Papers by Russell Mannion
BMC Health Services Research, May 13, 2022
Background: In 2021, during the COVID-19 pandemic, England's Department of Health and Social Care... more Background: In 2021, during the COVID-19 pandemic, England's Department of Health and Social Care (DHSC) released a White Paper outlining proposed legislative reform of the National Health Service (NHS). Key to the proposals is the shift from relationships between providers based on competition, to cooperation, as the central driver of improved performance and quality. Against this background we explore potential regulatory barriers and enablers to collaboration identified by key NHS stakeholders and assess whether the proposed policy changes are likely to deliver the desired improvement in collaborative relationships, in the context of challenges experienced during the COVID-19 pandemic. We conducted 32 semi-structured interviews with 30 key stakeholders, taking place during the COVID-19 pandemic from Jan 2020 to May 2021. Participants were selected for their expertise regarding collaboration and were recruited purposively. Interviews were conducted online with the use of video conferencing software. The interviews were thematically analysed to identify themes. Proposals contained in the DHSC White Paper helped to structure the thematic analysis, interpretation, and reporting of the results. Results: Requirements to compete to provide services, regulatory ability to block collaborative arrangements, lack of collaboration between providers and Clinical Commissioning Groups, and current lack of data sharing were found to hamper collaborative efforts. These issues often negatively affected collaborative relations by increasing bureaucracy and prompted leaders to attempt to avoid future collaborations. Other barriers included opaque accountability arrangements, and erosion of trust in regulators. The COVID-19 pandemic was found to foster collaboration between organisations, but some changes mandated by the new legislation may stifle further collaboration. Conclusions: Many of the proposed legislative changes in the White Paper would help to remove existing barriers to service integration and collaboration identified by stakeholders. However, the proposed shift in the concentration of power from NHS England to the DHSC may exacerbate historically low levels of trust between providers and regulators. Many of the proposed changes fail to address endemic NHS policy issues such as chronic understaffing. Further dialogue is needed at all levels of the health and social care system to ensure future legislative changes meet the needs of all stakeholders.
Implications of resource constraints and high workload on speaking up about threats to patient safety: a qualitative study of surgical teams in Ghana
BMJ Quality & Safety, 2022
BackgroundAlthough under-resourcing of healthcare facilities and high workload is known to underm... more BackgroundAlthough under-resourcing of healthcare facilities and high workload is known to undermine patient safety, there is a dearth of evidence about how these factors affect employee voice and silence about unsafe care. We address this gap in the literature by exploring how resource constraints and high workload influence the willingness of staff to speak up about threats to patient safety in surgical departments in Ghana.MethodSemistructured interviews with a purposeful sample of 91 multidisciplinary professionals drawn from a range of specialities, ranks and surgical teams in two teaching hospitals in Ghana. Conservation of Resources theory was used as a theoretical frame for the study. Data were processed and analysed thematically with the aid of NVivo 12.ResultsEndemic resource constraints and excessive workload generate stress that undermines employee willingness to speak up about unsafe care. The preoccupation with managing scarce resources predisposes managers in surgical...
Theories of board behaviour and research design
BackgroundInter-organisational collaboration is increasingly prominent within contemporary health... more BackgroundInter-organisational collaboration is increasingly prominent within contemporary healthcare systems. A range of collaboration types such as alliances, networks, and mergers have been proposed as a means to turnaround organisations, by reducing duplication of effort, and enabling resource sharing, greater influence, and novel innovations. However, in practice, due to the complexity of the process, such efforts are often rife with difficulty. Notable contributions have sought to make sense of this area, however further understanding is needed in order to gain a better understanding of why some inter-organisational collaborations work when others do not, to be able to more effectively implement collaborations in the future.MethodsRealist review methodology was used, combining systematically searched papers and purposively searched ‘middle-range’ theories. The systematic review encompassed searches for reviews, commentaries, opinion pieces and case studies on HMIC, Medline, Ps...
