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Foláyan MO, Haire B. What's trust got to do with research: why not accountability? Front Res Metr Anal 2023; 8:1237742. [PMID: 38025960 PMCID: PMC10679329 DOI: 10.3389/frma.2023.1237742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
This paper explores the intricate dynamics of trust, power, and vulnerability in the relationship between researchers and study participants/communities in the field of bioethics. The power and knowledge imbalances between researchers and participants create a structural vulnerability for the latter. While trust-building is important between researchers and study participants/communities, the consenting process can be challenging, often burdening participants with power abrogation. Trust can be breached. The paper highlights the contractual nature of the research relationship and argues that trust alone cannot prevent exploitation as power imbalances and vulnerabilities persist. To protect participants, bioethics guidance documents promote accountability and ethical compliance. These documents uphold fairness in the researcher-participant relationship and safeguard the interests of socially vulnerable participants. The paper also highlights the role of shared decision-making and inclusive deliberation with diverse stakeholders and recommends that efforts should be made by researchers to clarify roles and responsibilities, while research regulatory agents should transform the research-participant relationship into a legal-based contract governed by accountability principles. While trust remains important, alternative mechanisms may be needed to ensure ethical research practices and protect the interests of participants and communities. Striking a balance between trust and accountability is crucial in this regard.
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Affiliation(s)
| | - Bridget Haire
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Mathew M, Klabbers G, de Wert G, Krumeich A. Towards understanding accountability for physicians practice in India. Asian J Psychiatr 2023; 82:103505. [PMID: 36791611 DOI: 10.1016/j.ajp.2023.103505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/24/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
The lack of accountability is considered to be a major cause of the crisis in health care in India. Physicians as key stakeholders in the health care delivery system have traditionally been accountable for health concerns at the doctor-patient interface. Following social and organizational dynamics, the interpretations of accountability have broadened and shifted in the recent literature, expanding accountability to the community, national and global levels and to social domains. The objective of this study is to provide a comprehensive framework of accountability in medical practice that can be used as a vehicle for further contextualized research and policy input. Through literature review, this paper is presented in two parts. First, a description of accountability of a physician inclusive of the social domains is extracted by posing three pertinent questions: who is accountable? accountability to whom? and accountability for what? which addresses the roles, relationships with other stakeholders and domains of accountability. Second, a framework of accountability of a physician is designed and presented to illustrate the professional and social domains. This study revealed a shift from individual physician's accountability to collective accountability involving multiple stakeholders through complex reciprocal and multi-layered mechanisms inclusive of the social dimensions. We propose a comprehensive framework of accountability of the physician to include the social domains that its multidimensional and integrative of all stakeholders. Furthermore, we discuss the utility of the framework in the Indian health care system and how this can facilitate further research in understanding the social dimensions of all stakeholders.
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Affiliation(s)
- Mary Mathew
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Gonnie Klabbers
- Faculty of Health, Medicine and Life Sciences, Department of Health Ethics and Society, Maastricht University, Maastricht, the Netherlands.
| | - Guido de Wert
- Maastricht University, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences; Department of Health Ethics and Society, Maastricht, the Netherlands.
| | - Anja Krumeich
- Maastricht University, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences; Department of Health Ethics and Society, Maastricht, the Netherlands.
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Flynn MA, Brennan NM. Grounded accountability in life-and-death high-consequence healthcare settings. J Health Organ Manag 2021; ahead-of-print. [PMID: 34423926 PMCID: PMC9136857 DOI: 10.1108/jhom-03-2021-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction between formal “imposed accountability” and front-line “felt accountability”. From these insights, the paper introduces an emergent concept, “grounded accountability”. Design/methodology/approach Interviews are conducted with 41 clinicians, managers and governors in two large academic hospitals. The authors ask interviewees to recall a critical clinical incident as a focus for elucidating their experiences of and observation on the practice of accountability. Findings Accountability emerges from the front-line, on-the-ground. Together, clinicians, managers and governors co-construct accountability. Less attention is paid to cost, blame, legal processes or personal reputation. Money and other accountability assumptions in business do not always apply in a hospital setting. Originality/value The authors propose the concept of co-constructed “grounded accountability” comprising interrelationships between the concept’s three constituent themes of front-line staff’s felt accountability, along with grounded engagement by managers/governors, supported by a culture of openness.
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Muller SHA, Kalkman S, van Thiel GJMW, Mostert M, van Delden JJM. The social licence for data-intensive health research: towards co-creation, public value and trust. BMC Med Ethics 2021; 22:110. [PMID: 34376204 PMCID: PMC8353823 DOI: 10.1186/s12910-021-00677-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background The rise of Big Data-driven health research challenges the assumed contribution of medical research to the public good, raising questions about whether the status of such research as a common good should be taken for granted, and how public trust can be preserved. Scandals arising out of sharing data during medical research have pointed out that going beyond the requirements of law may be necessary for sustaining trust in data-intensive health research. We propose building upon the use of a social licence for achieving such ethical governance. Main text We performed a narrative review of the social licence as presented in the biomedical literature. We used a systematic search and selection process, followed by a critical conceptual analysis. The systematic search resulted in nine publications. Our conceptual analysis aims to clarify how societal permission can be granted to health research projects which rely upon the reuse and/or linkage of health data. These activities may be morally demanding. For these types of activities, a moral legitimation, beyond the limits of law, may need to be sought in order to preserve trust. Our analysis indicates that a social licence encourages us to recognise a broad range of stakeholder interests and perspectives in data-intensive health research. This is especially true for patients contributing data. Incorporating such a practice paves the way towards an ethical governance, based upon trust. Public engagement that involves patients from the start is called for to strengthen this social licence. Conclusions There are several merits to using the concept of social licence as a guideline for ethical governance. Firstly, it fits the novel scale of data-related risks; secondly, it focuses attention on trustworthiness; and finally, it offers co-creation as a way forward. Greater trust can be achieved in the governance of data-intensive health research by highlighting strategic dialogue with both patients contributing the data, and the public in general. This should ultimately contribute to a more ethical practice of governance. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00677-5.
