Showing papers in "Journal of Health Services Research & Policy in 2016"

Improving access: modifying Penchansky and Thomas's Theory of Access.

Abstract: Access is defined as the degree of fit between the user and the service; the better the fit, the better the access. Using the theory developed by Penchansky and Thomas, access is optimized by accounting for the different dimensions of access: accessibility; availability; acceptability; affordability; and adequacy in service design, implementation and evaluation. These dimensions are independent yet interconnected and each is important to assess the achievement of access. However, I argue that one dimension is missing - awareness. I propose that awareness is integral to access, that it should become a permanent part of the theory, and be applied whenever using the theory to develop, implement, or evaluate health care services and access more generally.

The PRISMS taxonomy of self-management support: derivation of a novel taxonomy and initial testing of its utility

Abstract: BackgroundSupporting self-management is a core response of health care systems globally to the increasing prevalence of long-term conditions. Lack of a comprehensive taxonomy (or classification) of self-management support components hinders characterization and, ultimately, understanding of these frequently complex, multi-component interventions.ObjectiveTo develop a comprehensive, descriptive taxonomy of self-management support components.MethodsComponents were derived from the 969 unique randomized controlled trials described in the 102 systematic reviews and 61 implementation trials, examining 14 diverse long-term conditions included in the Practical Reviews in Self-Management Support (PRISMS) project followed by discussion at an expert stakeholder workshop. The utility of the taxonomy was then tested using a self-management support intervention for cancer survivors.ResultsThe PRISMS taxonomy comprises 14 components that might be used to support self-management (e.g. information about condition/managem...

Evaluation of public involvement in research: time for a major re-think?

Abstract: The way that public involvement in research has been evaluated as a complex intervention has derailed the development of an evidence base. Two alternative approaches are available for constructing and evaluating patient involvement, each of which requires us to revisit the purposes and values that underpin it in each stage of the research process.

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

Abstract: ObjectivesOur 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.MethodsIn 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.ResultsIn 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 consens...

Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries

Abstract: Objectives: Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores ...

Integrated care: theory to practice.

Abstract: 'Integrated care' is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team case management is frequently the primary focus of integrated care when implemented internationally. We examine the practical application of integrated care in the NHS in England to exemplify the prevalence of the case management focus. We look at the evidence for effectiveness of multi-disciplinary team case management, for the focus on high-risk groups and for integrated care more generally. We suggest realistic expectations of what integration of care alone can achieve and additional research questions.

Service user engagement in health service reconfiguration: a rapid evidence synthesis

Abstract: Objective: To assess what is known about effective patient and public engagement in health service reconfiguration processes and identify implications for further research and health care practice. Methods: Rapid systematic review of published and grey literature to identify methods or approaches to engagement in decisions about health service reconfiguration; and to examine how engagement has worked or not worked in specific examples of system change. Following a search for literature published in English from 2000 to March 2014, eight systematic reviews, seven primary studies and 24 case studies (of which 6 were exemplars) were included. We undertook a narrative synthesis to consider five aspects of engagement with health service reconfiguration. Results: Engagement varied in nature and intensity, and efforts generally involved multiple methods. There was no evidence on the isolated impact of any particular engagement method or collection of methods. In general, engagement was most likely to be successful when started early, when led and supported by clinicians, and when it offered opportunities for genuine interaction. The impact of engagement was variably measured and demonstrated, and frequently defined as process measures rather than the outcomes of proposals for service reconfiguration. Little was reported on the potential negative impact of service user engagement. Conclusions: Patients and the public can be engaged through various methods. Problems often arise because decisionmakers paid insufficient attention to issues considered important by patients and the public. Guidance setting out the stages of reconfiguration and opportunities for service user input could be a helpful practical framework for future engagement activity. Future evaluation and explicit reporting of engagement and impact is needed.

