Abstract:
OBJECTIVE:To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. DESIGN:Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. SETTING:Nine trusts (cross sectional study) and four trusts (case study) in London. PARTICIPANTS:96 interviews with trust board members, other senior managers, clinicians, service managers, and representatives of health authorities, regional office, community health councils, local authorities, other trusts in the area, and primary care groups and trusts. MAIN OUTCOME MEASURES:Stated and unstated drivers, and impact of merger on delivery and development of services, management structures, and staff recruitment, retention, and morale. Effects of difference in trust size before and after the merger. Savings in management costs two years after merger. RESULTS:Some important drivers for merger are not publicly stated. Mergers had a negative effect on delivery of services because of a loss of managerial focus on services. Planned developments in services were delayed by at least 18 months. Trusts' larger sizes after mergers had unintended negative consequences, as well as predicted advantages. The tendency for one trust's management team to dominate over the other resulted in tension. No improvement in recruitment or retention of clinical and managerial staff was reported. Perceived differences in organisational culture were an important barrier to bringing together two or more organisations. Two years after merger, merged trusts had not achieved the objective of saving pound 500 000 a year in management costs. CONCLUSIONS:Important unintended consequences need to be accounted for when mergers are planned. Mergers can cause considerable disruptions to services, and require greater management support than previously acknowledged. Other organisations undergoing restructuring, such as primary care groups developing into primary care trusts and health authorities merging into strategic health authorities, should take these findings into account.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Fulop N,Protopsaltis G,Hutchings A,King A,Allen P,Normand C,Walters Rdoi
10.1136/bmj.325.7358.246keywords:
subject
Has Abstractpub_date
2002-08-03 00:00:00pages
246issue
7358eissn
0959-8138issn
1756-1833journal_volume
325pub_type
杂志文章,多中心研究abstract:OBJECTIVE:To determine the effectiveness of exercise as an intervention in the management of depression. DESIGN:Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with exp...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.322.7289.763
更新日期:2001-03-31 00:00:00
abstract:OBJECTIVE:To determine the association of resting echocardiography before elective intermediate to high risk non-cardiac surgery with survival and length of hospital stay. DESIGN:Population based retrospective cohort study. SETTING:Acute care hospitals in Ontario, Canada, between 1 April 1999 and 31 March 2008. PART...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d3695
更新日期:2011-06-30 00:00:00
abstract:OBJECTIVES:To identify the need for reproductive health care among a community affected by conflict, and to ascertain the priority given by the community to reproductive health issues. DESIGN:Rapid appraisal. This comprised interviews with key informants, in-depth interviews, and group discussions. Secondary data were...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.319.7212.743
更新日期:1999-09-18 00:00:00
abstract:OBJECTIVE:To show the influence of variations in case mix on clinical outcome indicators for patients admitted to hospital with acute stroke. DESIGN:"Before and after" cohort study, with prospective, consecutive identification of patients and prospective follow up; multiple logistic regression analyses to correct for ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7045.1503
更新日期:1996-06-15 00:00:00
abstract::Recent changes in the Russian government introduced by Boris Yeltsin include the appointment of Eduard Nechaev as health minister at the beginning of this year. The appointment received little publicity in the West, although his predecessor was sacked after only one year for failing to make any effort to improve healt...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6882.909
更新日期:1993-04-03 00:00:00
abstract:OBJECTIVES:To identify factors that differentiate between effective and ineffective computerised clinical decision support systems in terms of improvements in the process of care or in patient outcomes. DESIGN:Meta-regression analysis of randomised controlled trials. DATA SOURCES:A database of features and effects of...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.f657
更新日期:2013-02-14 00:00:00
abstract::Objective To estimate the incidence and prevalence of resistant hypertension among a UK population treated for hypertension from 1995 to 2015.Design Cohort study.Setting Electronic health records from the UK Clinical Practice Research Datalink in primary care.Participants 1 317 290 users of antihypertensive drugs with...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j3984
