University of Birmingham: HSMC
April 2016: focus on quality and safety of care
Welcome to the second edition of our Health Services Management Centre (HSMC) update
in which we set out key highlights from our current programme of research, teaching and leadership development in relation to the quality and safety of care.

Alongside the ever pressing financial pressures facing healthcare systems, assuring and improving the quality and safety of care remains a global issue. Against a backdrop of these continuing concerns, HSMC is undertaking research, teaching and practice based activities that aim to provide evidence-based and timely insights to support healthcare services to improve the quality and safety of care.

Our ground-breaking new research on hospital boards and patient safety is profiled this month, showcasing key findings and evidence based recommendations of relevance to all those involved in health and social care.
Mind the gap: bridging healthcare management and research
In her inaugural lecture as Professor of Health Policy and Management and Director of HSMC, Judith Smith will use research evidence to examine what she argues to be the relatively separate and insular worlds of healthcare management and research, identifying their distinctive professional and cultural features.

She will use this analysis to explore the ways in which healthcare management and research can be drawn more closely together to mutual benefit, using examples from emerging UK and international evidence and best practice, and from her own experience of working in healthcare management, policy and research.

The lecture will be held at the Barber Institute of Fine Arts on Tuesday 3rd May 2016. To attend, please register via the University website.
More news stories >
HSMC Viewpoints
The recent Viewpoint by Russell Mannion and Ross Millar ‘Getting Hospital Boards on Board with Patient Safety’ presents some key reflections and learning from their recently completed three year study of hospital board governance of patient safety.

In ‘The curious incident of the Chief Executives in the night time’, Yvonne Sawbridge reflects on the introduction of NHS Improvement. With the current regulatory landscape often leading to panic, anxiety or knee jerk reactions, the Viewpoint opens the debate regarding the extent to which NHS Improvement will encourage the necessary patient safety cultures and behaviours that build on curiosity, openness and acknowledgement of error.
Visit our viewpoints >
Hospital Boards and Patient safety: in depth research focus
Despite guidance available to NHS boards on effective governance, significant gaps remain in our understanding of what board governance of safe care looks like and how it is accomplished and sustained. Our ground breaking new research funded by the National Institute of Health Research offers important new insights into this area.

The key points from this study are:

What are the types of activities undertaken by hospital trust boards to ensure safe care?
Our survey found a high proportion of trust boards reported being involved in ‘high performance’ activities such as setting explicit objectives related to improving patient safety. However, our case study work did identify differences in local processes.

What is the role of trust boards as opposed to councils of governors in the oversight of patient safety?
Governors served a useful educational and community linkage role, but were often unable to challenge or hold executives to account on matters of quality and safety.

Is there an association between particular board activities and patient safety processes and outcomes?
We did not find any statistically significant relationship between board attributes and (self-reported) processes and patient safety outcome measures.

What are the facilitators and barriers to developing effective board governance of safe care?
Facilitators included the implementation of a clear corporate strategy and operational plan focused on quality and safety, board stability, and strong and committed clinical leadership. Barriers included problems and disputes over the validity and reliability of performance data, and difficulties in communication between clinical units and the board.

What is the impact of commissioning arrangements and incentives on hospital board oversight of patient safety?
Contracting issues appeared to play a relatively minor role in incentivising quality and safety improvement. Building strong and trustworthy relationships between commissioners and providers was often viewed as a better way of stimulating positive change, rather than focusing on incentives and sanctions.

The final report for the Hospital Boards & Patient Safety can be found here.

Other research on quality and safety from HSMC:

Russell Mannion, Martin Powell and Ross Millar have been funded by the National Institute for Health Research to undertake research providing evidence-informed guidance regarding effective whistleblowing policies in the NHS.

Robin Miller, Ross Millar and Russell Mannion have been funded by the Health Foundation to further understand what can be learned from inter-organisational partnerships in their facilitation of quality improvement.