Is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls:

Abstract: Objectives A wide range of patient benefits have been attributed to single room hospital accommodation including a reduction in adverse patient safety events. However, studies have been limited to the US with limited evidence from elsewhere. The aim of this study was to assess the impact on safety outcomes of the move to a newly built all single room acute hospital. Methods A natural experiment investigating the move to 100% single room accommodation in acute assessment, surgical and older people’s wards. Move to 100% single room accommodation compared to ‘steady state’ and ‘new build’ control hospitals. Falls, pressure ulcer, medication error, meticillin-resistant Staphylococcus aureus and Clostridium difficile rates from routine data sources were measured over 36 months. Results Five of 15 time series in the wards that moved to single room accommodation revealed changes that coincided with the move to the new all single room hospital: specifically, increased fall, pressure ulcer and Clostridium difficile rates in the older people’s ward, and temporary increases in falls and medication errors in the acute assessment unit. However, because the case mix of the older people’s ward changed, and because the increase in falls and medication errors on the acute assessment ward did not last longer than six months, no clear effect of single rooms on the safety outcomes was demonstrated. There were no changes to safety events coinciding with the move at the new build control site. Conclusion For all changes in patient safety events that coincided with the move to single rooms, we found plausible alternative explanations such as case-mix change or disruption as a result of the re-organization of services after the move. The results provide no evidence of either benefit or harm from all single room accommodation in terms of safety-related outcomes, although there may be short-term risks associated with a move to single rooms.

Hospital steam sterilizer usage: could we switch off to save electricity and water?

Abstract: ObjectivesSteam sterilization in hospitals is an energy and water intensive process. Our aim was to identify opportunities to improve electricity and water use. The objectives were to find: the time sterilizers spent active, idle and off; the variability in sterilizer use with the time of day and day of the week; and opportunities to switch off sterilizers instead of idling when no loads were waiting, and the resultant electricity and water savings.MethodsAnalyses of routine data for one year of the activity of the four steam sterilizers in one hospital in Melbourne, Australia. We examined active sterilizer cycles, routine sterilizer switch-offs, and when sterilizers were active, idle and off. Several switch-off strategies were examined to identify electricity and water savings: switch off idle sterilizers when no loads are waiting and switch off one sterilizer after 10:00 h and a second sterilizer after midnight on all days.ResultsSterilizers were active for 13,430 (38%) sterilizer–hours, off for 4822 (1...

Harmonizing routinely collected health information for strengthening quality management in health systems: requirements and practice

Abstract: ObjectiveOur aim was to specify the requirements of an architecture to serve as the foundation for standardized reporting of health information and to provide an exemplary application of this archi...

What happens when GPs engage in commissioning? Two decades of experience in the English NHS

Abstract: ObjectiveTo review the evidence on commissioning schemes involving clinicians in the United Kingdom National Health Service, between 1991 and 2010; report on the extent and impact of clinical engag...

How is feedback from national clinical audits used? Views from English National Health Service trust audit leads

Abstract: ObjectiveTo explore how the output of national clinical audits in England is used by professionals and whether and how their impact could be enhanced.MethodsA mixed-methods study with the primary r...

Evaluating the inclusivity of hospital wayfinding systems for people with diverse needs and abilities.

Abstract: ObjectivesWayfinding in hospitals is a complex problem since patients, who are likely to be under stress, may have to navigate their way to multiple locations in the course of a single visit. While good wayfinding design can reduce stress, poor wayfinding can not only increase individuals' anxiety but also generate additional costs for the hospital due to: lost time among staff members who need to direct patients rather than concentrate on their designated task; missed appointments or delayed meetings; and additional security staff to ensure that patients do not enter restricted areas. We investigated to what extent a questionnaire, developed by collecting data about the subjective experiences of wayfinders with diverse needs and abilities, could uncover wayfinding problems in hospitals.MethodsThe methodology we developed involved four steps: creating an initial questionnaire based on the literature; customizing the questionnaire to a hospital environment; validating and verifying the questionnaire; and e...

Rethinking the private-public mix in health care: analysis of health reforms in Israel during the last three decades.

Abstract: ObjectivesTo analyse the process of health care privatization using the case of Israeli health care reforms during the last three decades.MethodsWe used mixed methods including quantitative analysi...