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Affiliation(s)
- Sam H A Muller
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands.
| | - Shona Kalkman
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Ghislaine J M W van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Menno Mostert
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
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Khan G, Kagwanja N, Whyle E, Gilson L, Molyneux S, Schaay N, Tsofa B, Barasa E, Olivier J. Health system responsiveness: a systematic evidence mapping review of the global literature. Int J Equity Health 2021; 20:112. [PMID: 33933078 PMCID: PMC8088654 DOI: 10.1186/s12939-021-01447-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems' functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness. METHODS A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts. RESULTS Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of 'health system responsiveness', which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system. CONCLUSIONS This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.
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Affiliation(s)
- Gadija Khan
- School of Public Health and Family Medicine, Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
| | - Nancy Kagwanja
- Kenya Medical Research Institute (KEMRI)-Wellcome-Trust Research Programme, Kilifi, Kenya
| | - Eleanor Whyle
- School of Public Health and Family Medicine, Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
| | - Lucy Gilson
- School of Public Health and Family Medicine, Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI)-Wellcome-Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Center for Tropical medicine and Global Health, University of Oxford, Oxford, UK
| | - Nikki Schaay
- University of the Western Cape, School of Public Health, Cape Town, South Africa
| | - Benjamin Tsofa
- Kenya Medical Research Institute (KEMRI)-Wellcome-Trust Research Programme, Kilifi, Kenya
| | - Edwine Barasa
- Kenya Medical Research Institute (KEMRI)-Wellcome-Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Center for Tropical medicine and Global Health, University of Oxford, Oxford, UK
| | - Jill Olivier
- School of Public Health and Family Medicine, Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
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Gupta N, Thiele CM, Daum JI, Egbert LK, Chiang JS, Kilgore AE, Johnson CD. Building Patient-Physician Trust: A Medical Student Perspective. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:980-983. [PMID: 32079958 DOI: 10.1097/acm.0000000000003201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Public trust in physicians has declined over the last 50 years. Future physicians will need to mend the patient-physician trust relationship. In conjunction with the American Medical Association's Accelerating Change in Medical Education initiative, the Mayo Clinic Alix School of Medicine implemented the Science of Health Care Delivery (SHCD) curriculum-a 4-year curriculum that emphasizes interdisciplinary training across population-centered care; person-centered care; team-based care; high-value care; leadership; and health policy, economics, and technology-in 2015. In this medical student perspective, the authors highlight how the SHCD curriculum has the potential to address issues that have eroded patient-physician trust. The curriculum reaches this aim through didactic and/or experiential teachings in health equity, cultural humility and competence, shared decision making, patient advocacy, and safety and quality of care. It is the authors' hope that novel medical education programs such as the SHCD curriculum will allow the nation's future physicians to own their role in rebuilding and fostering public trust in physicians and the health care system.
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Affiliation(s)
- Nikita Gupta
- N. Gupta is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. C.M. Thiele is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. J.I. Daum is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. L.K. Egbert is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. J.S. Chiang is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. A.E. Kilgore Jr is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. C.D. Johnson is a consultant, Department of Radiology, Mayo Clinic Hospital, Scottsdale, Arizona
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Jacobs S, Hann M, Bradley F, Elvey R, Fegan T, Halsall D, Hassell K, Wagner A, Schafheutle EI. Organisational factors associated with safety climate, patient satisfaction and self-reported medicines adherence in community pharmacies. Res Social Adm Pharm 2019; 16:895-903. [PMID: 31558413 DOI: 10.1016/j.sapharm.2019.09.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence suggests that community pharmacy service quality varies, and that this may relate to pharmacy ownership. However little is known about wider organisational factors associated with quality. OBJECTIVE To investigate organisational factors associated with variation in safety climate, patient satisfaction and self-reported medicines adherence in English community pharmacies. METHODS Multivariable regressions were conducted using data from two cross-sectional surveys, of 817 pharmacies and 2124 patients visiting 39 responding pharmacies, across 9 diverse geographical areas. Outcomes measured were safety climate, patient satisfaction and self-reported medicines adherence. Independent variables included service volume (e.g. dispensing volume), pharmacy characteristics (e.g. pharmacy ownership), patient characteristics (e.g. age) and areal-specific demographic, socio-economic and health-needs variables. RESULTS Valid response rates were 277/800 (34.6%) and 971/2097 (46.5%) for pharmacy and patient surveys respectively. Safety climate was associated with pharmacy ownership (F8,225 = 4.36, P < 0.001), organisational culture (F4, 225 = 12.44, P < 0.001), pharmacists' working hours (F4, 225 = 2.68, P = 0.032) and employment of accuracy checkers (F4, 225 = 4.55, P = 0.002). Patients' satisfaction with visit was associated with employment of pharmacy technicians (β = 0.0998, 95%CI = [0.0070,0.1926]), continuity of advice-giver (β = 0.2593, 95%CI = [0.1251,0.3935]) and having more reasons for choosing that pharmacy (β = 0.3943, 95%CI = [0.2644, 0.5242]). Satisfaction with information received was associated with continuity of advice-giver (OR = 1.96, 95%CI = [1.36, 2.82]), weaker belief in medicines overuse (OR = 0.92, 95%CI = [0.88, 0.96]) and age (OR = 1.02, 95%CI = [1.01, 1.03]). Regular deployment of locums by pharmacies was associated with poorer medicines adherence (OR = 0.50, 95%CI = [0.30, 0.84]), as was stronger patient belief in medicines overuse (OR = 0.88, 95%CI=[0.81, 0.95]) and younger age (OR = 1.04, 95%CI = [1.01, 1.07]). No patient outcomes were associated with pharmacy ownership or service volume. CONCLUSIONS This study characterised variation in the quality of English community pharmacy services identifying the importance of skill-mix, continuity of care, pharmacy ownership, organisational culture, and patient characteristics. Further research is needed into what constitutes and influences quality, including the development of validated quality measures.
