James G Barlow

Imperial College London | Imperial · Imperial College Business School

Purpose of the study: to examine the costs and cost-effectiveness of ‘second-generation’ telecare, in addition to standard support and care that could include ‘first-generation’ forms of telecare, compared with standard support and care that could include ‘first-generation’ forms of telecare. Design and methods: a pragmatic cluster-randomised contr...

Prompted in part by constrained national budgets, European governments are increasingly partnering with the private sector to underwrite the costs of constructing and operating public hospitals and other health care facilities and delivering services. Through such public-private partnerships, governments hope to avoid up-front capital expenditure a...

Key messages • Technology can improve global health, and includes not only pharmaceuticals, vaccines, and devices, but also advances such as better sanitation and agriculture. • At present, technology for health focuses on the needs of the wealthy. • More frugal technology, specifically designed for the world’s poorest people, is needed. • Such tec...

In healthcare there is a long held wisdom that 'champions' are a key aspect of organizational change. Drawing on organizational management theory, we examine the role of champions in three health and social care organizations in England as they attempt to move services to a remote model of delivery, 'telecare'. The delivery of remote care is a sign...

Purpose Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-...

Hypoxic ischaemic encephalopathy (HIE) is a major cause of neonatal mortality and disability in the United Kingdom (UK) and has significant human and financial costs. Therapeutic hypothermia (TH), which consists of cooling down the newborn’s body temperature, is the current standard of treatment for moderate or severe cases of HIE. Timely initiatio...

Frugal innovation (FI), which has gained traction in various sectors, is loosely defined as developing quality solutions in a resource-constrained environment that are affordable to low-income consumers. However, with its popularity, multiple and diverse definitions have emerged that often lack a theoretical foundation. This has led to a convoluted...

Introduction Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting o...

Objectives This study investigated the barriers and facilitators to the adoption of point-of-care tests (POCTs). Design Qualitative study incorporating a constant comparative analysis of stakeholder responses to a series of interviews undertaken to design the Point-of-Care Key Evidence Tool. Setting The study was conducted in relation to POCTs us...

Introduction Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting o...

The study aims to conduct a systematic review to characterise the spread and use of the concept of ‘disruptive innovation’ within the healthcare sector. We aim to categorise references to the concept over time, across geographical regions and across prespecified healthcare domains. From this, we further aim to critique and challenge the sector-spec...

When there is significant uncertainty in an innovation project, research literature suggests that strictly sequencing actions and stages may not be an appropriate mode of project management. We use a longitudinal process approach and qualitative system dynamics modelling to study the development of genetically modified (GM) mosquitoes for malaria e...

The Chapter places health sector Public-Private Partnerships (PPPs) in their wider historical context, and shows the market size over time; Europe has seen the majority of projects. We define the principal purpose of PPP as raising fresh capital on behalf of the state and introducing commercial project development capacities; all to create scalable...

Background This study aimed to develop the Point-of-Care Key Evidence Tool (POCKET); a multi-dimensional checklist to guide the evaluation of point-of-care tests (POCTs) incorporating validity, utility, usability, cost-effectiveness and patient experience. The motivation for this was to improve the efficiency of evidence generation in POCTs and red...

Mitigating the risks of antibiotic resistance requires a horizon scan linking the quality with the quantity of data reported on drivers of antibiotic resistance in humans, arising from the human, animal, and environmental reservoirs. We did a systematic review using a One Health approach to survey the key drivers of antibiotic resistance in humans....

Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of...

Improving the quality of healthcare involves collaboration between many different stakeholders. Collaborative learning theory suggests that teaching different professional groups alongside each other may enable them to develop skills in how to collaborate effectively, but there is little literature on how this works in practice. Further, though it...

We use the case of a “whole-system” change program in a national healthcare system to empirically examine the multilevel dynamics underlying organizational adaptation. Our analysis demonstrates how the cognitive distance between agents’ causal representations affects opportunities to cooperate in hierarchical systems. Using complexity theory, we id...

Across the world, the demands placed on health systems are growing rapidly. Developed countries face the challenge of providing services to an ageing population with changing health needs, while countries with developing health systems must find ways of ensuring their populations are provided with access to healthcare. Innovative thinking is essent...

Social accounts are a powerful tool in influencing the behavior of organizational members during major change. Examination of their effectiveness has largely focused on the design of accounts to influence behavioral and affective responses. However, when used in real life practice, more individualized, interpretive and agentic responses to social a...

As part of the Royal Dutch Shell Group, the Shell Projects organisation, which is responsible for all major construction projects in Shell, shares the Shell-wide Goal Zero aspiration of no harm and no leaks. To help accelerate the journey to Goal Zero, a set of standard safety rules and a roadmap of activities that can help to deliver strong safety...

Background and objectives There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. Methods Mixed methods pre/post ‘move’ comparison within four nested case study wards in a single acute...