Challenges, solutions and future directions in evaluative research.

Abstract: There is a need for ‘step change in the historic performance of the health, health care and social care system’ that will depend on ‘skilful design and robust implementation of a range of initiatives, not just once but in a dynamic stream, rooted in and modified by information on impact: in short, rooted in intelligent evaluation that is sensitive to the complexity’. This call to arms appears in the foreword to a new collection of papers by leading thinkers that sets out the current state of the science for the ‘intelligent evaluation’ of complex health and public health interventions. It offers insights into methodological challenges and potential future directions across the broad disciplinary menu of evaluative research and proposes thoughtful approaches to the competing priorities of, on the one hand, rigour and generalizability, and on the other hand, appropriate scale, cost and the need for prompt results. A particular trigger for the production of this volume was the launch in England of the NHS Five Year Forward View which articulates not just the urgency of change for health care systems given new patterns of ill health but also the aspiration that such changes should no longer be centrally driven. The NHS is being encouraged to pursue local and regional experiments to bring about a range of new models of care; innovation is henceforth to be achieved from the ‘bottom up’. Writers involved in this volume felt that an authoritative ‘forward view’ of evaluative research methods was also required in response: bottom-up transformation has to be shown to work (using a range of appropriate research methods), underlying mechanisms and accommodating contexts need to be clarified and research evidence needs to be provided in a timely fashion to ensure effective dissemination and the adoption of optimal system and service change. The Health Foundation (THF), the Medical Research Council (MRC) and the National Institute for Health Research (NIHR), via its Health Services and Delivery Research (HSDR) programme and Collaborations for Leadership in Applied Health Research and Care (CLAHRCs), together with Universities UK and AcademyHealth (the US health services research association), formed a partnership to develop the methodological underpinnings for evaluative research. A round table discussion in May 2015, involving these partners, set out an agenda for the democratization of evaluation via increased engagement between researchers and service leadership. Key messages included the need to move beyond the unhelpful notion of service and research being two separate cultures – researchers can help service leaders to clarify goals, gather relevant evidence and identify proportionate approaches for evaluating planned changes – and the availability of a spectrum of study designs and methods to tackle challenges in evaluating complex and emergent services. This was followed by a meeting in London in June 2015 at which 90 leading researchers came together for two days of challenge and debate. The eight methodological domains that were the focus of plenaries and facilitated discussions were then drafted as essays. In the spirit of collective endeavour, drafts were shared with plenary speakers for critique and revision before they were sent to the two editors, who suggested final modifications. The essays were further revised in the light of independent reviewers. Despite the plurality of methodological approaches, a number of themes emerge from across the essays. For example: the need for researchers from different disciplines to engage early and often with policy-makers, practitioners and funders through transparent and wide ranging discussions to ensure that common understandings are achieved about perceived objectives; the identification of relevant and feasible outcomes and the maintenance of appropriate boundaries between interested parties. Such discussions will often shift the focus from the traditional binary question of effectiveness towards a broader understanding of mechanisms, processes and outcomes of relevance to patients, practitioners and policy-makers with differing perspectives, priorities and timelines. The essays also include a call to co-ordinate analyses of macro-, mesoand micro-level determinants of system change. Such contextual factors are too often dismissed as unique features, too intangible to define and yet they can act as barriers to the successful transplantation of service innovation to other settings. This is unhelpful. Instead, there is a need to identify generalizable elements of beneficial processes by exploring Journal of Health Services Research & Policy 2016, Vol. 21(4) 215–216 ! The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1355819616664495 hsr.sagepub.com

Ernest Codman and the end result system: a pioneer of health outcomes revisited.

