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首页> 外文期刊>Social science and medicine >Reducing emergency bed-days for older people? Network governance lessons from the 'Improving the Future for Older People' programme
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Reducing emergency bed-days for older people? Network governance lessons from the 'Improving the Future for Older People' programme

机译：减少老年人的紧急卧床时间？ “改善老年人的未来”计划中的网络治理课程

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In 2007, the UK government set performance targets and public service agreements to control the escalation of emergency bed-days. Some years earlier, nine English local authorities had each created local networks with their health and third sector partners to tackle this increase. These networks formed the improving the Future for Older People' initiative (IFOP), one strand of the national 'Innovation Forum' programme, set up in 2003. The nine sites set themselves one headline target to be achieved jointly over three years; a 20 per cent reduction in the number of emergency bed-days used by people aged 75 and over. Three ancillary targets were also monitored: emergency admissions, delayed discharges and project sustainability. Collectively the sites exceeded their headline target.Using a realistic evaluation approach, we explored which aspects of network governance appeared to have contributed to these emergency bed-day reductions. We found no simple link between network governance type and outcomes. The governance features associated with an effective IFOP network appeared to suggest that the selection and implementation of a small number of evidence-based services was central to networks' effectiveness. Each service needed to be coordinated by a network-based strategic group and hierarchically implemented at operational level by the responsible network member. Having a network-based implementation group with a 'joined-at-the-top' governance structure also appeared to promote network effectiveness. External factors, including NHS incentives, health reorganisations and financial targets similarly contributed to differences in performance.Targets and financial incentives could focus action but undermine horizontal networking. Local networks should specify which interventions network structures are intended to deliver. Effective projects are those likely to be evidence based, unique to the network and difficult to implement through vertical structures alone.
机译：2007年，英国政府制定了绩效目标和公共服务协议，以控制紧急病床日数的增加。几年前，九个英国地方政府分别与他们的卫生和第三部门合作伙伴建立了本地网络，以应对这一增长。这些网络构成了完善的“老年人的未来”倡议（IFOP），该倡议是2003年建立的国家“创新论坛”计划的一环。这9个站点为自己设定了一个标题目标，该目标将在三年内共同实现;将75岁及以上的老人使用的紧急病床天数减少20％。还监测了三个辅助目标：紧急入场，延迟出院和项目可持续性。这些站点总体上超出了其总体目标。使用一种现实的评估方法，我们探索了网络治理的哪些方面似乎对减少这些紧急工作日做出了贡献。我们发现网络治理类型和结果之间没有简单的联系。与有效的IFOP网络相关的治理功能似乎表明，选择和实施少量基于证据的服务对于网络有效性至关重要。每个服务需要由基于网络的战略小组协调，并由负责的网络成员在操作级别上分层实施。建立具有“最高层联合”治理结构的基于网络的实施小组似乎也可以提高网络效率。外部因素，包括NHS激励措施，健康重组和财务目标，也同样导致绩效差异;目标和财务激励措施可能集中于行动，但会破坏横向网络。本地网络应指定打算提供哪些干预措施的网络结构。有效的项目可能是基于证据的项目，对于网络而言是独特的，并且仅凭垂直结构难以实施。

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