understanding of team building, design thinking and marketing communications as well as increased involvement in innovation. Many teams received funding after Hexcite. Outcomes from previous cohorts will guide more robust evaluation measures for future cohorts.

AHSCs as Health Policy Transfer: Some Emergent Evidence From Australia Comment on "Academic Health Science Centres as Vehicles for Knowledge Mobilisation in Australia? A Qualitative Study".

This commentary discusses Edelman et al 2020's recent exploratory study of the early development of 4 Academic Health Services Centres (AHSCs) in Australia. AHSCs were originally invented in the United States, but have then diffused to the United Kingdom and Canada over the last decade or so and now to Australia so they are a good example of health policy transfer. They are dedicated to advancing more speedy knowledge translation (KT)/mobilization ('from bench to bedside') and also the more effective commercialization of scientific inventions. The commentary argues some interesting if preliminary findings are identified in their study. Its limitations will also be considered. Finally, suggestions for future research are made, including more cross national and comparative studies.

IT Evaluation of Foundation Healthcare Group NHS Vanguard programme: IT simultaneously an enabler and a rate limiting factor.

The goal of the Foundation Healthcare Group (FHG) Vanguard model was to develop a sustainable local hospital model between two National Health Service (NHS) Trusts (a London Teaching Hospital Trust and a District General Hospital Trust) that makes best use of scarce resources and can be replicated across the NHS, UK. The aim of this study was to evaluate the provision, use, and implementation of the IT infrastructure based on qualitative interviews focused mainly on the perspectives of the IT staff and the clinicians' perspectives. METHODS: In total, 24 interview transcripts, along with 'Acute Care Collaboration' questionnaire responses, were analyzed using a thematic framework for IT infrastructure, sharing themes across the vascular, pediatric, and cardiovascular strands of the FHG programme. RESULTS: Findings indicated that Skype for Business had been an innovative and helpful development widely available to be used between the two Trusts. Clinicians initially reported lack of IT support and infrastructure expected at the outset for a national Vanguard project but later appreciated that remote access to most clinical applications including scans between the two Trusts became operational. The Local Care Record (LCR), an IT project was perceived to have been delivered successfully in South London. Shared technology reduced patient traveling time by providing locally based shared care. CONCLUSION: Lesson learnt is that ensuring patient benefit and priorities is a strong driver to implementation and one needs to identify IT rate-limiting steps at an early stage and on a regular basis and then focus on rapid implementation of solutions. In fact, future work may also assess how the IT infrastructure developed by FHG vanguard project might have helped/boosted the 'digital health' practice during the COVID-19 times. Spreading and scaling-up innovations from the Vanguard sites was the aspiration and challenge for system leaders. After COVID-19, the use of IT is scaled up and now, the challenges in the use of IT are much less compared to the pre-COVID-19 time when this project was evaluated.

Understanding professional stratification and hybridisation in the medical profession: exploratory evidence from Brazilian federal university hospitals / Comprendiendo la estratificación e hibridación profesional en la profesión médica: evidencia exploratoria de los hospitales universitarios federales de Brasil / Compreendendo a estratificação profissional e hibridização na profissão médica: evidências exploratórias de hospitais universitários federais brasileiros

Abstract This paper explores drivers, implications, and trends of professional stratification and hybridisation in the medical profession employed in Brazilian substituir por: federal university hospitals (HUFs). Drawing on exploratory findings, we examine some repercussions of the migration of university hospitals to EBSERH, a public company established by the federal government to manage and organise HUFs integrated into the Unified Health System (SUS). Our research shows that transferring hospital administration to EBSERH has led to further internal stratification of the medical workforce. The shift from the logic of medical-academic professionalism to the new logic of business-like healthcare, with the adoption of distinct job contracts and more managerial logics of work and control, may well be changing subjective and formal links established between professionals, universities, and hospitals. We identify and discuss trends towards hybridisation and dehybridisation. These findings are relevant because this shift can have profound implications for the academic nature of HUFs and for the future of professionalism within these health and teaching organisations.

