Today's leaders need to change radically to meet the challenge of complex organizations in business landscapes that are in flux. This requires not merely new skills and competencies, but a step-change in development in three fundamental dimensions: how you do things, who you are, and how you relate to other people. 4D Leadership is what happens when this step-change in doing, being and relating takes place. When you move up to the next level of ability and sophistication in these three dimensions, you will have unlocked the fourth dimension (verticality) and you will receive a significant comp.
"Business spends billions on innovation with very little to show for their investment or effort. This book challenges some of the 'ingrained truths' of innovation and suggests a different approach. Innovation is not the creation of a novel idea. It is the successful commercialisation of that novel idea. Rather than starting with costly, time-consuming problem assessment that seeks to push potential solutions through an innovation funnel, an 'impeller approach' starts with possible solutions and gets the market to pull the best ones forward so they can fail fast or flourish fast. This approach is made possible by the addition of a 'bee' - a new type of integrative thinker who can harvests existing knowledge from the 'meadow of experts.' Completely reversing the innovation process means organisations are much better placed to win in the market rather than focus on finding theoretical solutions or clearing innovation stage gates. In addition, this approach also recognises that the people who shepherd the solution through the ideation and testing stage are not the same people who must then take that solution to market for successful commercialisation. Given the current innovation failure rate, coupled with the fact that society is beset with multiple wicked problems, it's time to think differently and innovate innovation itself. This book is essential reading for Heads of Innovation and Commercialisation, Directors of Marketing, Heads of New Product Development and New Service Development, Strategy Directors, Chief Technology Officers, Government advisers and policy makers"--
"Many observers have suggested that capitalism is fast destroying our planet, concentrating power in a few big companies. Excessive short-termism, leveraged debt, digitisation and disruption are the new normal. We stand at a critical juncture where the two paths ahead could lead to very different futures. One route could take us back to the harshest days of the early Industrial Revolution and the Great Depression. The other could lead to a world of abundance, equality, inclusivity and prosperity for all. Which future awaits us will largely be determined by business and HR in particular. Books on HR tend to focus on HR practices and potential interventions, but they rarely look at the profession, how it evolved and how and why those people practices were created. HR (R)Evolution: Change the Workplace, Change the World describes the 'Seven Great Waves' of change and explains how each wave impacted business. It explains how some companies are stuck in the past and how HR can break the deadlock if it understands what the future holds. This book is meant for senior business leaders or anyone currently working in HR who are grappling with the paradoxes of business today. It's for leaders who recognise that people issues are the central challenge of our time. Whether we embrace the waves yet to come will determine whether we survive or regress, whether we flourish or flounder. The future is in your hands"--
IntroductionThe electronic Frailty Index (eFI) and the Hospital Frailty Risk Score (HFRS) have been developed in primary and secondary care respectively.
Objectives and ApproachOur objective was to investigate how frailty progresses over time, and to include the progression of frailty in a survival analysis.To do this, we performed a retrospective cohort study using linked data from the Secure Anonymised Information Linkage Databank, comprising 445,771 people aged 65-95 living in Wales (United Kingdom) on 1st January 2010. We calculated frailty, using both the eFI and HFRS, for individuals at quarterly intervals for 8 years with a total of 11,702,242 observations.
ResultsWe created a transition matrix for frailty states determined by the eFI (states: fit, mild, moderate, severe) and HFRS (states: no score, low, intermediate, high), with death as an absorbing state. The matrix revealed that frailty progressed over time, but that on a quarterly basis it was most likely that an individual remained in the same state.
We calculated Hazard Ratios (HRs) using time dependent Cox models for mortality, with adjustments for age, gender and deprivation. Independent eFI and HFRS models showed increased risk of mortality as frailty severity increased. A combined eFI and HFRS revealed the highest risk was primarily determined by the HFRS and revealed further subgroups of individuals at increased risk of an adverse outcome. For example, the HRs (95% Confidence Interval) for individuals with an eFI as fit, mild, moderate and severe with a high HFRS were 18.11 [17.25,19.02], 20.58 [19.93,21.24], 21.45 [20.85,22.07] and 23.04 [22.34,23.76] respectively with eFI fit and no HFRS score as the reference category.
ConclusionFrailty was found to vary over time, with progression likely in the 8-year time-frame analysed. We refined HR estimates of the eFI and HFRS for mortality by including time dependent covariates.