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Affiliation(s)
- Sally Jacobs
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK.
| | - Mark Hann
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Fay Bradley
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Rebecca Elvey
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Tom Fegan
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Devina Halsall
- NHS England (North Region) Cheshire and Merseyside, Liverpool, UK
| | - Karen Hassell
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Andrew Wagner
- NIHR Comprehensive Research Network - Eastern, Norwich, UK
| | - Ellen I Schafheutle
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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Karekla M, Kasinopoulos O, Neto DD, Ebert DD, Van Daele T, Nordgreen T, Höfer S, Oeverland S, Jensen KL. Best Practices and Recommendations for Digital Interventions to Improve Engagement and Adherence in Chronic Illness Sufferers. EUROPEAN PSYCHOLOGIST 2019. [DOI: 10.1027/1016-9040/a000349] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Abstract. Chronic illnesses cause considerable burden in quality of life, often leading to physical, psychological, and social dysfunctioning of the sufferers and their family. There is a growing need for flexible provision of home-based psychological services to increase reach even for traditionally underserved chronic illness sufferer populations. Digital interventions can fulfill this role and provide a range of psychological services to improve functioning. Despite the potential of digital interventions, concerns remain regarding users’ engagement, as low engagement is associated with low adherence rates, high attrition, and suboptimal exposure to the intervention. Human–computer interaction (e.g., theoretical models of persuasive system design, gamification, tailoring, and supportive accountability) and user characteristics (e.g., gender, age, computer literacy) are the main identified culprits contributing to engagement and adherence difficulties. To date, there have not been any clear and concise recommendations for improved utilization and engagement in digital interventions. This paper provides an overview of user engagement factors and proposes research informed recommendations for engagement and adherence planning in digital intervention development. The recommendations were derived from the literature and consensualized by expert members of the European Federation of Psychology Associations, Psychology and Health Standing Committee, and e-Health Task Force. These recommendations serve as a starting point for researchers and clinicians interested in the digitalized health field and promote effective planning for engagement when developing digital interventions with the potential to maximize adherence and optimal exposure in the treatment of chronic health conditions.
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Affiliation(s)
- Maria Karekla
- Department of Psychology, University of Cyprus, Nikosia, Cyprus
- Psychology and Health Standing Committee of the European Federation of Psychology Associations, Brussels, Belgium
- e-Health Task Force of the European Federation of Psychology Associations, Brussels, Belgium
| | | | - David Dias Neto
- Psychology and Health Standing Committee of the European Federation of Psychology Associations, Brussels, Belgium
- APPsyCI – Applied Psychology Research Center Capabilities & Inclusion, ISPA – Instituto Universitário, Lisbon, Portugal
| | - David Daniel Ebert
- e-Health Task Force of the European Federation of Psychology Associations, Brussels, Belgium
- Friedrich Alexander University, Erlangen-Nürnberg, Germany
| | - Tom Van Daele
- e-Health Task Force of the European Federation of Psychology Associations, Brussels, Belgium
- Thomas More University of Applied Sciences, Belgium
| | - Tine Nordgreen
- e-Health Task Force of the European Federation of Psychology Associations, Brussels, Belgium
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Stefan Höfer
- Psychology and Health Standing Committee of the European Federation of Psychology Associations, Brussels, Belgium
- Medical University Innsbruck, Austria
| | - Svein Oeverland
- e-Health Task Force of the European Federation of Psychology Associations, Brussels, Belgium
- SuperEgo AS, Norway
| | - Kit Lisbeth Jensen
- e-Health Task Force of the European Federation of Psychology Associations, Brussels, Belgium
- Clinical Psychology, Private Practice, Denmark
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Revell S, Searle J, Thompson S. The information needs of patients receiving procedural sedation in a hospital emergency department. Int Emerg Nurs 2017; 33:20-25. [PMID: 28457743 DOI: 10.1016/j.ienj.2016.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/11/2016] [Accepted: 12/26/2016] [Indexed: 11/16/2022]
Abstract
This research investigated the information needs of patients receiving ED procedural sedation to determine the best format to consistently deliver key information in a way acceptable to all involved. Of particular interest was the question concerning patients' need for receiving written information. A descriptive exploratory study gathered qualitative data through face-to-face interviews and focus groups involving patients, nurses and medical staff. Individual interviews were conducted with eight adult patients following procedural sedation. They identified very few gaps in terms of specific information they needed pertaining to procedural sedation and rejected the need for receiving information in a written format. Their information needs related to a central concern for safety and trust. Focus groups, reflecting on the findings from patients, were conducted with five ED nurses and four emergency medicine consultants/registrars who regularly provided procedural sedation. Themes that emerged from the analysis of data from all three groups identified the issues concerning patient information needs as being: competence and efficiency of staff; explanations of procedures and progress; support person presence; and medico-legal issues. The research confirms that the quality of the patient's ED experience, specifically related to procedural sedation, is enhanced by ED staff, especially nurses, providing them with ongoing and repeated verbal information relevant to their circumstances.
