Book contents
- Frontmatter
- Dedication
- Contents
- List of abbreviations
- Notes on the authors
- Introduction
- one Transplanted roots: where the innovation came from
- two Fertile ground? The organisational milieux of the treatment centres
- three Taking up the challenge: local motives for the innovation
- four The impact of the wider policy context
- five Achieving the goals? How and why the treatment centres evolved
- six Improving practice? Evidence of innovative ways of working
- seven Summary and conclusions: making sense of what happened
- eight Implications for policy, practice and research
- Appendix 1 Early definitions of a treatment centre
- Appendix 2 The study design and methods
- References
one - Transplanted roots: where the innovation came from
Published online by Cambridge University Press: 01 September 2022
- Frontmatter
- Dedication
- Contents
- List of abbreviations
- Notes on the authors
- Introduction
- one Transplanted roots: where the innovation came from
- two Fertile ground? The organisational milieux of the treatment centres
- three Taking up the challenge: local motives for the innovation
- four The impact of the wider policy context
- five Achieving the goals? How and why the treatment centres evolved
- six Improving practice? Evidence of innovative ways of working
- seven Summary and conclusions: making sense of what happened
- eight Implications for policy, practice and research
- Appendix 1 Early definitions of a treatment centre
- Appendix 2 The study design and methods
- References
Summary
The NHS archetype of treatment centres
‘… the revolution in care that you have pioneered here is to be applied all over the country.’ (former Prime Minister Tony Blair in a speech at the Ambulatory Care and Diagnostic Centre [ACAD], Central Middlesex Hospital, London, February 2001)
In a traditional hospital, the patient is certainly central to diagnostic and therapeutic preoccupations, but not to the organization. Indeed, the physician and the nursing staff are at the centre of the organisation…. The order of organisational priorities is reversed in an ambulatory surgery unit. This substantive organisational revolution is even more: it is indeed a genuine cultural revolution. (De Lathouwer, 1999)
The ACAD … is … a building capable of doing the work of a DGH [district general hospital] two to three times larger. (Black, 1999, p 4)
The concept of the treatment centre (TC) had roots that existed well before the 2000 NHS Plan that promulgated the scheme. The model of ambulatory surgical centres and other forms of ‘focused factories’ (Casalino and Robinson, 2003; Casalino et al, 2004), which had existed in US healthcare since the 1970s, had meant that neither the archetype nor its context was wholly new to the NHS. Indeed five planned ambulatory care centres in England, two of which subsequently became part of the TC programme, were discussed in a report in the mid-1990s (NHS Estates, 1996, p 4). But it was the Ambulatory Care and Diagnostic Centre (ACAD) opened at the Central Middlesex Hospital in North West London in 1999 that was most cited as the prototype for the TC programme.
The ACAD is a purpose-built two-storey free-standing unit on the site of, but administratively distinct from, its host hospital. The building itself won high praise and awards from architects and others involved with healthcare construction and facilities provision, which probably contributed to the ACAD's high profile in the NHS. However, the ACAD's main claim to fame was the process by which it managed a wide range of elective day case work with in-patient stays that exceeded one day in only five per cent of patients. Its distinguishing features relative to conventional day case units were the ‘strong emphasis on protocol-driven care’ and the significant role played by the ‘scheduler’ in the organisation (Bowers et al, 2002, p 306).
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- Information
- Organisational Innovation in Health ServicesLessons from the NHS Treatment Centres, pp. 7 - 18Publisher: Bristol University PressPrint publication year: 2011