Objectives Point-of-care (POC) C reactive protein (CRP) is incorporated in National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis of pneumonia, reduces antibiotic prescribing and is cost effective. Aim To determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary car...

Seventy six senior academics from 11 countries invite The BMJ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority.They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission

Purpose: In this paper we investigate what happens when a lack of role sending results in ambiguous change agent roles during a large scale organisational reconfiguration. We consider the role of sensemaking in resolving role ambiguity of middle manager change agents and the consequences of this for organisational restructuring Design/methodology/a...

Background and objectives: There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. Methods: Mixed methods pre/post 'move' comparison within four nested case study wards in a single a...

The UK's National Health Service is widely held to be lagging behind the health systems of other countries in its innovativeness. In particular, there is said to be a " technology deficit " in certain clinical areas, such that patients are unable to access the latest drugs or medical devices. Moreover, the UK conducts world-leading research in heal...

Thrombolysis is associated with reduced disability for selected patients who have suffered ischemic stroke. However only a fraction of all patients who have suffered this type of stroke receive thrombolysis. The short time window of 4.5 hours in which treatment is licensed means that rapid care and well-organised pathways are essential. We studied...

Point-of-care in vitro diagnostics (POC-IVD) are increasingly becoming widespread as an acceptable means of providing rapid diagnostic results to facilitate decision-making in many clinical pathways. Evidence in utility, usability and cost-effectiveness is currently provided in a fragmented and detached manner that is fraught with methodological ch...

In April 2004, the Audit Commission published a series of five reports under the banner of Independence and Well-beingI. The fourth report in the series examined the opportunities for public services to promote the well-being and independence of older, disabled or vulnerable people through the use of assistive technology (AT), particularly telecare...

Report published in 2006 by the Evidence Working Group of the Dept of Health Telecare Policy Collaborative. Reviews the evidence base for remote care (telehealth / telecare).

Report published in 2008 of a study for OFCOM on the likely future spectrum requirements of the UK’s health sector. The study included a range of possible future scenarios for the health sector over the next 10-20 years, mapping the likely intersections between wireless and health technologies, and possible wireless health applications, and calcula...

Report published in 2008 on the challenges of adopting and diffusing new technologies and practices within the NHS, and potential solutions.

The aim of the research was to explore the relationship between the UK's PFI (Private Finance Initiative) model for funding healthcare infrastructure and the potential for design innovation to accommodate future changing needs, especially through flexibility and adaptability in the built form. The study included case studies of pre- and post-PFI ho...

There are calls for widespread scaling up of remote care – ‘telehealth’ and ‘telecare’. These are driven by an ageing population, increasing numbers of people with chronic conditions and constrained resources available for health and social services. This report is concerned with the supply-side of remote care and its ability to meet anticipated fu...

Report exploring potential changes in health care in England over the next 20 years. Published in 2013.

The report, published in 2001, sets out the findings of a DTI-funded Expert Mission on approaches to customer focus adopted by Japanese housebuilders. The mission investigated the tools, systems and procedures by which Japanese housebuilders capture customer housing needs, and manage the supply chain and customer interface to deliver high levels of...

Calls for successful knowledge translation (KT) in health care have multiplied over recent years. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) program is a policy initiative in the United Kingdom aimed at speeding-up the translation of research into health care practice....

Calls for successful knowledge translation (KT) in health care have multiplied over recent years. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) program is a policy initiative in the United Kingdom aimed at speeding-up the translation of research into health care practice....

Joint consultations - such as teleconsultations - provide opportunities for continuing education of general practitioners (GPs). It has been reported this form of interactive case-based learning may lead to fewer GP referrals, yet these studies have relied on expert opinion and simple frequencies, without accounting for other factors known to influ...

Background New hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences. Objectives To explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient expe...

A particular concern within the healthcare field is the issue of research informing practice, as often a substantial time lag exists between research being taken up and utilised in a reliable or consistent fashion. This has consequences, in terms of wasting resources and leading to an inefficient and unproductive health system. A requirement remain...

Thrombolysis is associated with reduced disability for selected patients who have suffered ischemic stroke. However only a fraction of all patients who have suffered this type of stroke receive thrombolysis. The short time window of 4.5 h in which treatment is licensed means that rapid care and well-organized pathways are essential. We studied meas...

Purpose – As management innovations become more complex, infrastructure needs to change in order to accommodate new work practices. Different challenges are associated with work practice redesign and infrastructure change however; combining these presents a dual challenge and additional challenges associated with this interaction. The purpose of th...

This paper presents managerial attempts at implementing telehealthcare. Our longitudinal, ethnographic case studies document both successful and failed implementations across five health and social care organisations in England. We draw on theories of organisational identity, sensemaking and sensegiving to highlight how managerial organisational id...