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Affiliation(s)
- Sue Revell
- Hawke's Bay District Health Board, Hastings, New Zealand
| | - Judy Searle
- Eastern Institute of Technology, Taradale, Hawkes Bay, New Zealand
| | - Shona Thompson
- Eastern Institute of Technology, Taradale, Hawkes Bay, New Zealand.
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Hillman A. Institutions of care, moral proximity and demoralisation: The case of the emergency department. SOCIAL THEORY & HEALTH 2016; 14:66-87. [PMID: 26823656 PMCID: PMC4709833 DOI: 10.1057/sth.2015.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
This article draws on concepts of morality and demoralisation to understand the problematic nature of relationships between staff and patients in public health services. The article uses data from a case study of a UK hospital Emergency Department to show how staff are tasked with the responsibility of treating and caring for patients, while at the same time their actions are shaped by the institutional concerns of accountability and resource management. The data extracts illustrate how such competing agendas create a tension for staff to manage and suggests that, as a consequence of this tension, staff participate in processes of 'effacement' that limit the presence of patients and families as a moral demand. The analysis from the Emergency Department case study suggests that demoralisation is an increasingly important lens through which to understand health-care institutions, where contemporary organisational cultures challenge the ethical quality of human interaction.
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Affiliation(s)
- Alexandra Hillman
- School of Social Sciences, Cardiff University , 10 Museum Place, Cathays, Cardiff CF10 3BG, UK . E-mail:
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Abstract
Quality improvement differs from quality assurance (which is retrospective in nature) in that it attempts to use a quality assessment cycle and focuses on the organisation or system of production as a whole. In this paper, the third in a series of three published in this Journal, we discuss the concept and evidence base of quality improvement, the main approaches that have been used in other healthcare settings and the importance of a multi-faceted strategy to address this issue. These topics are then related to the context of primary dental care and the way dentistry currently addresses quality improvement. Finally, we set out an agenda and provide recommendations for a system-based quality improvement strategy for primary dental care and identify the likely barriers and facilitators for this approach.
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Van Den Assem B, Dulewicz V. Doctors’ trustworthiness, practice orientation, performance and patient satisfaction. Int J Health Care Qual Assur 2015; 28:82-95. [DOI: 10.1108/ijhcqa-04-2013-0037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to provide a greater understanding of the general practitioner (GP)-patient relationship for academics and practitioners. A new model for dyadic professional relationships specifically designed for research into the doctor-patient relationship was developed and tested. Various conceptual models of trust and related constructs in the literature were considered and assessed for their relevance as were various related scales.
Design/methodology/approach
– The model was designed and tested using purposefully designed scales measuring doctors’ trustworthiness, practice orientation performance and patient satisfaction. A quantitative survey used closed-ended questions and 372 patients responded from seven GP practices. The sample closely reflected the profile of the patients who responded to the DoH/NHS GP Patient Survey for England, 2010.
Findings
– Hierarchical regression and partial least squares both accounted for 74 per cent of the variance in “overall patient satisfaction”, the dependent variable. Trust accounted for 39 per cent of the variance explained, with the other independent variables accounting for the other 35 per cent. ANOVA showed good model fit.
Practical implications
– The findings on the factors which affect patient satisfaction and the doctor-patient relationship have direct implications for GPs and other health professionals. They are of particular relevance at a time of health reform and change.
Originality/value
– The paper provides: a new model of the doctor-patient relationship and specifically designed scales to test it; a greater understanding of the effects of doctors’ trustworthiness, practice orientation and performance on patient satisfaction; and a new framework for examining the breadth and meaning of the doctor-patient relationship and the management of care from the patient’s viewpoint.
