Articles for tag: change, health, NHS, policy, reform, transformation

September 15, 2024

Fast on the heels of Lord Darzi’s report, Sir Keir Starmer has set out sweeping plans for NHS reforms. The first component of Starmer’s reform blueprint focuses on the digitalisation of healthcare services. This involves leveraging technological advancements to enhance patient empowerment and streamline healthcare delivery. Key elements include the development of a comprehensive NHS ...

April 16, 2024

TheEditor

Investigative Mental Health

The Ties That Bind: Exploring the Impact of Relationships on Mental Health and Business Success

The biopsychosocial model of mental health recognises that our psychological well-being is influenced by a complex interplay of biological, psychological, and social factors. Within this framework, relationships play a crucial role in shaping our mental health. Strong, supportive relationships can provide a sense of belonging, emotional support, and a buffer against stress and adversity. On ...

December 24, 2023

TheEditor

Investigative Management

Radical Transparency – is it for everybody?

The term sounds great, but what is it? Who invented this? Can we have it in the NHS or any other public sector service in the UK? This and more will be explored. Radical Transparency Radical Transparency is a management and organisational philosophy that emphasises open, honest, and direct communication within a company. It was ...

November 5, 2023

TheEditor

Management

Why lessons are not so easy to learn

The context of this exploration is twofold a) to examine how lessons may not be learned by individuals and b) difficulty for organisations in learning lessons. What ordinary people expect Let us start by understanding how ordinary people might decide what is a lesson learned. I suggest that they may expect the following: Cause and ...

July 28, 2023

TheEditor

Investigative Management Mental Health

The relevance of culture in mental health services

I imagine that most people would begin thinking of the influence of culture on expression of signs and symptoms among mental disorders. However, there are wider areas of importance. What is culture? The concept of ‘culture’ is broad and multifaceted, encompassing a wide range of ideas, practices, and societal norms. The main concepts that comprise ...

July 15, 2023

TheEditor

Management

Change management

Over the last 10 years I’ve visited for work, many public sector health services. Whilst no service is perfect, at each place I found things that were fundamentally wrong. Nearly every senior manager knew about the things that were wrong but they were unable to implement changes. I am referring to things that were known ...

July 12, 2023

TheEditor

Investigative Management

Followership

Not so long ago there were stampedes of people rushing towards ‘leadership’ courses. Leadership Universities were set up. MBAs and other management qualifications were in high demand. All courses emphasised leadership in change management. In many health services a culture was promoted that ‘everybody’ had to lead, though it was never stated like that. The ...

Stage	Cost/Price (£)	Tax/Duty (£)	Tax/Duty Type	Calculation	Calculation
1. Manufacturer’s Cost	2	0	N/A	This is a hypothetical cost of production.
2. Specific Duty Added	2	5.89	Specific Duty	£294.72 per 1000 cigarettes / 1000 * 20	Fixed amount per pack.
3. Manufacturer’s Profit	7.89	0	N/A	(Assumed to bring the total to £7.89)	This is a hypothetical profit margin.
4. Ad Valorem Duty Included	9	1.11	Ad Valorem Duty	16.5% of £9.00 (approx. retail price before VAT)	Included within the retail price, not added separately.
5. Retailer’s Profit	10.11	0	N/A	(Assumed to bring the total to £10.11)	This is a hypothetical profit margin.
6. Final Retail Price (excl VAT)	13	0	N/A	(Includes specific duty and ad valorem duty)	This is the price displayed on the shelf, excluding VAT.
7. VAT Added	13	2.6	Value Added Tax (VAT)	20% of £13.00	Applied at the point of sale.
Total	15.6	9.6	Approximately 61.5% of the final price (£15.60) is tax – due to the simplified conservative assumptions about manufacturer and retailer costs and profit margins.

Documentation Issue	Critique
Vague Descriptors	Terms like “distressed state,” “emptiness,” and “intense anger” lack specific behavioural anchors. The descriptions are mere observations without any real substance. How was the intensity of the anger manifested? What did the patient say? How did she appear? Was she grimacing? Without concrete examples, these descriptors are open to interpretation and do not provide a clear picture of the patient’s presentation.
Generalised Interventions	Phrases like “explored coping mechanisms” and “discussed strategies” are so general that they amount to padding. No one will know what specific coping mechanisms were explored. How did this worker actually attempt to help the patient? What exact strategies were discussed? How were these tailored to the patient’s individual needs and the nature of their emotional instability?
Lack of Measurable Outcomes	The record mentions the patient feeling “slightly calmer” but lacks objective measures to assess the effectiveness of the interventions. How was this improvement gauged? Is it just ‘your’ word for saying so? Many services will accept such records as ‘standard’ because of cultural norms.
Ambiguous Plan	The plan to “continue to work on developing skills” and “encourage the patient to practice techniques” is vague and lacks specific, measurable goals. What specific skills will be targeted? What techniques were discussed ‘between sessions’? How will progress be monitored? What constitutes “practice” in this context, and how will adherence be assessed?
Omission of Risk Assessment	Given the nature of EUPD and the potential for self-harm, the record should include a formal risk assessment. What specific risk factors were considered? How was the risk of self-harm evaluated and managed?
Limited Patient-Specific Insight	While the record mentions EUPD, it does not provide specific insights into how this diagnosis informs the interventions or the plan. How were the chosen strategies tailored to the patient’s unique challenges related to their personality disorder?

Cognitive Activity	Description
1. Information synthesis	Gathering and integrating diverse information; evaluating reliability and relevance of each piece
2. Evidence evaluation	Critically assessing quality and strength of available evidence; identifying gaps
3. Principle balancing	Weighing competing ethical principles; reconciling guidelines with case-specific considerations
4. Stakeholder consideration	Analysing individual patient needs/rights; considering regulatory and societal requirements
5. Consequence projection	Anticipating potential outcomes; assessing short-term and long-term consequences
6. Risk-benefit analysis	Systematically evaluating risks; weighing risks against potential benefits
7. Legal framework integration	Incorporating relevant legal standards; ensuring compliance with statutory obligations
8. Ethical reasoning	Applying ethical frameworks; resolving ethical dilemmas in forensic psychiatric practice
9. Interdisciplinary integration	Synthesising perspectives from various disciplines; reconciling conflicting viewpoints
10. Decision refinement	Iteratively reviewing and adjusting decisions; fine-tuning to address all relevant factors
11. Uncertainty management	Acknowledging areas of uncertainty; developing mitigation strategies
12. Prioritisation	Determining relative importance of factors; focusing on critical elements
13. Cognitive bias recognition	Identifying potential biases; implementing strategies to minimise their impact
14. Justification formulation	Developing clear, logical rationale; ensuring transparent and defensible reasoning
15. Contextual adaptation	Tailoring approach to specific case factors; recognising unique case influences

Sir Keir Starmer’s Reforms of the NHS – referenced in part against Lord Darzi’s Report.

The Ties That Bind: Exploring the Impact of Relationships on Mental Health and Business Success

Radical Transparency – is it for everybody?

Why lessons are not so easy to learn

The relevance of culture in mental health services

Change management

Followership

We Need to do Something about Smoking and Mental Health

Documentation 2.0

Articles for tag: change, health, NHS, policy, reform, transformation

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