更新日期:2017-09-22 00:00:00
abstract:OBJECTIVES:To investigate use of commodes and attitudes of users and carers to them. DESIGN:Interview with semi-structured questionnaire of subjects supplied with commodes from Leeds community appliance centre. SUBJECTS:140 users of a commode and 105 of their carers. RESULTS:Main reasons for being supplied with a co...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6914.1258
更新日期:1993-11-13 00:00:00
abstract:OBJECTIVE:To test the hypothesis of an association between neonatal intramuscular vitamin K and childhood leukaemia and other cancers. DESIGN:Population based case-control study with data abstracted from hospital records. SETTING:Scotland. SUBJECTS:Children aged 0-14 years resident in Scotland from 1991-4 and diagno...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.316.7126.173
更新日期:1998-01-17 00:00:00
abstract:OBJECTIVE:To examine doctors' perspectives about their experiences with handheld computers in clinical practice. DESIGN:Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. SETTING:Six practice settings across the United States and two additional focus group sessi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.328.7449.1162
更新日期:2004-05-15 00:00:00
abstract:OBJECTIVE:To assess the risk of hyperglycaemia with two standard oral rehydration solutions that contain carbohydrate compared with a carbohydrate free solution during rehydration of diabetic patients with acute diarrhoea. DESIGN:Prospective randomised allocation to one of three oral rehydration solutions (World Healt...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.308.6929.624
更新日期:1994-03-05 00:00:00
abstract:OBJECTIVE:To determine whether the increased iron demands of pregnancy could be met by increased absorption from dietary sources. DESIGN AND SETTING:Longitudinal prospective study in the research unit of a maternity hospital. SUBJECTS:12 normal pregnant women. INTERVENTIONS:At 12, 24, and 36 weeks' gestation (within...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.309.6947.79
更新日期:1994-07-09 00:00:00
abstract:OBJECTIVE:To determine if trimethoprim use for urinary tract infection (UTI) is associated with an increased risk of acute kidney injury, hyperkalaemia, or sudden death in the general population. DESIGN:Cohort study. SETTING:UK electronic primary care records from practices contributing to the Clinical Practice Resea...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.k341
更新日期:2018-02-09 00:00:00
abstract:OBJECTIVE:To compare the clinical effectiveness of local corticosteroid injection, standard non-steroidal anti-inflammatory drugs, and simple analgesics for the early treatment of lateral epicondylitis in primary care. DESIGN:Multicentre pragmatic randomised controlled trial. SETTING:23 general practices in North Sta...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.319.7215.964
更新日期:1999-10-09 00:00:00
abstract:OBJECTIVE:To assess whether customised mobile phone reminders would improve adherence to therapy and thus decrease virological failure among HIV infected patients starting antiretroviral treatment (ART). DESIGN:Randomised controlled trial among HIV infected patients initiating antiretroviral treatment. SETTING:Three ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.g5978
更新日期:2014-10-24 00:00:00
abstract:OBJECTIVE:To describe the association between epithelial cell IgM, which has previously been associated with an increased incidence of loss of renal graft in children, with a novel cutaneous eruption and unexplained native renal disease. DESIGN:Observational study on children with epithelial cell antibody presenting w...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6795.161
更新日期:1991-07-20 00:00:00
abstract:OBJECTIVE:To obtain data on sexual contact between doctors and their patients. DESIGN:Anonymous questionnaire with 17 items sent to all working gynaecologists (n = 595) and all ear, nose, and throat specialists (n = 380) in the Netherlands. RESULTS:Response rate was 74%; a total 64 doctors gave a reason for not compl...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6841.1531
更新日期:1992-06-13 00:00:00
abstract:OBJECTIVE:To develop an evidence base for recommendations on the use of atypical antipsychotics for patients with schizophrenia. DESIGN:Systematic overview and meta-regression analyses of randomised controlled trials, as a basis for formal development of guidelines. SUBJECTS:12 649 patients in 52 randomised trials co...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.321.7273.1371
更新日期:2000-12-02 00:00:00