Raising and responding to frontline concerns in healthcare
BMJ, 2019
Frontline staff are well placed to identify failings in care, but speaking up requires a supporti... more Frontline staff are well placed to identify failings in care, but speaking up requires a supportive organisational culture to be effective, say Russell Mannion and Huw Davies
‘Groundhog Day’: the Coalition government’s quality and safety reforms
Dismantling the NHS?, 2017
Quality and safety are defined and measured in different ways by academics, commentators and agen... more Quality and safety are defined and measured in different ways by academics, commentators and agencies, while the relationships between them are viewed in different ways. Raleigh and Foot write that while the definitions of quality vary in different settings, some themes – safety, effectiveness and patient experience – are common to most quality frameworks and are regarded as the three pillars of quality in healthcare. This chapter examines these three pillars, and, after a brief review of earlier periods, it focuses on reforms in England under the Coalition government. It then explores the impact of reforms on quality and safety, providing a wider comparative perspective.
Reorganising the NHS, 1990–2010
Reforming healthcare, 2014
John Wiley & Sons, Ltd eBooks, Sep 17, 2016
The governance of patient safety is a challenging concern for all health systems. Yet, while the ... more The governance of patient safety is a challenging concern for all health systems. Yet, while the role of executive boards receives increased scrutiny, the area remains theoretically and methodologically underdeveloped. Specifically, we lack a detailed understanding of the performative aspects at play: what board members say and do to discharge their accountabilities for patient safety. This article draws on qualitative data from overt non-participant observation of four NHS hospital Foundation Trust boards in England. Applying a dramaturgical framework to explore scripting, setting, staging and performance, we found important differences between case study sites in the performative dimensions of processing and interpretation of infection control data. We detail the practices associated with these differences -the legitimation of current performance, the querying of data classification, and the naming and shaming of executivesto consider their implications.
Frontiers in Public Health, Jul 14, 2023
Introduction: Traditional methods for modelling human interactions within organisational contexts... more Introduction: Traditional methods for modelling human interactions within organisational contexts are often hindered by the complexity inherent within these systems. Building on new approaches to information modelling in the social sciences and drawing on the work of scholars in transdisciplinary fields, we proposed that a reliable model of human interaction as well as its emergent properties can be demonstrated using theories related to emergent information. Methods: We demonstrated these dynamics through a test case related to data from a prevalence survey of incivility among medical staff. For each survey respondent we defined their vulnerability profile based upon a combination of their biographical characteristics, such as age, gender, and length of employment within a hospital and the hospital type (private or public). We modelled the interactions between the composite vulnerability profile of staff against their reports of their exposure to incivility and the consequent negative impact on their wellbeing. Results: We found that vulnerability profile appeared to be proportionally related to the extent to which they were exposed to rudeness in the workplace and to a negative impact on subjective wellbeing.
Journal of Integrated Care, Sep 19, 2020
The NHS is facing unprecedented financial strain. These significant economic pressures have coinc... more The NHS is facing unprecedented financial strain. These significant economic pressures have coincided with concerns regarding the quality and safety of the NHS provider sector. To make the necessary improvements to performance, policy interest has turned to encouraging greater collaboration and partnership working across providers. Using a purposive search of academic and grey literature, this narrative review aimed (1) to establish a working typology of partnering arrangements for improvement across NHS providers, and (2) inform the development of a plausible initial rough theory of partnering to inform an ongoing realist synthesis. Different types of partnership were characterised by varying degrees of integration and/or organisational change. A review of existing theories of partnering also identified a suitable framework which incorporated elements key to partnerships, such as governance, workforce, leadership, and culture. This informed the creation of an initial rough theory of partnerships, which proposes that partnership 'interventions' are proposed to primarily cause changes in governance, leadership, IT systems, and care model design, which will then go on to affect culture, user engagement, and workforce. Further realist evaluation, informed by this review, will aim to uncover configurations of mechanisms, contexts, and outcomes in various partnering arrangements. As is the starting point for building a programme theory, this draws on limited evidence. This paper presents a novel theory of partnering and collaborating in healthcare with practical implications for policy makers and practitioners.