Resumen Este artículo explora impulsores, implicaciones y tendencias de la estratificación y la hibridación profesional en la profesión médica empleada en los hospitales universitarios federales brasileños (HUFs). A partir de hallazgos exploratorios, examinamos algunas de las repercusiones de la migración de los hospitales universitarios a la EBSERH, una empresa pública creada por el gobierno federal para administrar y organizar los HUFs integrados en el Sistema Único de Salud (SUS). Nuestra investigación muestra que la transferencia de la administración hospitalaria a la EBSERH ha llevado a una mayor estratificación interna de la fuerza laboral médica. El cambio de la lógica del profesionalismo médico-académico a una lógica empresarial en salud, con la adopción de diferentes regímenes de empleo y modos de trabajo y control más gerenciales, puede estar alterando los vínculos subjetivos y formales que se establecen entre los profesionales, las universidades y los hospitales involucrados. Se identifican y discuten tendencias hacia la hibridación y deshibridación. Estos hallazgos son relevantes porque tales cambios pueden tener profundas implicaciones para la naturaleza académica de los HUFs, así como para el futuro del profesionalismo dentro de estas organizaciones de salud y educación.

Resumo: Este artigo explora motivadores, implicações e tendências de estratificação e hibridização profissional na profissão médica atuante em hospitais universitários federais brasileiros (HUFs). Com base em achados exploratórios, examinamos algumas das repercussões da migração dos hospitais universitários para a EBSERH, uma empresa pública criada pelo governo federal para gerenciar e organizar os HUFs vinculados ao Sistema Único de Saúde (SUS). A pesquisa mostra que a transferência da administração hospitalar para a EBSERH tem acarretado maior estratificação interna da força de trabalho médica. A mudança da lógica de profissionalismo médico-acadêmico para uma nova lógica empresarial de saúde, com a adoção de distintos regimes empregatícios e formas de trabalho e controle mais gerenciais, podem estar alterando vínculos subjetivos e formais estabelecidos entre os profissionais, as universidades e os hospitais envolvidos. Tendências em direção à hibridização e desibridização foram identificadas e discutidas. Esses achados são relevantes tendo em vista que tais movimentos podem representar implicações profundas para a natureza acadêmica dos HUFs e para o futuro do profissionalismo nessas organizações de saúde e ensino.

Macro level influences on strategic responses to the COVID-19 pandemic - an international survey and tool for national assessments.

BACKGROUND: Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning. METHODS: A cross-sectional electronic survey of health and non-health care professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains - Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks. RESULTS: 928 respondents from 66 countries (57% health care professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains. CONCLUSIONS: The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.

Macro level factors influencing strategic responses to emergent pandemics: A scoping review.

BACKGROUND: Strategic planning is critical for successful pandemic management. This study aimed to identify and review the scope and analytic depth of situation analyses conducted to understand their utility, and capture the documented macro-level factors impacting pandemic management. METHODS: To synthesise this disparate body of literature, we adopted a two-step search and review process. A systematic search of the literature was conducted to identify all studies since 2000, that have 1) employed a situation analysis; and 2) examined contextual factors influencing pandemic management. The included studies are analysed using a seven-domain systems approach from the discipline of strategic management. RESULTS: Nineteen studies were included in the final review ranging from single country (6) to regional, multi-country studies (13). Fourteen studies had a single disease focus, with 5 studies evaluating responses to one or more of COVID-19, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Influenza A (H1N1), Ebola virus disease, and Zika virus disease pandemics. Six studies examined a single domain from political, economic, sociological, technological, ecological or wider industry (PESTELI), 5 studies examined two to four domains, and 8 studies examined five or more domains. Methods employed were predominantly literature reviews. The recommendations focus predominantly on addressing inhibitors in the sociological and technological domains with few recommendations articulated in the political domain. Overall, the legislative domain is least represented. CONCLUSIONS: Ex-post analysis using the seven-domain strategic management framework provides further opportunities for a planned systematic response to pandemics which remains critical as the current COVID-19 pandemic evolves.