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Peters D, Youssef FF. Public trust in the healthcare system in a developing country. Int J Health Plann Manage 2014; 31:227-41. [PMID: 25533779 DOI: 10.1002/hpm.2280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 11/22/2014] [Accepted: 11/27/2014] [Indexed: 11/06/2022] Open
Abstract
Broadly defined, trust in the healthcare system is concerned with how the public perceives the system and the actors therein as it pertains to their ability to both deliver services and seek the best interests of their clientele. Trust is important because it impacts upon a range of health behaviors including compliance and ultimately affects the ability of the healthcare system to meet its goals. While several studies exist on public trust within the developed world, few studies have explored this issue in developing countries. This paper therefore assesses public trust in the healthcare system of a developing small island nation, Trinidad and Tobago. A cross-sectional survey of adults was conducted using a questionnaire that has been successfully used across Europe. We report that trust levels in the healthcare system in Trinidad and Tobago are relatively low with less than 50% of persons indicating fair trust in the healthcare system. In addition, individual health professionals also did not score highly with lowest scores found for nurses and complementary therapists. Results on four out of five dimensions of trust also demonstrated scores significantly lower than those reported in more developed nations. Open-ended comments supported these findings with the majority of persons indicating a lack of confidence in the healthcare system. These results may reflect the reality in the wider developing world, and we suggest that bolstering trust is a needed area of focus in the delivery of healthcare services throughout the nation. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Dexnell Peters
- Department of Preclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Farid F Youssef
- Department of Preclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Scholte M, Neeleman-van der Steen CWM, Hendriks EJM, Nijhuis-van der Sanden MWG, Braspenning J. Evaluating quality indicators for physical therapy in primary care. Int J Qual Health Care 2014; 26:261-70. [PMID: 24699199 DOI: 10.1093/intqhc/mzu031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate measurement properties of a set of public quality indicators on physical therapy. DESIGN An observational study with web-based collected survey data (2009 and 2010). SETTING Dutch primary care physical therapy practices. PARTICIPANTS In 3743 physical therapy practices, 11 274 physical therapists reporting on 30 patients each. MAIN OUTCOME MEASURES Eight quality indicators were constructed: screening and diagnostics (n= 2), setting target aim and subsequent of intervention (n = 2), administrating results (n = 1), global outcome measures (n = 2) and patient's treatment agreement (n = 1). Measurement properties on content and construct validity, reproducibility, floor and ceiling effects and interpretability of the indicators were assessed using comparative statistics and multilevel modeling. RESULTS Content validity was acceptable. Construct validity (using known group techniques) of two outcome indicators was acceptable; hypotheses on age, gender and chronic vs. acute care were confirmed. For the whole set of indicators reproducibility was approximated by correlation of 2009 and 2010 data and rated moderately positive (Spearman's ρ between 0.3 and 0.42 at practice level) and interpretability as acceptable, as distinguishing between patient groups was possible. Ceiling effects were assessed negative as they were high to extremely high (30% for outcome indicator 6-95% for administrating results). CONCLUSION Weaknesses in data collection should be dealt with to reduce bias and to reduce ceiling effects by randomly extracting data from electronic medical records. More specificity of the indicators seems to be needed, and can be reached by focusing on most prevalent conditions, thus increasing usability of the indicators to improve quality of care.
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Affiliation(s)
- Marijn Scholte
- IQ Healthcare, University Medical Centre St. Radboud, PO Box 9101, 114, Nijmegen 6500 HB, The Netherlands IQ Healthcare, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
| | | | - Erik J M Hendriks
- Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, Maastricht University, PO Box 616, Maastricht 6200 MD, The Netherlands Faculty of Health, P. Debyeplein 1, Maastricht 6229 HA, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- IQ Healthcare, University Medical Centre St. Radboud, PO Box 9101, 114, Nijmegen 6500 HB, The Netherlands IQ Healthcare, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
| | - Jozé Braspenning
- IQ Healthcare, University Medical Centre St. Radboud, PO Box 9101, 114, Nijmegen 6500 HB, The Netherlands IQ Healthcare, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
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Hillman A, Tadd W, Calnan S, Calnan M, Bayer A, Read S. Risk, governance and the experience of care. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:939-55. [PMID: 23356787 PMCID: PMC3813989 DOI: 10.1111/1467-9566.12017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Drawing on perspectives from the governmentality literature and the sociology of risk, this article explores the strategies, tools and mechanisms for managing risk in acute hospital trusts in the United Kingdom. The article uses qualitative material from an ethnographic study of four acute hospital trusts undertaken between 2008 and 2010 focusing on the provision of dignified care for older people. Extracts from ethnographic material show how the organisational mechanisms that seek to manage risk shape the ways in which staff interact with and care for patients. The article bridges the gap between the sociological analysis of policy priorities, management strategy and the organisational cultures of the NHS, and the everyday interactions of care provision. In bringing together this ethnographic material with sociological debates on the regulation of healthcare, the article highlights the specific ways in which forms of governance shape how staff care for their patients challenging the possibility of providing dignified care for older people.
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Löfgren S, Hansson J, Øvretveit J, Brommels M. Context challenges the champion: improving hip fracture care in a Swedish university hospital. Int J Health Care Qual Assur 2012; 25:118-33. [PMID: 22455177 DOI: 10.1108/09526861211198281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to describe and explain a clinician-led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation. DESIGN/METHODOLOGY/APPROACH The paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes. FINDINGS Using a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital-wide process improvement programme, which "took over" the responsibility for improving hip fracture care. RESEARCH IMPLICATIONS/LIMITATIONS A clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services. ORIGINALITY/VALUE This case study is an illustration of both the strengths and the weaknesses of a "bottom-up, clinician-champion-led improvement initiative" in a complex university hospital.