Telehealth is an emerging field of clinical practice but current UK health policy has not taken account of the perceptions of front-line healthcare professionals expected to implement it. AIM To investigate telehealth care for people with long-term conditions from the perspective of the front-line health professional. DESIGN AND SETTING A quali...

Increasing attention has been paid in both public administration and organizational theory to understanding how physicians assume a ‘hybrid’ role as they take on managerial responsibilities. Limited theoretical attention has been devoted to the processes involved in negotiating, developing, and maintaining such a role. We draw on identity theory, u...

Background and objectivesPatient and public involvement (PPI) is seen as a way of helping to shape health policy and ensure a patient-focused health-care system. While evidence indicates that PPI can improve health-care decision making, it also consumes monetary and non-monetary resources. Given the financial climate, it is important to start think...

Citizens across the world are increasingly called upon to participate in healthcare improvement. It is often unclear how this can be made to work in practice. This 4-year ethnography of a UK healthcare improvement initiative showed that patients used elements of organizational culture as resources to help them collaborate with healthcare profession...

The objective of the study was to understand the extent to which financial incentives such as Payment by Results and other payment mechanisms motivate kidney centres in England to change their practices. The study followed a qualitative design. Data collection involved 32 in-depth semistructured interviews with healthcare professionals and managers...

This chapter reviews the European experience in delivering healthcare infrastructure and services through public-private partnerships (PPPs), a strategic alliance between public and private partners over extended time periods. We investigate the concepts of contracting and bundling public sector infrastructure and services and draw lessons learnt a...

Objectives Our work explores the gap between evidence, management practices and the adoption of innovations. The article draws on the results of a longitudinal study examining the adoption of remote care (telecare) services. Method Five UK organisations form purposively chosen case studies. In the process of adoption, we explore how managers inter...

The use of agents to facilitate change in healthcare organisations is widely advocated. Organisational literature distinguishes between a variety of different types of agents (champions, opinion leaders and change agents), but we know little about how this distinction is implemented in practice and how different organisational members make sense of...

The paper is concerned with developing theory on identity formation. Existing research has explored the role of organizational identity change in mature organizations undergoing transformation. Our aim was to understand how organizational identity is developed from inception onwards. We studied a nascent organisation, concurrently collecting qualit...

In this paper we suggest that by regarding the authenticity of organizational narratives, we are able to explore how stories enable or constrain organizational action. We used data from a range of managers and front-line staff across seven public sector organizations attempting to introduce the same change initiative over a period of six years. It...

Abstract Alentejo covers a third of Portugal, yet it is home to only 5% of the population. Residents of the region are poorer, older, and less educated than the rest of the country. There is a shortage of physicians in several specialties. The low population density, a concentration of specialized services, and a poor public transportation network...

Background: Ten years on from the National Institute of Health and Clinical Excellence' technology appraisal guideline on haemodialysis in 2002; the clinical community is yet to rise to the challenge of providing home haemodialysis (HHD) to 10-15% of the dialysis cohort. The renal registry report, suggests underutilization of a treatment type that...

Health services contribute significantly to greenhouse gas emissions. New models of delivering care closer to patients have the potential to reduce travelling and associated emissions. We aimed to compare the emissions of patients attending a teleconsultation - an outpatient appointment using video-conferencing equipment - with those of patients at...

Objectives: Whole system integration of health and social care has been positioned as key to improving care, increasing efficiency and controlling costs. However, evidence for the benefits of whole system integration is scarce. Drawing on organizational theory, this study uses the implementation of remote care services, viewed as an enabler for wh...

Objective:- To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions. Design:- A study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmati...

Web appendix 2: Description of the telehealth intervention

Web figure 2: Early removal of telehealth for reasons other than death across the 12 month trial period

Web table 3: Means and estimated marginal means at each assessment point (intention-to-treat)

Web table 4: Means and estimated marginal means at each assessment point (per protocol)

Web appendix 4: Comparison of characteristics of participating and non-participating practices

Web table 1: Unadjusted mean change scores (Complete Case Cohort)

Web table 2: Unadjusted mean change scores (Available Case Cohort)

Web appendix 1: Whole Systems Demonstrator (WSD) terminology

Web appendix 3: Per protocol criteria

Web figure 1: Provision of peripheral telehealth devices to intervention participants in the WSD Telehealth Questionnaire Study

Since 2006 a series of government sponsored initiatives in the United Kingdom have sought to increase the adoption of remote care - telehealth and telecare. These aim to address the increased demand on health and social care services caused by an ageing population and rise in the number of people with long term chronic conditions. The scale of acti...

Using social accounts as cognitive tools for change, we examine middle managers during a large hospital facility move. We elucidate how group consensus and the alignment of a social account with existing schemata, mediates sensemaking. Our findings expand theory regarding how middle managers incorporate or reject new information.