IT Evaluation of Foundation Healthcare Group Vanguard Project.

The aim of the Foundation Healthcare Group (FHG) Vanguard model was to develop a sustainable local hospital model between two National Health Service (NHS) Trusts (a London Teaching Hospital Trust and a District General Hospital Trust) that makes best use of scarce resources and can be replicated across the NHS, UK. The aim of this study was to evaluate the provision, use and implementation of the IT infrastructure; based on qualitative interviews and focused mainly on the perspectives of the IT staff and the clinicians' perspectives. In total 24 interview transcripts, along with 'Acute Care Collaboration' questionnaire responses, were analysed using a thematic framework for IT infrastructure, sharing themes across the vascular, paediatric and cardiovascular strands of the FHG programme. Findings indicated that Skype for Business had been an innovative and helpful development widely available to be used between the two Trusts. Clinicians initially reported lack of IT support and infrastructure expected at the outset for a national Vanguard project, but later appreciated that remote access to most clinical applications between the two Trusts became operational. The Local Care Record (LCR), an IT project was perceived to have been delivered successfully in South London. Shared technology reduced patient travelling time by providing locally based shared care. Spreading and scaling-up innovations from the Vanguard sites was the aspiration and challenge for system leaders.

Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review.

INTRODUCTION: The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. METHODS: A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. RESULTS: 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. CONCLUSION: The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation efforts should be focussed, and also how to build contingency at the strategic level for agile responses to macro-level environmental influences.

Biopolitics, space and hospital reconfiguration.

Major service change in healthcare - whereby the distribution of services is reconfigured at a local or regional level - is often a contested, political and poorly understood set of processes. This paper contributes to the theoretical understanding of major service change by demonstrating the utility of interpreting health service reconfiguration as a biopolitical intervention. Such an approach orients the analytical focus towards an exploration of the spatial and the population - crucial factors in major service change. Drawing on a qualitative study from 2011-12 of major service change in the English NHS combining documentary analyses of historically relevant policy papers and contemporary policy documentation (n = 125) with semi-structured interviews (n = 20) we highlight how a particular 'geography of stroke' in London was created building upon multiple types of knowledge: medical, epidemiological, economic, demographic, managerial and organisational. These informed particular spatial practices of government providing legitimation for the significant political upheaval that accompanies NHS service reconfiguration by problematizing existing variation in outcomes and making these visible. We suggest that major service change may be analysed as a 'practice of security' - a way of redefining a case, conceiving of risks and dangers, and averting potential crises in the interests of the population.

An integrated care programme in London: qualitative evaluation.

PURPOSE: A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment. DESIGN/METHODOLOGY/APPROACH: Qualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes. FINDINGS: The integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of "successes", "challenges" and "lessons learnt". RESEARCH LIMITATIONS/IMPLICATIONS: Evaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit. PRACTICAL IMPLICATIONS: Key lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation. ORIGINALITY/VALUE: Primary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.

Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries.

Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones - antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed.

Personalisation - An Emergent Institutional Logic in Healthcare? Comment on "(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare".

This commentary on the recent think piece by Mannion and Exworthy reviews their core arguments, highlighting their suggestion that recent forces for personalization have emerged which may counterbalance the strong standardization wave which has been evident in many healthcare settings and systems over the last two decades. These forces for personalization can take very different forms. The commentary explores the authors' suggestion that these themes can be fruitfully examined theoretically through an institutional logics (ILs) literature, which has recently been applied by some scholars to healthcare settings. This commentary outlines key premises of that theoretical tradition. Finally, the commentary makes suggestions for taking this IL influenced research agenda further, along with some issues to be addressed.

The governance of pluralist health care systems: An initial review and typology.

