Not everything that counts can be counted; not everything that can be counted counts

Beyond new public management: Empowering community-based organisations

AIMS

To describe how new public management practices, a global public service management trend, and a provincial community of practice, a group of people who learn from each other by interacting on an ongoing basis, affected a group of 240 community-based organisations.

METHODS

We conducted a holistic single case study of 240 grassroots, community-based organisations called Family Resource Centres in the province of Québec, Canada. Data was collected from 36 research interviews, 6 years of participant observation, institutional documents and a research journal, and analysed qualitatively.

RESULTS

New public management practices foster social injustice and endanger the integrity of the community-based organisations, whereas the provincial community of practice empowered them to fight back deleterious new public management practices and reclaim their identity.

CONCLUSION

A provincial community of practice allowed 240 independent community-based organisations in Québec, Canada to become empowered on a macro level while remaining faithful to their small scale community orientation. We hope this model can serve as an example of alternatives to current (new public) management practices.

Embryo Selection and Mate Choice: Can 'Honest Signals' Be Trusted?

When a measure becomes a target, it often ceases to be a good measure - an effect familiar from the declining usefulness of standardized testing in schools. This economic principle also applies to mate choice and, perhaps surprisingly, pregnancy. Just as females screen potential mates under many metrics, human mothers unconsciously screen embryos for quality. 'Examinees' are under intense selection to improve test performance by exaggerating formerly 'honest' signals of quality. Examiners must change their screening criteria to maintain useful information (but cannot abandon old criteria unilaterally). By the resulting 'proxy treadmill', new honest indicators arise while old degraded indicators linger, resulting in trait elaboration and exaggeration. Hormone signals during pregnancy show extreme evolutionary escalation (akin to elaborate mating displays).

Historical notes on immaturity. Part 2: surviving against the odds

Survivors of immaturity of outstanding intelligence include Fortunio Licetus, born in 1577, and Isaac Newton, born in 1643. Reliable descriptions began appearing around 1820, and over a dozen infants were born weighing under 1000 g and before World War II, who developed normally. From 1876 to 2006, the birth weight at which half of the infants survived dropped from 2200 to 600 g. Statistics depended on how abortion, stillbirth and live birth were defined, which differed greatly from country to country. WHO definitions in 1993 required the registration of all infants weighing 500 g (22 complete weeks) or above. This definition was not universally adopted, resulting in considerable underreporting. Many medical societies issued ethical recommendations concerning the obligatory or optional treatment of immature infants. The "window", at which treatment is optional has been set at 22-23 weeks (Japan, Germany), 23-24 weeks (UK, USA, Canada), or 24-26 weeks (France, Netherlands, Switzerland). Instead of assessing an infant's individual prognosis, and ignoring its gender, co-morbidities, and particular cause of premature delivery, these rules frequently relied on gestational age alone to initiate or withhold life support.

Crisis, confidence and collectivity: Responding to the new public leadership challenge

The paper argues that the public sector context in the UK is characterized by a reform that focuses on ‘delivery’ with an unprecedented obsession with measurement. It examines whether the time is right to move from new public management (NPM) to new public leadership (NPL) and supports its argument by reference to literature and a content analysis of the Economic and Social Research Council (ESRC) seminar series papers and the subsequent edited volume ( The New Public Leadership Challenge [NPLC]) that set a public leadership challenge. The paper endorses the view that the focus on NPM has resulted in a culture of ‘counting what can be counted rather than what counts’ (McKee, 2004) and proposes a frame of reference that has potential for supporting the development and evaluation of new public leadership.

Prioritisation of road traffic injury interventions: results of a participative research with stakeholders in Mexico

The objective of this study is to use a qualitative approach to prioritise road traffic injury (RTI) interventions for the city of Cuernavaca in Mexico. Seven focus group discussions and two nominal groups were held with participants representing different road users and social groups. All the focus group sessions were recorded and video filmed. Processing and analysis of the information gathered was done using qualitative methods. The problem of RTIs was well recognised by members of the local community, represented by participants in this study. The participants showed knowledge of the causes and related urban development dynamics. Participants identified possible interventions, and even rated them. The participatory approach utilised generated helpful insights and it enabled the researchers to identify key local actors and issues, for example, concerns of different road users, perception of certain factors and actors as causes of RTIs, and attitudes and behaviour within a specific physical environment. A prioritised list for 18 different interventions was developed. The first one will be implemented to prevent RTIs in the youth population. Understanding the social context to analyse the problem and possible solutions as seen by the community is important when analysing public health problems because it informs decision making when developing and implementing interventions.

Evaluating imaging systems: practical applications

There are many ways in which imaging systems can be evaluated. The aim of the present paper is to provide an overview of a number of selected approaches to evaluating imaging systems, often encountered by the medical physicist, and discuss their validity and reliability. Specifically, it will cover (i) characterisation of an imaging system in terms of its detective quantum efficiency using linear-systems analysis; (ii) attempts to calculate relevant measures directly in images using the Rose model and the pixel signal-to-noise ratio; (iii) task-based methods incorporating human observers such as receiver-operating characteristics and (iv) visual grading-based methods using experienced radiologists as observers.

Publishing outcome data: is it an effective approach?

RATIONALE, AIMS AND OBJECTIVES

The publication of health outcome data--rather than merely the measurement and collection--is being given increasing consideration. Publication reflects society's increasing emphasis on a general 'right to know', as well as being a means of informing consumer choice. In theory, publication may help to promote public trust, support patient choice, and stimulate action to improve the quality of care whilst controlling costs.

METHODS

Drawing on a literature review, this paper overviews the strategies employed in the UK and US to publish outcome data. The focus is on outcomes, and certain related process measures, that measure the performance of hospitals or surgeons.

RESULTS AND CONCLUSIONS

Presenting the limited evidence that exists, we review the potential beneficial and harmful effects of publishing hospital outcome data. We also consider the risks of making incorrect inferences based on these data and the potential for dysfunctional consequences. Recognizing that the public largely mistrusts currently published health outcome data, we offer some recommendations for the future direction of strategies for publication.