Springer eBooks, 2020
Networks modes of organising continue to be promoted by policy makers as a lever for improving th... more Networks modes of organising continue to be promoted by policy makers as a lever for improving the performance of healthcare services. The development of inter-organisational partnerships such as public-private partnerships, federations, mergers, and alliances signify these trends with the widespread adoption of joint working arrangements across a range of service areas . Over recent years particular interest has been given to how partnership working can be better used to improve the performance of the hospitals and community services in the English NHS (NHS England 2018; NHS England 2019a). Recent scandals highlighting poor and deficient care in provider organisations (Francis 2013; Kirkup 2018) have led to regulatory approaches that mandate partnership arrangements such as mergers and acquisitions between underperforming and high performing NHS provider organisations. Running in parallel with these developments have been initiatives designed to promote new partnerships with the aim of better integrating health and social care services (NHS England 2014). Reflecting on the rise of partnership and collaborative working, Dickinson and Sullivan (2014) locate these trends within the tradition of performance improvement in the public sector. Heavily influenced by the principles of New Public Management, inter-organisational collaboration has tended to centre on techno-bureaucratic approaches to improvement through the use of performance targets and measures narrowly defined by measures of efficiency and effectiveness that ignore the cultural performances of collaboration that are deeply rooted in the meanings, values, norms that reside within a particular organisational and cultural milieu (Dickinson and Sullivan 2014). Current interest in inter organisational partnership working as a mechanism to stimulate turnaround in failing organisations can also be situated within a broader tradition of public service reforms related to the 'management for excellence': the construction of organisational best practice examples that are translated into prescriptions for high-performing organisations (Jas and Skelcher 2005). Jas and Skelcher (2005) note that while the pursuit of excellence may encourage isomorphic processes and secure legitimacy with key stakeholders, the approach cannot, in isolation, be used to explain
BMC Health Services Research, Oct 1, 2021
Background: The commitment of hospital managers plays a key role in decisions regarding investmen... more Background: The commitment of hospital managers plays a key role in decisions regarding investments in quality improvement (QI) and the implementation of quality improvement systems (QIS). With regard to the concept of social capital, successful cooperation and coordination among hospital management board members is strongly influenced by commonly shared values and mutual trust. The purpose of this study is to investigate the reliability and validity of a survey scale designed to assess Social Capital within hospital management boards (SOCAPO-B) in European hospitals. Methods: Data were collected as part of the EU funded mixed-method project "Deepening our understanding of quality improvement in Europe (DUQuE)" from 210 hospitals in 7 European countries (France, Poland, Czech Republic, Germany, Portugal, Spain, and Turkey). The Chief Executive Officers (CEOs) completed the SOCAPO-B scale (six-item survey, numeric scale, 1='strongly disagree' to 4='strongly agree') regarding their perceptions of social capital within the hospital management board. We investigated the factor structure of the social capital scale using exploratory and confirmatory factor analyses. Internal consistency was assessed using Cronbach's alpha, while construct validity was assessed through Pearson's correlation coefficients between the scale items. Results: A total of 188 hospitals participated in the DUQuE-study. Of these, 177 CEOs completed the questionnaire(172 observations for social capital) Hospital CEOs perceive relatively high social capital among hospital management boards (average SOCAPO-B mean of 3.2, SD = 0.61). The exploratory factor analysis resulted in a 1-factor-model with Cronbach's alpha of 0.91. Pearson's correlation coefficients between the single scale items ranged from 0.48 to 0.68.
International journal of health policy and management, Nov 19, 2022
A range of conceptual models for understanding the policy process have been applied to the health... more A range of conceptual models for understanding the policy process have been applied to the health policy process, largely in particular sub areas or policy domains such as public health. However, these contributions appear to offer different rationales and present different frameworks for understanding the policy process. This Editorial critically examines articles that explore the health policy process with models from wider public policy and from health policy. It can be seen that very few of the wider models have been applied in studies of the health policy process. Conversely, some models feature in studies of the health policy process, but not in the wider policy process literature, which suggests that literature on the health policy process is semi-detached from the wider policy process literature. There seem to be two very different future research directions: focusing on 'home grown' models, or taking greater account of the wider policy process literature. Does 'one size fit all' or is it 'horses for courses'?