We here argue that study of governance systems within increasingly pluralist health care systems needs to be broadened beyond traditionally public sector orientated literature. We develop an initial typology of multiple governance systems within the English health care sector and derive exploratory questions to inform future empirical investigation. We add to existing literature by considering the coexistence of - and possible tensions between - multiple governance systems in a pluralised health and social care system.

Community-oriented integrated care and health promotion - views from the street.

On the 1st and 2nd May 2015, participants at the RCGP London City Health Conference debated practical ways to achieve integrated care at community level. In five connected workshops, participants reviewed current work and identified ways to overcome some of the problems that had become apparent. In this paper, we summarise the conclusions of each workshop, and provide an overall comment. There are layers of complexity in community-oriented integrated care that are not apparent at first sight. The difficult thing is not persuading people that it matters, but finding ways to do it that are practical and sustainable. The dynamic and complex nature of the territory is bewildering. The expectation of silo-operating and linear thinking, and the language and models that encourage it, pervade health and social care. Comprehensive integration is possible, but the theory and practice are unfamiliar to many. Images, theories and models are needed to help people from all parts of the system to see big pictures and focused detail at the same time and oscillate between them to envision-integrated whole systems. Infrastructure needs to enable this, with coordination hubs, locality-based multidisciplinary meetings and cycles of inter-organisational improvement to nurture relationships across organisational boundaries.

Commentary on text of interview with Professor Lord Ara Darzi: 'Desirable? Yes; but is it achievable?'.

This personal commentary explores some issues that arise in the text of the interview with Lord Darzi published in LJPC 6.6, from a point of view of an interest in health policy and change in healthcare organisations. It suggests that the vision is desirable but that there are four major questions about ready implementation that the field needs to consider: 1 Can primary care development and investment be protected in a cold financial climate? 2 Does the current marketisation of health care erode integration? 3 Does the health and social care system in London behave like a real system? 4 Is there really a cultural shift towards empowerment and organisational learning?

Knowledge mobilization in healthcare organizations: a view from the resource-based view of the firm.

This short literature review argues that the Resource-Based View (RBV) school of strategic management has recently become of increased interest to scholars of healthcare organizations. RBV links well to the broader interest in more effective Knowledge Mobilization (KM) in healthcare. The paper outlines and discusses key concepts, texts and authors from the RBV tradition and gives recent examples of how RBV concepts have been applied fruitfully to healthcare settings. It concludes by setting out a future research agenda.

Resource based view: a promising new theory for healthcare organizations: Comment on "Resource based view of the firm as a theoretical lens on the organisational consequences of quality improvement".

This commentary reviews a recent piece by Burton and Rycroft-Malone on the use of Resource Based View (RBV) in healthcare organizations. It first outlines the core content of their piece. It then discusses their attempts to extend RBV to the analysis of large scale quality improvement efforts in healthcare. Some critique is elaborated. The broader question of why RBV seems to be migrating into healthcare management research is considered. They conclude RBV is a promising new theory for healthcare organizations.

The international spread of Academic Health Science Centres: a scoping review and the case of policy transfer to England.

Academic Health Science Centres (AHSCs) have been a key feature of the North American healthcare landscape for many years, and the term is becoming more widely used internationally. The defining feature of these complex organisations is a tripartite mission of delivering high quality research, medical education and clinical care. The biomedical innovations developed in AHSCs are often well documented, but less is known about the policy and organisational processes which enable the translation of research into patient care. This paper has two linked purposes. Firstly, we present a scoping review of the literature which explores the managerial, political and cultural perspectives of AHSCs. The literature is largely normative with little social science theory underpinning commentary and descriptive case studies. Secondly, we contribute to addressing this gap by applying a policy transfer framework to the English case to examine how AHSC policy has spread internationally. We conclude by suggesting a research agenda on AHSCs using the relevant literatures of policy transfer, professional/managerial relations and boundary theory, and highlighting three key messages for policy makers: (1) competing policy incentives for AHSCs should be minimised; (2) no single AHSC model will fit all settings; (3) AHSC networks operate internationally and this should be encouraged.