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Affiliation(s)
- Susanne Löfgren
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
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Abstract
This study aims to explore how hospital organizations can use complaints to drive quality improvement. A teaching hospital in Taiwan was purposefully selected as a case study. Data were collected from a variety of sources, including interview with key managers and social workers, questionnaire survey of managers (n = 53), interview with government organizations (n = 4) and nongovernment organizations (n = 3), document collection and review, and the Critical Incident Technique using a questionnaire and nonparticipant observation (n = 59). This study revealed that the case hospital attempted to resolve complaints on a case-by-case basis. But it did not act on these complaints as a collective group to identify systemic problems and deficiencies. This approach provides single-loop learning, which may be sufficient to handle the problem on hand but is not enough to prevent such problems occurring again in the future. This study suggests some implications in regard to a best practice system for using complaints to improve quality.
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Greening J. How can we improve the effective engagement of doctors in clinical leadership? Leadersh Health Serv (Bradf Engl) 2012. [DOI: 10.1108/17511871211198043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
In a severe influenza pandemic, hospitals will likely experience serious and widespread shortages of patient pulmonary ventilators and of staff qualified to operate them. Deciding who will receive access to mechanical ventilation will often determine who lives and who dies. This prospect raises an important question whether pandemic preparedness plans should include some process by which individuals affected by ventilator rationing would have the opportunity to appeal adverse decisions. However, the issue of appeals processes to ventilator rationing decisions has been largely neglected in state pandemic planning efforts. If we are to devise just and effective plans for coping with a severe influenza pandemic, more attention to the issue of appeals processes for pandemic ventilator rationing decisions is needed. Arguments for and against appeals processes are considered, and some suggestions are offered to help efforts at devising more rational pandemic preparedness plans.
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Trauer T. The public reporting of organizational performance in mental health: coming soon to a mental health service near you. Aust N Z J Psychiatry 2011; 45:432-43. [PMID: 21510721 DOI: 10.3109/00048674.2011.566546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tom Trauer
- Department of Psychiatry, University of Melbourne, School of Psychology and Psychiatry, Monash University, St Vincent's Mental Health, St Vincent's Health (Melbourne), Australia
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22
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Mohr DC, Cuijpers P, Lehman K. Supportive accountability: a model for providing human support to enhance adherence to eHealth interventions. J Med Internet Res 2011; 13:e30. [PMID: 21393123 PMCID: PMC3221353 DOI: 10.2196/jmir.1602] [Citation(s) in RCA: 661] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 12/05/2010] [Accepted: 01/26/2011] [Indexed: 12/14/2022] Open
Abstract
The effectiveness of and adherence to eHealth interventions is enhanced by human support. However, human support has largely not been manualized and has usually not been guided by clear models. The objective of this paper is to develop a clear theoretical model, based on relevant empirical literature, that can guide research into human support components of eHealth interventions. A review of the literature revealed little relevant information from clinical sciences. Applicable literature was drawn primarily from organizational psychology, motivation theory, and computer-mediated communication (CMC) research. We have developed a model, referred to as "Supportive Accountability." We argue that human support increases adherence through accountability to a coach who is seen as trustworthy, benevolent, and having expertise. Accountability should involve clear, process-oriented expectations that the patient is involved in determining. Reciprocity in the relationship, through which the patient derives clear benefits, should be explicit. The effect of accountability may be moderated by patient motivation. The more intrinsically motivated patients are, the less support they likely require. The process of support is also mediated by the communications medium (eg, telephone, instant messaging, email). Different communications media each have their own potential benefits and disadvantages. We discuss the specific components of accountability, motivation, and CMC medium in detail. The proposed model is a first step toward understanding how human support enhances adherence to eHealth interventions. Each component of the proposed model is a testable hypothesis. As we develop viable human support models, these should be manualized to facilitate dissemination.
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Affiliation(s)
- David C Mohr
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
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Brown P, Calnan M. Braving a faceless new world? Conceptualizing trust in the pharmaceutical industry and its products. Health (London) 2010; 16:57-75. [PMID: 21169205 DOI: 10.1177/1363459309360783] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pharmaceutical products are commonly relied upon by professionals, and correspondingly patients, within a wide range of healthcare contexts. This dependence, combined with the inherent risk and uncertainty surrounding both medical practice and the drugs it harnesses, points towards the importance of trust in the pharmaceutical industry--a subject which has been much neglected by researchers. This article begins to address this deficiency by mapping out a conceptual framework which may form a useful basis for future research into this important topic. The often negative portrayal of the pharmaceutical industry in the public sphere belies a state of apparent confidence in its products. The role of prescribing professionals as 'mediators of trust' amid a faceless system of production and, alongside regulators, as bases of assurance in the quality of drugs goes some way towards explaining this contradiction. Recent policy moves towards fostering increased patient 'expertise' and responsibility for illness management, a widening of over-the-counter medication availability and a growing market of products (mainstream and illicit) via the Internet suggest this role of 'facework' in facilitating trust may be becoming more marginal. This heightened requirement for trusting amid the unfamiliar, and an apparent willingness to do so, underlines the need for further research into trust in the industry--both mainstream and underground--and its products. Within this discussion an agenda for furthering our understandings of the political-economy of the pharmaceutical industry becomes apparent, one which might be most effectively approached by way of a broader political-economy of hope and trust.