Looked after children (LAC) continue to be one of the most vulnerable groups in society with numbers and rates in care increasing year-on-year. The aim of this study was to explore the unique perspectives, perceptions and opinions of experienced social workers on the little explored subject of neurodevelopmental disorders (NDDs) in this population. Using purposeful sampling, 10 social work professionals with extensive experience of working with these children were interviewed using a semi-structured interview. A thematic analysis using NVivo software was utilised to analyse, code and identify themes that contributed to the aims of the study. Four overarching themes and sub-themes emerged from the findings: perceptions of NDDs, perceptions of diagnosis, access to service provision and the impact on care settings. Attention deficit hyperactivity disorder, autism spectrum disorder, dyslexia and dyspraxia were the more prominent conditions discussed. Even though these children are embedded in service provision, the findings raise important questions for both health and social care policy. There is a pressing need for research from a nationwide context to further explore areas of prevalence, training, resources, access to relevant specialist support services and the impacts on the already vulnerable LAC with an NDD.
BACKGROUND: Looked after children (LAC) that are placed in either a foster, kinship, residential care setting or transition to adoption continue to develop debilitating disorders that significantly impact their overall health and social well-being. The prevalence of these disorders is often depicted under broad categories such as mental, behavioural or neurodevelopmental disorders (NDDs). Limited in research is the prevalence of what specific disorders fall under these broad categories. NDDs such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) which fall under an umbrella group in the expert field of genetics and neuropsychiatry will be explored. Unsupported, these disorders can lead to suboptimal health and social outcomes for both the child and family. In the general population, the prevalence of these NDDs and impacts on health and social well-being are relatively well documented, but for minority groups such as LAC, research is extremely limited. This review aims to estimate the prevalence of NDDs among LAC and explore how they might impact the health and social well-being of these vulnerable children. If feasible, the review will compare the prevalence rates to those children who are not looked after, to illuminate any differences or similarities between populations. METHODS: PubMed, ASSIA, IBSS, Web of Science, PsychINFO, Scopus, Psych articles, Social Care Online, secondary, grey literature and government publications will be searched to identify any eligible studies. No restrictions will be placed on country, design or year of publication. Studies must provide primary data on the prevalence or incidence of NDDs for individuals < 25 years of age, supported by either a diagnostic code, standardised diagnostic assessment tool or survey response. The Joanna Briggs Institute (JBI) critical appraisal tools will be utilised to assess the quality and bias and the random-effects model used to estimate a pooled prevalence of NDDs. DISCUSSION: Attaining an estimated ...
IntroductionCommon mental health disorders (CMD) are significant contributors to impaired health and well-being, and drive greater health resource utilisation. Electronic health records (EHR) are increasingly used for case identification of CMD when ascertaining social determinants of mental health. We seek to compare self-reported well-being indicators in groups identified using EHR-based CMD methods.
Objectives and ApproachThe National Survey for Wales (NSW) contains self-reported well-being indicators (Warwick Edinburgh Mental Well-being Scale, WEMWBS) recorded annually on ~7,000 individuals. We combined data from two NSWs and linked well-being indicators with Welsh Longitudinal General Practice (WLGP) data within the Secure Anonymised Information Linkage (SAIL) Databank, using individual response dates. We then used WGLP data to algorithmically derive identifiers of CMD cases within survey respondents. This individual-level linkage enables a comparison of NSW responses in CMD and non-CMD cases, and to assess sensitivity and specificity of the current CMD algorithm.
ResultsSurvey participants comprised 18,450 adults aged 16+ and living in Wales during 16/17 or 18/19. WEMWBS responses indicate 2,338 (12.6%) participants could be considered possibly depressed, and 2,268 (12.3%) probably depressed with low mental well-being (LMW). For participants with LMW, a 42/58 percentage split is observed between male/female respondents, compared to a 45/55 respective split of those not identified with LMW. Participants with LMW recorded low measures for overall satisfaction with life, 998 (44%) reported a value of 5 or less (/10) compared to 1123 (7%) participants not identified with LMW. Similarly, 828 (37%) participants identified with LMW reported 5 or less (/10) on the life worthwhile index, compared to 800 (5%) of non-LMW participants.
Conclusion / ImplicationsLinkage to the NSW provides a rich data source to compare objective well-being to algorithmically derived CMD cases from routinely collected primary care data. The individual-level linkage involved will allow for the wider determinants of mental health disorders to be examined.
