Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, January 26, 2016

Lessons for major system change: centralization of stroke services in two metropolitan areas of England

Not one word on how these changes improve results. Complete failure and you as stroke survivors have to scream bloody murder.
http://hsr.sagepub.com/content/early/2016/01/22/1355819615626189.long
  1. Simon Turner1,2⇑
  2. Angus Ramsay1
  3. Catherine Perry3
  4. Ruth Boaden4
  5. Christopher McKevitt5
  6. Stephen Morris6
  7. Nanik Pursani7
  8. Anthony Rudd8
  9. Pippa Tyrrell9
  10. Charles Wolfe10
  11. Naomi Fulop11
  1. 1Senior Research Associate, Department of Applied Health Research, University College London, London, UK
  2. 2Senior Research Associate, National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care North Thames, London, UK
  3. 3Research Associate, Alliance Manchester Business School, University of Manchester, Manchester, UK
  4. 4Professor of Service Operations Management, Alliance Manchester Business School, University of Manchester, Manchester, UK
  5. 5Professor of Social Sciences & Health, Department of Primary Care and Public Health Sciences, King’s College London and National Institute of Health Research Comprehensive Biomedical Research Centre, Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, London, UK
  6. 6Professor of Health Economics, Department of Applied Health Research, University College London, UK
  7. 7Patient Representative, King’s College London Stroke Research Patients and Family Group, Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, King’s College London, London, UK
  8. 8Professor of Stroke Medicine, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK and National Clinical Director of Stroke, NHS England, and London Stroke Clinical Director, UK
  9. 9Professor of Stroke Medicine, Stroke & Vascular Centre, University of Manchester, Manchester Academic Health Science Centre, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
  10. 10Professor of Public Health Medicine, Department of Primary Care and Public Health Sciences, King’s College London, National Institute of Health Research Comprehensive Biomedical Research Centre, Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care South London, London, UK
  11. 11Professor of Health Care Organisation and Management, Department of Applied Health Research, University College London, London, UK
  1. Simon Turner, Department of Applied Health Research, University College London, London WC1E 7HB, UK. Email: simon.j.turner@ucl.ac.uk
 
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Abstract

Objectives Our aim was to identify the factors influencing the selection of a model of acute stroke service centralization to create fewer high-volume specialist units in two metropolitan areas of England (London and Greater Manchester). It considers the reasons why services were more fully centralized in London than in Greater Manchester.
Methods In both areas, we analysed 316 documents and conducted 45 interviews with people leading transformation, service user organizations, providers and commissioners. Inductive and deductive analyses were used to compare the processes underpinning change in each area, with reference to propositions for achieving major system change taken from a realist review of the existing literature (the Best framework), which we critique and develop further.
Results In London, system leadership was used to overcome resistance to centralization and align stakeholders to implement a centralized service model. In Greater Manchester, programme leaders relied on achieving change by consensus and, lacking decision-making authority over providers, accommodated rather than challenged resistance by implementing a less radical transformation of services.
Conclusions A combination of system (top-down) and distributed (bottom-up) leadership is important in enabling change. System leadership provides the political authority required to coordinate stakeholders and to capitalize on clinical leadership by aligning it with transformation goals. Policy makers should examine how the structures of system authority, with performance management and financial levers, can be employed to coordinate transformation by aligning the disparate interests of providers and commissioners.
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