Abstract: Financial incentives are transforming the United States health-care system. Payers increasingly measure readmissions, hospital-acquired infections, postoperative complications, patient-centered measures, control of long-term conditions such as diabetes, and much else, all to assess the outcomes of healthcare. But this is hardly the first attempt to enhance quality by measuring health-care outcomes. A century ago, the Boston surgeon Ernest Codman authored A Study in Hospital Efficiency. Many current practitioners and scholars still find Codman’s ideas to be recognizable and relevant. Our recent Google Scholar search identified 154 citations of Codman’s book, including over half (86) since 2000. Although some of these innovations may seem obvious today, we need to remember that all new ideas were created by people working in a particular place and a specific social, political, and economic context. In this instance, the place was early 20th century Boston, and the person was a brash, ambitious surgeon named Ernest Amory Codman. Codman was, from the outset, an especially promising young man. An 1895 graduate of the elite Harvard Medical School, he became a house officer at Massachusetts General Hospital (MGH) and then joined the hospital staff. From the outset, he pushed the boundaries of clinical care. He was the first person at MGH to diagnose and successfully operate on a patient with a perforated duodenal ulcer, and only three years after the invention of the X-ray machine, he studied the X-ray appearance of human joints. Codman came of age at a propitious time for someone wanting to shake up the medical establishment. He chose to enter the exciting field of surgery. Surgeons, the dominant specialists of the early twentieth century, armed themselves with the new tools of anesthesia and antisepsis and devised new and innovative ways to operate on patients, increasingly within hospitals. Those hospitals were fast becoming essential elements of the health-care system. They grew larger and more complex. How to manage these intricate institutions? Not for the last time, hospital administrators looked for solutions to the business world, emulating systems being used scientifically to manage rapidly growing factories. Perhaps no idea was so important within the factory walls, or to Codman’s efforts within the hospital, as the desire to be efficient, to measure, to use new scientific tools systematically to organize the hospital workplace in general and the operating room in particular. One central idea, Taylorism, originated with the mechanical engineer Frederick Winslow Taylor. Codman’s friends, Frank and Lillian Gilbreth, invoked Taylorism as they tried to standardize operative processes by recording movies inside operating rooms. These management philosophies resonated with Codman’s basic instincts. He believed that high-quality care did not derive from fancy equipment or showy offices. Nor did he place much faith in the self-assessments of his fellow surgeons, who he saw as

Variation in avoidable emergency admissions: multiple case studies of emergency and urgent care systems.

Abstract: ObjectiveTo identify factors affecting variation in avoidable emergency admissions that are not usually identified in statistical regression.MethodsAs part of an ethnographic residual analysis, we compared six emergency and urgent care systems in England, interviewing 82 commissioners and providers of key emergency and urgent care services.ResultsThere was variation between the six cases in how interviewees described three parts of their emergency and urgent care systems. First, interviewees’ descriptions revealed variation in the availability of services before patients decided to attend emergency departments. Poor availability of general practice out of hours services in some of the cases reportedly made attendance at emergency departments the easier option for patients. Second, there was variation in how interviewees described patients being dealt with during their emergency department visit in terms of availability of senior review by specialists and in coding practices when patients were at risk of b...

Rationalizing medical work.