BackgroundThe use of anonymised routine linked data in designing and conducting randomised controlled trials (RCTs) has great potential. Sample sizes can be large, inclusion rates high and follow up periods prolonged, while the disruption to participants' usual routines may be minimised. However, challenges and limitations in using routine linked data in RCTs remain.
Aims To describe, in primary and emergency settings, challenges and opportunities associated with designing and conducting RCTs using anonymised linked routine data to identify study participants and gather outcomes.
MethodsIn each of these trials we have used routine linked data as a key part of the research study design:
PRISMATIC (a stepped wedge trial of predictive risk stratification in primary care) utilised linked data outcomes related to emergency admissions to hospital, GP activity and outpatient appointments. Outcomes were included for 230,000 people registered to participating GP practices in the Swansea area
SAFER 2: a cluster randomised trial of referral to falls services by ambulance paramedics included linked data outcomes related to subsequent emergency episodes for 4,655 patients across three UK regions
TIME: feasibility trial of Take Home Naloxone randomised by city; routine linked data used to identify population for inclusion in follow up and outcomes
Regulatory processes - ethics, research and information governance permissions - have caused delay in each trial; inclusion rates have been much higher than is usual in RCTs (outcomes for >80% of eligible patients); large trials have been achievable at reasonable cost (each trial <£2,000,000). Questions remain about differences between self reported and routinely available outcomes; and between routine data outcomes collected prospectively and through the anonymised linked route.
ConclusionThere are clear benefits in using anonymised linked data outcomes in trials but further research is required to understand costs and limitations.
IntroductionResearch involving care homes is often difficult due to a lack of data and ethical issues. Wales (United Kingdom) contains approximately 1.3million residences, of these 717 are officially recorded as care homes for older people.
Objectives and ApproachOur objective was to develop a predictive methodology for identifying care homes in administrative data.
We used two data sources within the Secure Anonymised Information Linkage Databank to conduct our study. The Welsh Demographic Service Dataset (WDSD) contains all residences in Wales and demographic details of their occupants. An anonymised dataset of deterministically matched care home addresses was used to determine which of the residences in the WDSD were care homes.
We used details in the WDSD to determine the average age of the occupants, the number of people who moved into the residence in a year, and the number of people who died in a year. We were interested in care homes for older people and restricted all the residences in the WDSD to only those with an average age of 50+ years. We applied logistic regression to determine a probabilistic match for care homes based on the above characteristics. We determined an optimal cut-point for the probability of a residence being a care home based on the sensitivity and specificity.
ResultsRestricting the WDSD to have an average age of occupants of 50+ created a dataset of 3,939 residences, containing 562 care homes. After applying the logistic model to predict the care homes, we found an optimal probability cut-point which resulted in 548 true positives, 105 false positives, 14 false negatives, and 3,272 true negatives.
ImplicationsIdentification of care homes in an anonymised databank using only demographic data allows research into healthcare pathways for this hard to reach and under-researched population.
<b><i>Background:</i></b> Fatal opioid overdose is a significant public health problem with increasing incidence in developed countries. This study aimed to describe demographic and service user characteristics of decedents of opioid overdose in Wales to identify possible targets for behaviour modification and life-saving interventions. <b><i>Methods:</i></b> A retrospective cross-sectional analysis was conducted of a census sample of opioid overdose-related deaths recorded between January 01, 2012, and October 11, 2018, in Wales. UK Office for National Statistics, Welsh Demographic Service, and National Health Service datasets were linked deterministically. Decedents' circumstances of death, demographic characteristics, residency, and health service use were characterized over 3 years prior to fatal overdose using descriptive statistics. <b><i>Results:</i></b> In total, 638 people died of opioid overdose in Wales between January 01, 2012, and October 11, 2018, with an incidence rate of 3.04 per 100,000 people per year. Decedents were predominantly male (73%) and middle aged (median age 50 years). Fatal overdoses predominantly occurred in the community (93%) secondary to heroin (30%) or oxycodone derivative use (34%). In the 3 years prior to death, decedents changed address frequently (53%) but rarely moved far geographically. The majority of decedents had recently visited the emergency department (83%) or were admitted to the hospital (64%) prior to death. Only a minority had visited specialist drug services (32%). <b><i>Conclusions:</i></b> Deaths from opioid overdose typically occur in middle-aged men living peripatetic lifestyles. Victims infrequently visit specialist drug services but often attend emergency medical services. Emergency department-based interventions may therefore be important in prevention of opioid overdose fatalities in the community.