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Affiliation(s)
- Patrick Brown
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK.
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Thor J, Herrlin B, Wittlöv K, Øvretveit J, Brommels M. Evolution and outcomes of a quality improvement program. Int J Health Care Qual Assur 2010; 23:312-27. [DOI: 10.1108/09526861011029370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dixon-Woods M, Tarrant C. Why do people cooperate with medical research? Findings from three studies. Soc Sci Med 2009; 68:2215-22. [PMID: 19394741 DOI: 10.1016/j.socscimed.2009.03.034] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Indexed: 11/19/2022]
Abstract
In this paper, we distinguish decisions about cooperation with medical research from decisions about research participation. We offer an empirical and theoretical exploration of why people in three different UK-based medical research projects chose to cooperate. Data analysis of the accounts of 128 participants across the three studies was based on the constant comparative method. Participants' cooperation was engaged by a perception that they would be contributing to the 'public good', but they also wanted to justify their decision as sensible and safe. Critical to their cooperation was their belief that researchers would fulfil their side of the cooperative bargain, by not exposing participants to risks of harm or exploitation. Although participants were generally unaware of the details of the regulatory regime for research, they demonstrated a generalised reliance on regulation as a feature of everyday life that would provide a safe context for cooperation. In their assessment of particular projects, participants made judgements about whether to cooperate based on more specific cues, which acted as signs to assure them that researchers shared their cooperative intentions. These cues included organisational and professional credentials, the role identities and perceived trustworthiness of those involved in recruiting to research, and visible signs of reasonable practice mandated by regulatory systems. Thus participants drew on their understandings of an institutional field that was much broader than that of research alone. We propose that the social organisation of research is fundamental to the judgements people make about cooperation with research. Cooperation may be a more useful way of thinking about how people come to engage in collaboratively oriented actions such as research participation, rather than currently dominant individualistic models. Attention to the institutional context of research is critical to understanding what makes cooperation possible, and has important implications for the design of regulatory regimes for research.
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Lim JNW, Edlin R. Preferences of older patients and choice of treatment location in the UK: a binary choice experiment. Health Policy 2009; 91:252-7. [PMID: 19168256 DOI: 10.1016/j.healthpol.2008.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 09/11/2008] [Accepted: 09/20/2008] [Indexed: 10/21/2022]
Abstract
Current National Health Service (NHS) policy places importance on allowing patients to choose the time and location of their treatment. However, existing evidence suggests that older people have distinct needs and preferences from those of the general population. This study aimed to elicit preferences over cataract surgery from older people using a stated preference experiment. In order to reduce the cognitive load of the experiment, a binary choice format (accept treatment, reject treatment) was used. Analysis suggests that the strongest determinant of whether or not to accept treatment may be whether or not a consultant performs the operation. In monetary equivalents, a one mile increase in travel and a 1 week increase in waiting time are both valued at approximately 2 pounds, whilst consultant-led care is valued at approximately 25 pounds. Whilst the majority of our sample ultimately selected the closest treatment location available the results here suggest that older people are able to make trade-offs between pertinent attributes of choice. Here, the closest treatment location may simply be the one that best reflects their preferences.
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Affiliation(s)
- Jennifer N W Lim
- Leeds Institute of Health Sciences, University of Leeds, United Kingdom.
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27
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Dixon-Woods M, Ashcroft RE. Regulation and the social licence for medical research. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2008; 11:381-91. [PMID: 18633729 DOI: 10.1007/s11019-008-9152-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2008] [Indexed: 05/02/2023]
Abstract
Regulation and governance of medical research is frequently criticised by researchers. In this paper, we draw on Everett Hughes' concepts of professional licence and professional mandate, and on contemporary sociological theory on risk regulation, to explain the emergence of research governance and the kinds of criticism it receives. We offer explanations for researcher criticism of the rules and practices of research governance, suggesting that these are perceived as interference in their mandate. We argue that, in spite of their complaints, researchers benefit from the institutions of governance and regulation, in particular by the ways in which regulation secures the social licence for research. While it is difficult to answer questions such as: "Is medical research over-regulated?" and "Does the regulation of medical research successfully protect patients or promote ethical conduct?", a close analysis of the social functions of research governance and its relationship to risk, trust, and confidence permits us to pose these questions in a more illuminating way.
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Affiliation(s)
- Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, 2nd Floor, Adrian Building, Leicester, LE1 7RH, UK.
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28
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García-Lacalle J. A bed too far. Health Policy 2008; 87:31-40. [DOI: 10.1016/j.healthpol.2007.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 07/13/2007] [Accepted: 10/29/2007] [Indexed: 11/28/2022]
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Incentives and control in primary health care: findings from English pay‐for‐performance case studies. J Health Organ Manag 2008; 22:48-62. [DOI: 10.1108/14777260810862407] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wong G, Bentzen N, Wang L. Is the traditional family doctor an anachronism? LONDON JOURNAL OF PRIMARY CARE 2008; 1:93-9. [PMID: 25949569 DOI: 10.1080/17571472.2008.11493219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
KEY MESSAGES The polyclinics debate should recognise the need to balance the benefits of long-term personal doctor-patient relationship with the broader improved health outcomes from evidence based inputs from multidisciplinary teams in primary care. There is increasing evidence from the international health literature that a focus on integrated health systems is the key to better health outcomes both at the individual and population levels, in addition to being more cost effective. Although there is some evidence that other healthcare professionals such as nurse practitioners can deliver equally high health outcomes for patients, the GP role is not an anachronism and even seems increasingly more important in the 21st century given the increasing complexity of primary care and long term conditions.