BMC Health Services Research, Mar 6, 2021
Background: National standards are commonly used as an improvement strategy in healthcare, but or... more Background: National standards are commonly used as an improvement strategy in healthcare, but organisations may respond in diverse and sometimes negative ways to external quality demands. This paper describes how a sample of NHS hospital trusts in England responded to the introduction of national standards for 7-day services (7DS), from an organisational behaviour perspective. We conducted 43 semi-structured interviews with executive/director level and clinical staff, in eight NHS trusts that varied in size, location, and levels of specialist staffing at weekends. We explored approaches to implementing standards locally, and the impact of organisational culture and local context on organisational response. Results: Senior staff in the majority of trusts described a focus on hitting targets and achieving compliance with the standards. Compliance-based responses were associated with a hierarchical organisational culture and focus on external performance. In a minority of trusts senior staff described mobilising commitment-based strategies. In these trusts senior staff reframed the external standards in terms of organisational values, and used co-operative strategies for achieving change. Trusts that took a commitment-based approach tended to be described as having a developmental organisational culture and a history of higher performance across the board. Audit data on 7DS showed improvement against standards for most trusts, but commitment-focused trusts were less likely to demonstrate improvements on the 7DS audit. The ability of trusts to respond to external standards was limited when they were under pressure due to a history of overall poor performance or resource limitations. Conclusions: National standards and audit for service-level improvement generate different types of response in different local settings. Approaches to driving improvement nationally need to be accompanied by resources and tailored support for improvement, taking into account local context and organisational culture.
BMJ Open
IntroductionUnprofessional behaviours encompass many behaviours including bullying, harassment an... more IntroductionUnprofessional behaviours encompass many behaviours including bullying, harassment and microaggressions. These behaviours between healthcare staff are problematic; they affect people’s ability to work, to feel psychologically safe at work and speak up and to deliver safe care to patients. Almost a fifth of UK National Health Service staff experience unprofessional behaviours in the workplace, with higher incidence in acute care settings and for staff from minority backgrounds. Existing analyses have investigated the effectiveness of strategies to reduce these behaviours. We seek to go beyond these, to understand the range and causes of such behaviours, their negative effects and how mitigation strategies may work, in which contexts and for whom.Methods and analysisThis study uses a realist review methodology with stakeholder input comprising a number of iterative steps: (1) formulating initial programme theories drawing on informal literature searches and literature alre...
BMJ Publishing Group, Aug 11, 2020
In the extraordinary months since Covid-19, NHS healthcare professionals have found themselves in... more In the extraordinary months since Covid-19, NHS healthcare professionals have found themselves in a surreal situation, straddling two distinct realities. On the one hand, there is such enormous gratitude for their exceptional work from the public and politicians, that they have become the heroes in the frontline of our national fight against the virus. On the other hand, some have reported cases of workplace bullying, retaliation or threats of disciplinary action when raising legitimate concerns over access to crucial and reliable personal resources, like personal protective equipment (PPE), for their own and their patients' safety.
Pro forma of staff survey
BMJ Quality & Safety, 2020
BackgroundIn 2013, the English National Health Service launched the policy of 7-day services to i... more BackgroundIn 2013, the English National Health Service launched the policy of 7-day services to improve care quality and outcomes for weekend emergency admissions.AimsTo determine whether the quality of care of emergency medical admissions is worse at weekends, and whether this has changed during implementation of 7-day services.MethodsUsing data from 20 acute hospital Trusts in England, we performed randomly selected structured case record reviews of patients admitted to hospital as emergencies at weekends and on weekdays between financial years 2012–2013 and 2016–2017. Senior doctor (‘specialist’) involvement was determined from annual point prevalence surveys. The primary outcome was the rate of clinical errors. Secondary outcomes included error-related adverse event rates, global quality of care and four indicators of good practice.ResultsSeventy-nine clinical reviewers reviewed 4000 admissions, 800 in duplicate. Errors, adverse events and care quality were not significantly dif...
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Papers by Russell Mannion