Functional flexibility has been advocated as a mechanism for improving efficiency and service quality and is, it is argued, especially appropriate to service environments. In recent years the UK public health service has been subject to an ongoing programme of reform, designed to modernize the way in which health services are provided. A central feature of the reform involves breaking down traditional boundaries and the re‐organization of work roles. This article is concerned with examining the implementation of functional flexibility in three health‐care settings. Case‐study data are presented, focusing on the responses of employees and managers to initiatives to work more flexibly. For managers the implementation achieved efficiency gains and improvements to service quality, in spite of some resistance from employees. For employees the outcomes were more mixed. There was evidence of ‘humanization’ through greater job variety, challenge and access to training, but there were also costs in terms of intensification, role confusion and stress. The implications of these findings both for understanding the issues raised by the use of functional flexibility and for the implementation of policies in the NHS involving job redesign are discussed.

Purpose -The purpose of this paper is to explore the use of intangible resources in the performance management of European hospitals. The extent of the awareness of intangible resources as performance drivers is examined in five different European hospitals, from both the private and the public sector. Design/methodology/approach -An inductive approach was taken based on open ended, semi-structured interviews with key informants. Findings -Research results indicate that hospitals' managers realise the importance of intangible resources. In particular these relate to three different areas, namely the management of hospitals' human resources, the creation of relationships within and outside the organisation, and the measurement of individual performance. Research limitations/ implications -This research is exploratory in nature. Further and deeper research is needed which focuses on the identification of the most relevant resources in hospitals and their impact on performance. Both will then justify the integration of these intangible resources in performance measurement systems. Originality/value -This research gives insights into the awareness of intangible resources in different European hospitals. It explores the use of intangible resources in performance measurement systems. Much of the research in this area has been concentrated on the private commercial sector, linked to creating shareholder value, and this paper adds to the newly developing research looking at hospital settings.

BackgroundAnaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease (CKD) may improve outcomes. However, little is known about the scope to improve primary care management of anaemia in CKD.MethodsAn observational study (N = 1,099,292) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practices (ISRCTN5631023731). We explored variables associated with anaemia in CKD: eGFR, haemoglobin (Hb), mean corpuscular volume (MCV), iron status, cardiovascular comorbidities, and use of therapy which associated with gastrointestinal bleeding, oral iron and deprivation score. We developed a linear regression model to identify variables amenable to improved primary care management.ResultsThe prevalence of Stage 3–5 CKD was 6.76%. Hb was lower in CKD (13.2 g/dl) than without (13.7 g/dl). 22.2% of people with CKD had World Health Organization defined anaemia; 8.6% had Hb ≤ 11 g/dl; 3% Hb ≤ 10 g/dl; and 1% Hb ≤ 9 g/dl. Normocytic anaemia was present in 80.5% with Hb ≤ 11; 72.7% with Hb ≤ 10 g/dl; and 67.6% with Hb ≤ 9 g/dl; microcytic anaemia in 13.4% with Hb ≤ 11 g/dl; 20.8% with Hb ≤ 10 g/dl; and 24.9% where Hb ≤ 9 g/dl. 82.7% of people with microcytic and 58.8% with normocytic anaemia (Hb ≤ 11 g/dl) had a low ferritin (<100ug/mL). Hypertension (67.2% vs. 54%) and diabetes (30.7% vs. 15.4%) were more prevalent in CKD and anaemia; 61% had been prescribed aspirin; 73% non-steroidal anti-inflammatory drugs (NSAIDs); 14.1% warfarin 12.4% clopidogrel; and 53.1% aspirin and NSAID. 56.3% of people with CKD and anaemia had been prescribed oral iron. The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been standardised.ConclusionsMedication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron. Iron stores may be depleted in over >60% of people with normocytic anaemia. Prescribing oral iron has not corrected anaemia.

Background: There is increasing interest in quality initiatives that are locally owned and delivered, team based, multiprofessional, and formative. The Royal College of General Practitioners' Quality Team Development (QTD) programme is one such initiative aimed at developing primary healthcare teams and their services. Aims: To evaluate QTD from the perspective of participants and assessors. Setting: UK primary health care. Design and method: Twelve of 14 practices and all four primary care organisations (PCOs) approached agreed to participate. Thirty four semi-structured interviews were conducted with key stakeholders. The interviews were taped, transcribed, and analysed using the constant comparative method. Results:The QTD programme appears to be highly valued by participating organisations. Practice based respondents perceived it as acceptable and feasible, and reported positive changes in teamwork and patient services. They valued its formative, participative, and multiprofessional nature, especially the peer review element. PCOs saw QTD as a method of delivering on prevailing national policies on clinical quality and modernisation agendas as well as promoting interorganisational collaboration. The main concerns raised were the workload, particularly for assessors, and maintaining the quality of the assessments and the programme. Conclusion: This qualitative study suggests positive benefits for participants in the QTD programme. However, such practices are a self-selecting innovative minority. Further research is needed on more typical practices to identify barriers to their participation in QTD or other formative, team based quality improvement programmes.

Teamworking is a multi‐dimensional concept which has gained recent popularity and some success in manufacturing, but there is little evidence that large numbers of firms in the service sector have espoused teamworking methods. This paper explores this dilemma by comparing academic perceptions of teamworking, through a review of the literature, with a study of the perceptions of practitioners. Although much has been written about group behaviour, the more recent literature on teamworking is inconclusive and is often derived from anecdotal rather than empirical research. Using information obtained from a recent study, this article suggests that the richness of the teamworking experience is not captured by some of the academic literature. It argues for a view of teamworking that is both grounded in the literature and which represents the views of managers and employees in the service sector.