Abstract: Computer systems are the central organizing element in many, possibly most, white collar workplaces. In some sectors, such as retail and banking, their use has not just changed the processes for recording and retrieving data but fundamentally transformed almost every aspect of how business is transacted. The impact of computers in health care has been much less dramatic. In fact, the story of health care computing has largely been a history of failure, from the spectacular headlinegrabbing catastrophes of national IT programmes, to the more gradual failures of promising innovations which were never widely adopted. Health care computing is an important topic for health services research simply because we waste billions on it and lives are lost through our inability to marshal the information that could underpin effective care. It is also possible that studying the failures of health IT systems might reveal something important about the nature of clinical work and how it is organized. Good examples of thoughtful evaluations of computing systems include classic papers from Greenhalgh et al. documenting professional practices around the use and non-use of new computer systems and Koppel et al.’s papers describing how safety features in electronic prescribing systems prevent some errors but facilitate others. However, if I had to pick one publication to represent this body of research, it would be Marc Berg’s 1997 monograph. The book’s topic is the use of formal tools in medicine. It opens with an account of how ideas of ‘rational’ medicine have shaped, and been shaped by, three successive generations of rationalizing tools: decision analysis, expert systems and clinical protocols. The debate about the scientific character of medicine is taken to start with the notion that doctors are not themselves scientists but artisans whose skill is in the application of scientific knowledge. By the 1960s, however, it was argued that medical practice should be scientifically based. Statistics, for example, began to be seen not just as tool to be used in establishing medical knowledge but as a model for the kind of thinking that should inform medical decisions. Ledley and Lusted wrote a landmark article in the journal Science which characterized diagnosis as a process of reasoning on the basis of probabilistic information. If we know the frequency of a disease in a population and we know the frequency with which a given set of symptoms are associated with the disease, we can calculate a precise estimate of the probability that a patient who has these symptoms has that disease. Determining the most likely diagnosis could be the matter of a calculation rather than of expert judgement. A different, but equally controversial, model of medical reasoning was developed by research into artificial intelligence (AI). Many early AI systems attempted to represent the knowledge and reasoning of expert diagnosticians. Clinicians were not statisticians but logicians and computerized ‘expert systems’ would be perfect logicians with access to comprehensive sets of rules representing the pooled wisdom of experts. The third kind of formal system considered by Berg is that of the protocol. Protocols are attempts to rationalize the practice of medicine conceived as a ‘scientific process of distinctive clear-cut steps’. Clinical trials can be used to compare investigations, treatments and combinations of treatments, and the protocols can be used to promulgate their findings; ensuring that all patients have the benefit of those procedures which have been proved to be the most effective. The heart of the book is a detailed account of an example of each of these three kinds of decision aids, based partly on interviews with the developers and partly on observation of what happened when medical personnel tried to incorporate these tools into their routine. Berg looked at De Dombal’s statistical system for advising on the treatment of patients with acute abdominal pain; Emerson and Wyatt’s work on ACORN, a rule-based system for advising on the admission of patients to a coronary care unit and Eddy’s protocol for the management of breast cancer. Berg’s interviews reveal that in each case the developers

'Biohoarding': treasures not seen, stories not told.

Abstract: This article raises the concern that biobanks are failing to realize the expected research and health service outcomes. Rather than biobanking, we have been engaging in 'biohoarding', where building a quantifiable collection of tissue samples is the primary basis of the bio-resource. The root cause of 'biohoarding' is an ideological and motivational confusion as to the purpose for collecting the tissue in the first place. We have lost sight of the knowledge gain that biobanks should generate. The obligation to prevent 'biohoarding' lies not with researchers, funders or managers but with policy makers.

The interpreter as co-interviewer: the role of the interpreter during interviews in cross-language health research

Abstract: ObjectiveInterviews with ethnic minority patients provide a rich source of data to understand their perspectives of disease and its management. Language barriers are, however, often a problem so interpreters need to be used. We explored the impact of the interpreter on cross-language interviews between researchers and respondents.MethodsSecondary analysis of four interviews between researchers and patients involving professional interpreters.ResultsInterpreters were actively involved and influenced the interview in several ways: they assumed the interviewer’s communicative role, edited information; initiated information-seeking, took over control of the interview, and took over the respondent’s role. While the interpreter supported the interviewer, they posed risks to the quality of the interview.ConclusionResearchers need to be aware of the influence of interpreters. Researchers should instruct interpreters carefully about their roles though they may benefit from interpreters’ strategies to support them.

Why we need to move beyond diagnosis-related groups and how we might do so

Abstract: Diagnosis-related groups are widespread across Europe and they are meant to be a central instrument to improve the activity and efficiency of hospitals. However, there are many examples of diagnosis-related groups having adverse effects which are difficult to control and which endanger the goals of health care systems in terms of efficiency, equity and quality. Political and administrative decision makers therefore need to fundamentally rethink hospital governance and consider new systems of budgeting and performance measurement. Central Denmark Region is currently piloting a system, based on the Triple Aim approach, which may offer inspiration.