Ross Millar, Robin Miller and Yvonne Sawbridge have been funded by the West Midlands Academic Health Science Network to carry out a scoping review of their Patient Safety Collaborative which is part of a national programme to improve the safety of patients and ensure continual patient safety learning sits at the heart of healthcare in England.
More research >
Overhauling the NHS Complaints System - Reducing Complexity to Improve Patient Experience and Safety - 14 June 2016
Senior Fellow and HSMC’s Director
of Policy, Hilary Brown is chairing a symposium organised by the Public Policy Exchange in London.
The event will provide healthcare professionals and patient representatives the opportunity to examine the current complaints system and discuss ways it can be improved in order to enhance both service delivery and the quality of
visit the website >
International Conference on Priorities in Health:
7-9 September 2016
This major international conference is being organised by HSMC in partnership with the University of Birmingham Health Economics Unit, and will feature keynote and parallel sessions from academic and practitioner experts from across the globe. The conference will offer research-based insights for policy makers, practitioners and academics into the challenges facing health systems having to make difficult decisions about what to fund (or not)
in the wake of the world economic recession. Registration for this conference is now open.
visit the website >
MSc in Health Policy and Management specialising in Quality
For those interested in analysing and improving quality and safety of care, our MSc in Health Policy and Management provides a specialism in Quality. We offer two modules dedicated to improvement tools and techniques, engagement with different quality and safety perspectives, and different ways to support the successful spread of improvement.
visit the website >
Postgraduate MSc programmes
Our MSc programmes provide a challenging and inspiring study experience for those working in health and social care organisations. They equip participants with the knowledge, skills and confidence to develop both their careers and organisations. Our students, past and present, include senior managers, clinicians, and other health and social care practitioners and professionals. We are now accepting applications for courses commencing in September 2016.
visit the website >
The Elizabeth Garrett Anderson programme
This is a two year NHS Leadership Academy course aimed at mid-tier clinicians and managers in health and care. It leads to an MSc in Healthcare Leadership jointly accredited and awarded with the University of Manchester.
visit the website >
Recent Publications
Board governance of patient safety:
Freeman, T., Millar, R., Mannion, R. and Davies, H. (2015) Enacting corporate governance of health care safety and quality: a dramaturgy of hospital boards in England. Sociology of Health and Illness, 38(2): 233-251

Mannion, R., Freeman, T., Millar, R. and Davies, H. (2016) Effective board governance of safe care: A (theoretically underpinned) cross-sectional examination of the breadth and depth of relationships through national quantitative surveys and in-depth qualitative case studies. Health Services and Delivery Research, 4(4)

Mannion, R., Davies, H., Millar, R., Freeman, T., Jacobs, R. and Kasteridis, P. (2015) Overseeing oversight: governance of quality and safety by hospital boards in the English NHS. Journal of Health Services Research and Policy, 20(15): 9-16

Millar, R., Mannion, R., Freeman, T. and Davies, H. (2013) Hospital board oversight of quality and patient safety: a narrative review and synthesis of recent empirical research. Milbank Quarterly, 91(4): 738–770

Millar, R., Freeman, T. and Mannion, R. (2015) Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence. BMC Health Services Research, 15: 196 [online]. Available at: [Accessed 21 April 2016]

Other recent publications examining quality and safety:
Mannion, R. and Davies, H. (2015) Cultures of silence and cultures of voice: whistleblowing in healthcare organisations. International Journal of Health Policy and Management, 4(8): 503-505

Braithwaite, J., Matsuyama, Y., Mannion, R. and Johnson, J. (2015) Healthcare reform, quality and safety: perspectives, participants, partnerships and prospects in 30 countries. Abingdon: Ashgate.

Groene, O., Klazinga, N., Mannion, R. et al. (2015) The influence of context on the effectiveness of hospital improvement strategies: a review of systematic reviews. BMC Health Services Research, 15: 277 [online]. Available at: [Accessed 21 April 2016]

White, S., Wastell, D., Smith, S., Hall, C., Whitaker, E., Debelle, G., Mannion, R. and Waring, J. (2015) Improving practice in safeguarding at the interface between hospital services and children's social care: a mixed-methods case study. Health Services Delivery Research, 3(4)

Botje, D., Klazinga, N.S., Sunol, R., Groene, O., Pfaff, H., Mannion, R. et al. (2014) Is having quality as an item on the executive board agenda associated with the implementation of quality management systems in European hospitals: a quantitative analysis. International Journal for Quality in Health Care, 26(S1): 92-99

Mannion, R. and Thompson, C. (2014) Systematic biases in group decision making: implications for patient safety. International Journal for Quality in Health Care, 26(6): 606-612

Mannion, R. (2014) Enabling compassionate healthcare: perils, prospects and perspectives. International Journal of Health Policy and Management, 2(3): 115-117

Wagner, C., Mannion, R., Hammer, A., Groene, O., Arah, O. A., Dersarkissian, M., Sunol, R. (2014) The associations between organizational culture, organizational structure and quality management in European hospitals. International Journal for Quality in Health Care, 26(S1): 74-80
View our recent publications >
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