Cancer patient satisfaction is measurably different between hospitals, as well as by tumour type. For many aspects of care there is evidence of systemic hospital-level factors that influence satisfaction as well as factors common to the care pathways experienced by individual patients. Factors amenable to clinical or managerial intervention deserve further investigation.
This study suggests that compliance with some clinical service standards, such as guidelines, could contribute to better survival at population level, while more general organisational aspects of cancer services may not directly improve survival.
The Cancer Plan for England, introduced in 2000, has promoted cancer service specialization. We have investigated how far specialization and general hospital factors each contributed to service performance for four common cancers-breast, colorectal, lung and prostate-at the time of the Cancer Plan. Performance measures of service standards, waiting time to treatment, satisfaction with care, in-hospital mortality and population-level survival were identified from secondary data sets for 167 acute hospitals and 34 cancer networks in England. We correlated rankings of networks and hospitals between the data sets using non-parametric statistics. At cancer network level, peer-review service standards were associated (P < 0.05) with 1-year survival for colorectal and lung cancers, and waiting times for lung cancer. At hospital level, standards were associated (P < 0.01) with waiting time to treatment for breast and colorectal cancers. However, there were stronger associations between specializations within hospitals: rankings of breast, colorectal and prostate cancers were highly associated (P < 0.001) for 5-year survival, patient satisfaction, standards and in-hospital mortality. Hospital-level differences appear to contribute more to variations in cancer performance than specialization differences within hospitals. The findings may be used for planning and commissioning better cancer services.
Organizational characteristics in English NHS hospitals and the experiences of patients with three common cancers – breast, colorectal and lung – were examined using secondary data analyses. Two specific measures of satisfaction, Respect and Dignity, reflecting inpatient care, and Communication reflecting hospital outpatient care, were drawn from a national survey of cancer patients after first hospital treatment. They were compared at hospital level with hospital cancer service standards, and measures of hospital provision, each drawn from national surveys. Respect and Dignity was greater in hospitals with fewer complaints, slower admission procedures and a greater proportion of medicine consultants, for breast and colorectal cancers only. For breast cancer alone, Respect and Dignity was greater in hospitals achieving more participation in meetings by lead team members at the cancer unit level. For lung cancer alone, there were tumour-specific team organizational measures (relating to outpatient assessment) associated with Communication. However, the majority of recorded standards did not show associations, and there were occasional negative associations (dissatisfaction). The impact of organizational factors on patients may be examined through observational studies when experimental designs are not possible. Understanding how organizational factors affect quality of care for cancer patients can contribute to planning and management of cancer services.
Human Resource Development (HRD) within an organizational context continues to face challenges to demonstrate impact and contribution to business success. This article provides an account of HRD practice in a large Indian manufacturing company. A difficult business and industrial relations context in the early 2010s provided the stimulus for HRD to take a more strategic role within the organization. The article focuses upon HRD's initiative with the company's line managers. Fundamentally managers needed to take greater responsibility for managing their people. The approach followed and the interventions made to equip managers with a set of new capabilities are critically assessed. The initiative reflects how, appropriately positioned and supported, HRD's impact can be significant in terms of business performance.
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