Does the 'diffusion of innovations' model enrich understanding of research use? Case studies of the implementation of thrombolysis services for stroke.

Abstract: Objective To test whether the model of ‘diffusion of innovations’ enriches understanding of the implementation of evidence-based thrombolysis services for stroke patients.Methods Four case studies of the implementation of evidence on thrombolysis in stroke services in England and Sweden. Semistructured interviews with 95 staff including doctors, nurses and managers working in stroke units, emergency medicine, radiology, the ambulance service, community rehabilitation services and commissioners.Results The implementation of thrombolysis in acute stroke management benefited from a critical mass of the factors featured in the model including: the support of national and local opinion leaders; a strong evidence base and financial incentives. However, while the model provided a starting point as an organizational framework for mapping the critical factors influencing implementation, to understand properly the process of implementation and the importance of the different factors identified, more detailed analyses of context and, in particular, of the human and social dimensions of change was needed.Conclusions While recognising the usefulness of the model of diffusion of innovations in mapping the processes by which diffusion occurs, the use of methods that lend themselves to in-depth analysis, such as ethnography and the application of relevant bodies of social theory, are needed.

Implementing climate change mitigation in health services: the importance of context:

Abstract: Academic interest in strategies to reduce the impact of health services on climate change is quickening. Research has largely focused on local innovations with little consideration of the contextual and systemic elements that influence sustainable development across health systems. A realistic framework specifically to guide decision-making by health care providers is still needed. To address this deficit, the literature is explored in relation to health services and climate change mitigation strategies, and the contextual factors that influence efforts to mitigate climate effects in health service delivery environments are highlighted. A conceptual framework is proposed that offers a model for the pursuit of sustainable development practice in health services. A set of propositions is advanced to provide a systems approach to assist decision-making by decoding the challenges faced in implementing sustainable health services. This has important implications for health care providers, funders and legislators since the financial, policy and regulatory environment of health care, along with its leadership and models of care generally conflict with carbon literacy and climate change mitigation strategies.

Trends in job satisfaction among German nurses from 1990 to 2012.

Abstract: ObjectiveImproving the job satisfaction of nurses is essential to enhance their productivity and retention and to improve patient care. Our aim was to analyse trends in German nurses' job satisfaction to enhance understanding of the nursing labour market and inform future policies.MethodsWe used 1990–2012 German Socioeconomic Panel data for trends in nurses' job satisfaction. Comparisons were drawn with doctors, other health care workers, and employees in other sectors of employment. Analysis explored associations between job satisfaction trends and other aspects of employment, such as whether full time or part time and pay. To account for fluctuations across the period of analysis, linear trends were generated using ordinary least squares.ResultsOver 23 years, job satisfaction of German nurses underwent a steady and gradual decline, dropping by an average 7.5%, whereas that of doctors and other health care workers increased by 14.4% and 1%, respectively. The decline for part-time nurses (13%) was more pr...

Care homes and health services: an uneasy alliance.

Abstract: Claire Goodman, Editorial, 'Care homes and health services@ an uneasy alliance', Journal of Health Services Research & Policy, Vol. 21(1):1-3, published online 15 June 2015, doi: https://doi.org/10.1177/1355819615590674.

Transferring research from researchers to knowledge users: the importance of relationships and getting them right:

Abstract: Health system reform efforts around the world focus on evidence-informed decision making as a critical element to creating high-performing health systems. Although the use of evidence to inform policy is limited, over the last decade, significant achievements have been made in supporting the use of evidence to inform policy making and decision making, in high, low and middle income countries. Knowledge transfer and exchange (KTE) has emerged as a paradigm to address many of the challenges and barriers associated with transferring evidence into policy and to start closing the ‘know-do’ gap. KTE is defined as ‘the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health.’ However, the uptake of evidence is challenging and numerous barriers exist that impede the implementation of evidence-informed decision making. Scholars point to the importance of relationships when linking research and policy, but they rarely articulate why – from a theoretical perspective – relationships are important, nor do they create a platform for a deeper understanding of how to use relationships effectively to transfer evidence into practice. Within the business literature, inter-organizational relationships have been studied for decades with a traditional focus on fixed organizational traits (such as the effect of internal organizational characteristics, resource dependency or uncertainty on types of cooperation). Building on existing research, Heide and Miner examined the role of relationships and focused on ongoing interaction as a factor influencing the success of inter-organizational relationships. Interactive theorists suggest that cooperation comes from the commitment between two or more ‘players’, and that over time, the players care about the ‘other’ and cooperate out of altruism. In their paper, Effects of Anticipated Interaction and Frequency of Contact on Buyer-Seller Cooperation, Heide and Miner explored whether the interaction patterns may themselves affect cooperation between players in an industrial purchasing setting. Heide and Miner identified four types of cooperation: (1) flexibility with one another or adjusting behaviour to accommodate the needs of the other, (2) information exchange or disclosing information to the other, (3) shared problem solving or relying on the other in order to solve issues together, and (4) restraint in the use of power or refraining from exploiting the other. Using a game theory approach based on the Prisoner’s Dilemma, where players can gain more from cooperation than from non-cooperation, Heide and Miner hypothesized that three factors would influence the degree of cooperation: (a) the extendedness of a relationship or how far into the future each party believes it will continue the relationship, (b) frequency or the expected amount of interaction between players; and (c) tolerance of performance ambiguity or the level of difficulty a player faces in evaluating the other party’s products and outcomes. The authors hypothesized that an increase in the first two factors would lead to an increase in cooperation, but a decrease in the third factor would lead to a decrease in cooperation. Heide and Miner tested these hypotheses by examining purchasing relationships between industrial suppliers and original equipment manufacturers whose

Unpacking knowledge translation in participatory research: a micro-level study.

Abstract: ObjectivesFunding bodies, policy makers, researchers and clinicians are seeking strategies to increase the translation of knowledge between research and practice. Participatory research encompasses a range of approaches for clinicians’ involvement in research in the hope of increasing the relevance and usability of research. Our aim was to explore how knowledge is translated and integrated in participants’ presentations and negotiations about knowledge.MethodsTwelve collaboration meetings were observed, and discussions between researchers and clinicians were recorded. The material was examined using the following analytical terms: knowledge object, knowledge form, knowledge position and knowledge tasks.ResultsWe identified a recurring rhetorical pattern in translational processes that we call ‘relevance testing’: a strategy by which the participants attempt to create coherence and identify relevance across different contexts. The limitation of this translational strategy was a tendency to reinforce a ‘two...

An evaluation tool for assessing performance in priority setting and resource allocation: multi-site application to identify strengths and weaknesses:

Abstract: IntroductionAn evaluation tool should help improve formal priority setting and resource allocation (PSRA) processes in Canada and elsewhere. These are crucial to maximizing value from limited resources.MethodsOn the basis of case studies, balanced scorecard development protocols and use-focused evaluation principles, an evaluation tool was developed based on an existing framework for high PSRA performance and implemented in two health care organizations in British Columbia, Canada.ResultsImplementation of the tool identified areas of strength, improvement and weakness in the pilot organizations’ processes for PSRA including: communication, staff engagement and culture. Refinements were identified and incorporated into the tool for future application.ConclusionThis is the first documented multi-site application of such an evaluation tool. Broader dissemination should have use both in further refining the basis of the tool and in catalysing improved performance of PSRA practice.

Why are doctors dissatisfied? The role of origin myths

Abstract: Leaders of the medical profession are increasingly concerned about the extent to which members have become discontented with their lot. Predictably, the profession tends to look outwards for explanations, to the changing social, economic and organizational contexts of health care. Sociologists, however, have long recognized that a ‘social problem’ is not an objective state of affairs but a complaint that the world falls short of the complainant’s ideals. If we want to understand doctors’ dissatisfaction, then, another approach might be to ask what would make them content. What are the ideals of medical practice? What are new doctors – and the wider public – led to expect that professional life will be like? How do these expectations relate to the contingencies and experiences of everyday medical work?