abstract:OBJECTIVE:To discover if there is an association between respiratory tract infections and pericoronitis of erupting third molars in young adults. DESIGN:Data from male military conscripts' medical records were collected over five years and the incidence of respiratory tract infection before and after acute pericoronit...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6983.834
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVE:To assess the associations between childhood and adulthood social class and insulin resistance. DESIGN:Cross sectional survey. SETTING:23 towns across England, Scotland, and Wales. PARTICIPANTS:4286 women aged 60-79 years. MAIN OUTCOME MEASURES:Insulin resistance and other cardiovascular disease risk fact...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.325.7368.805
更新日期:2002-10-12 00:00:00
abstract:OBJECTIVE:To determine whether the more intensive screening and treatment for prostate cancer in the Seattle-Puget Sound area in 1987-90 led to lower mortality from prostate cancer than in Connecticut. DESIGN:Natural experiment comparing two fixed cohorts from 1987 to 1997. SETTING:Seattle-Puget Sound and Connecticut...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.325.7367.740
更新日期:2002-10-05 00:00:00
abstract:OBJECTIVE:To estimate the high risk group for cardiovascular disease in a well defined Norwegian population according to European guidelines and the systematic coronary risk evaluation system. DESIGN:Modelling study. SETTING:Nord-Tröndelag health study 1995-7 (HUNT 2), Norway. PARTICIPANTS:5548 participants of the N...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38555.648623.8F
更新日期:2005-09-10 00:00:00
abstract:OBJECTIVE:To assess the ability of radiographers to identify abnormal radiographs of patients attending accident and emergency departments. DESIGN:Prospective study over six weeks. SETTING:Teaching hospital casualty x ray department. PATIENTS:3394 consecutive patients referred for radiography. INTERVENTIONS:Radiogr...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.302.6776.568
更新日期:1991-03-09 00:00:00
abstract:OBJECTIVE:To evaluate the impact of the revised diagnostic criteria for diabetes mellitus adopted by the American Diabetes Association on prevalence of diabetes and on classification of patients. For epidemiological purposes the American criteria use a fasting plasma glucose concentration >=7.0 mmol/l in contrast with ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7155.371
更新日期:1998-08-08 00:00:00
abstract:OBJECTIVE:This study updates work published in 1998, which found that of 47 rating instruments appearing on websites offering health information, 14 described how they were developed, five provided instructions for use, and none reported the interobserver reliability and construct validity of the measurements. DESIGN:...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.324.7337.569
更新日期:2002-03-09 00:00:00
abstract:OBJECTIVES:To explore the assumptions underlying consumers' responses to questions of resource priorities in the NHS. DESIGN:Qualitative analysis of semi-structured interviews with a heterogeneous sample of 16 patients drawn from a general practice. RESULTS:Interviewees were not persuaded that they had a legitimate r...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7013.1137
更新日期:1995-10-28 00:00:00
abstract:OBJECTIVE:To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital. DESIGN:Pragmatic randomised controlled trial. SETTING:Acute hospital wards and community in north of Bristol, with a catchment population of about 224 000 people. S...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.316.7147.1796
更新日期:1998-06-13 00:00:00
abstract:OBJECTIVE:To compare the efficacy of five probiotic preparations recommended to parents in the treatment of acute diarrhoea in children. Design Randomised controlled clinical trial in collaboration with family paediatricians over 12 months. SETTING:Primary care. PARTICIPANTS:Children aged 3-36 months visiting a famil...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.39272.581736.55
更新日期:2007-08-18 00:00:00
abstract:AIM:To compare perinatal morbidity and mortality for babies delivered in water with rates for babies delivered conventionally (not in water). DESIGN:Surveillance study (of all consultant paediatricians) and postal survey (of all NHS maternity units). SETTING:British Isles (surveillance study); England and Wales (post...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.319.7208.483
更新日期:1999-08-21 00:00:00
abstract:OBJECTIVE:To study the circumstances of dog bites and identify risk factors. DESIGN:Postal questionnaire survey and case note review of victims of dog bites referred between 1982 and 1989. SETTING:One referral based regional plastic surgery unit. PATIENTS:146 consecutive patients referred for primary treatment of do...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6816.1512
更新日期:1991-12-14 00:00:00