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Affiliation(s)
- Geoff Wong
- GP Principal and Walport Clinical Lecturer, Royal Free and University College Medical School, London, UK
| | - Niels Bentzen
- Institute of Public Health, University of Copenhagen, Denmark
| | - Liejun Wang
- Assistant Research Fellow, Deputy Director of Social Policy Research Division, Development Research Center of the State Council of People's Republic of China, Beijing, China
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Barrett R, Moore RG, Staines A. Blood transfusion in Ireland: Perceptions of risk, a question of trust. HEALTH RISK & SOCIETY 2007. [DOI: 10.1080/13698570701612600] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Campbell S, Reeves D, Kontopantelis E, Middleton E, Sibbald B, Roland M. Quality of primary care in England with the introduction of pay for performance. N Engl J Med 2007; 357:181-90. [PMID: 17625132 DOI: 10.1056/nejmsr065990] [Citation(s) in RCA: 279] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Stephen Campbell
- National Primary Care Research and Development Centre, University of Manchester, Manchester, United Kingdom
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Thornton H. Publish, or not publish? More regulation or better motivation? The enemy is apathy. Int J Surg 2007; 5:1-2. [PMID: 17386906 DOI: 10.1016/j.ijsu.2006.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 07/21/2006] [Indexed: 11/15/2022]
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Calman L. Patients' views of nurses' competence. NURSE EDUCATION TODAY 2006; 26:719-25. [PMID: 17014931 DOI: 10.1016/j.nedt.2006.07.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 07/23/2006] [Indexed: 05/12/2023]
Abstract
This study examines, from the patients' perspective, what is meant by competent nursing and how, with this perspective in mind, patients would view the prospect of assessing the competence of nurses. There is a little empirical research that clarifies professional competence from the patient's perspective. Nursing curricula in the UK have shifted attention to 'competencies' as the outcome of nurse education and, in an era of patient involvement, their views are important to investigate. The study utilises a grounded theory approach. Data were collected in Central Scotland between 2001 and 2003. Twenty-seven patients participated. Data were analysed, in keeping with the grounded theory tradition, utilising the constant comparative method. Patients described the foundation of competent nursing practice as technical care and nursing knowledge. Patients assume that technical care is competent as safe guards are considered to be in place to protect patients. When technical competence is assumed, interpersonal attributes become the most important indicator of the quality of nursing care. The results of this study highlight uncertainty about whether patients feel able to assess the competence of nurses. The results of this study may have implications for nurses internationally when trying to involve patients in the assessment of nurses.
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Affiliation(s)
- Lynn Calman
- School of Nursing, Midwifery and Social Work, The University of Manchester, Coupland 3, Oxford Road, Manchester M13 9PL, UK.
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35
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Calman L. Patients’ views of nurses’ competence. Nurse Educ Pract 2006; 6:411-7. [DOI: 10.1016/j.nepr.2006.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 07/23/2006] [Indexed: 11/16/2022]
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Plochg T, Klazinga NS. Talking towards excellence: a theoretical underpinning of the dialogue between doctors and managers. ACTA ACUST UNITED AC 2005. [DOI: 10.1108/14777270510579288] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Beersen N, Redekop WK, de Bruijn JHB, Theuvenet PJ, Berg M, Klazinga NS. Quality based social insurance coverage and payment of the application of a high cost medical therapy: the case of spinal cord stimulation for chronic non-oncologic pain in The Netherlands. Health Policy 2005; 71:107-15. [PMID: 15563997 DOI: 10.1016/j.healthpol.2004.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article describes a project in which a national continuous quality improvement system and a payment scheme were explicitly linked, while introducing an expensive treatment (Spinal Cord Stimulation (SCS)) in the social health insurance benefit package, in The Netherlands. By linking a national CQI system and a payment scheme in a conditional financing policy a steering instrument for future control of the quality of neuromodulation treatment through SCS is created.
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Affiliation(s)
- Nicoline Beersen
- Department of Health Policy and Management, Erasmus MC, University Medical Center, Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Checkland K, Harrison S. Policy implementation in practice: the case of national service frameworks in general practice. J Tissue Viability 2004; 14:133-6. [PMID: 15516101 DOI: 10.1016/s0965-206x(04)44003-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
National Service Frameworks are an integral part of the government's drive to 'modernise' the NHS, intended to standardise both clinical care and the design of the services used to deliver that clinical care. This article uses evidence from qualitative case studies in three general practices to illustrate the difficulties associated with the implementation of such top-down guidelines and models of service. In these studies it was found that, while there had been little explicit activity directed at implementation overall, the National Service Framework for coronary heart disease had in general fared better than that for older people. Gunn's notion of 'perfect implementation' is used to make sense of the findings.
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Affiliation(s)
- Kath Checkland
- National Primary Care Research and Development Centre, University of Manchester, Manchester.
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