NHS owned pathology joint venture expects £4.5m loss – Health Service Journal 
A pathology joint venture owned by six NHS trusts is forecasting a £4.5m deficit for its first year of operation, HSJ has learned.

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Good progress? The coalition’s track record on inequalities in health – King’s Fund Blog 
One of the early mantras of the coalition government was the intention to ‘improve the health of the poorest, fastest’. So where have we got to with this ambition, and more broadly, with inequalities in health? It finds inequalities in health are cross-cutting complex issues that require coherent cross-system action and leadership. The fragmentation wrought by the health reforms has made any coherence of leadership on inequalities of health all the harder. Finds the lack of a coherent strategy and translating that into accountability means the initial rhetoric has not been lived up to.

Exploring the effect of complex patients on care delivery tasks
International Journal of Health Care Quality Assurance, Volume 28, Issue 5, June 2015.
Purpose: The needs of complex patients with chronic conditions can be unpredictable and can strain resources. Exploring how tasks vary for different patients, particularly those with complex needs, can yield insights about designing better processes in healthcare. This study explored the tasks required to manage complex patients in an anticoagulation therapy context. Design/methodology/approach: We analyzed interviews with 55 staff in six anticoagulation clinics using the Systems Engineering Initiative for Patient Safety (SEIPS) work system framework. We qualitatively described complex patients and their effects on care delivery. Findings: Data analysis highlighted how identifying complex patients and their effect on tasks and organization, and the interactions between them was important. Managing complex patients required similar tasks as non-complex patients, but with greater frequency or more intensity and several additional tasks. After complex patients and associated patient interaction and care tasks were identified, a work system perspective was applied to explore how such tasks are integrated within clinics and the resulting implications for resource allocation. Practical implications We present a complex patient management framework to guide workflow design in specialty clinics, to better support high quality, effective, efficient and safe healthcare. Originality/value: The complex patient framework presented here, based on the SEIPS framework, suggests a more formal and integrated analysis be completed to provide better support for appropriate resource allocation and care coordination.

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Investigating emergency room service quality using lean manufacturing
International Journal of Health Care Quality Assurance, Volume 28, Issue 5, June 2015.
Purpose: To investigate a lean manufacturing metric called Takt time as a benchmark evaluation measure to evaluate a public hospital’s service quality. Lean manufacturing is an established managerial philosophy with a proven track record in industry. A lean metric called Takt time is applied as a measure to compare the relative efficiency between two emergency departments (EDs) belonging to the same public hospital. Outcomes guide managers to improve patient services and increase hospital performances. Design/methodology/approach: The patient treatment lead time within the hospital’s two EDs (one department serves male and the other female patients) are the study’s focus. A lean metric called Takt time is used to find the service’s relative efficiency. Findings: Findings show that the lean manufacturing metric called Takt time can be used as an effective way to measure service efficiency by analysing relative efficiency and identifies bottlenecks in different departments providing the same services. Originality/value: The article presents a new procedure to compare relative efficiency between two EDs. It can be applied to any healthcare facility.

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Care quality instruments
International Journal of Health Care Quality Assurance, Volume 28, Issue 5, June 2015.
Purpose: This article describes instruments used for quality assessment in acute care. Quality care assessment is essential for improving care delivery. Quality instruments can be used to evaluate nurse and patient perspectives in multi-professional care. Therefore, valid and reliable measurement instruments are vital. Design/methodology/approach: A literature search identified several instruments that measure quality from a nurse and patient perspectives. The questionnaires were appraised in several steps with specific criteria: psychometric properties, underlying construct or test theory, study context, sample characteristics and target population. Findings: Overall, 14 instruments were evaluated, but only eight questionnaires represented nurse and patient views regarding quality. Instruments showed several disparities in their theoretical foundations and their psychometric properties. Two instruments did not provide validity data and one questionnaire did not report reliability data. Practical implications To inform healthcare managers about acute care quality, the authors demonstrated the need for more valid and reliable measurements by using the Guidelines for Critiquing Instrument Development and Validation Reports to evaluate quality care instruments’ psychometric properties. Originality/value There is a long tradition in quality care evaluations using questionnaires. Only a few instruments can be recommended for practical use.

Trust lures community nurses back to hospital with course – Nursing Times
A refresher training programme in hospital nursing is being rolled out at a trust in Somerset to try and attract community nurses back into the acute sector.