Care Policy (care + policy)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care Policy

  • health care policy


  • Selected Abstracts


    RESTRUCTURING THE NHS AGAIN: SUPPLY SIDE REFORM IN RECENT ENGLISH HEALTH CARE POLICY

    FINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 4 2009
    Pauline Allen
    Introducing market-like structures to public services is a key aspect of New Public Management. The restructuring of the NHS into an internal market of the 1990s is an example. Recent policies have further developed this notion. A new aspect of the restructuring is a focus on increasing the diversity of types of provider of healthcare organisations. The objectives of the restructuring policy entailing the increase in supply side diversity are examined, and the challenges raised by these changes are discussed. It is argued that the government is too optimistic about the benefits, and insufficiently concerned about possible undesirable consequences. [source]


    Similar and Yet So Different: Cash-for-Care in Six European Countries' Long-Term Care Policies

    THE MILBANK QUARTERLY, Issue 3 2010
    BARBARA Da ROIT
    Context: In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes,allowances instead of services provided to dependents,represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. Methods: A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. Findings: While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. Conclusions: A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require. [source]


    Dermatologists Perform More Skin Surgery Than Any Other Specialist: Implications for Health Care Policy, Graduate and Continuing Medical Education

    DERMATOLOGIC SURGERY, Issue 3 2008
    RANDALL K. ROENIGK MD
    First page of article [source]


    Accounting, Modernity and Health Care Policy

    FINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 4 2001
    Irvine Lapsley
    The National Health Service of the United Kingdom has been the subject of many reforms since it was established in 1948. This paper examines the process of reform in relation to significant changes to the NHS in recent decades. This reform process places ideas of the modern at the heart of these various initiatives. This paper also examines the intended or actual role of accounting in this modernisation process to examine its significance in the making of health care policy. [source]


    Pressure ulcer prevention in intensive care patients: guidelines and practice

    JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2009
    Eman S. M. Shahin BSc MSc RN PhD
    Abstract Background, Pressure ulcers are a potential problem in intensive care patients, and their prevention is a major issue in nursing care. This study aims to assess the allocation of preventive measures for patients at risk for pressure ulcers in intensive care and the evidence of applied pressure ulcer preventive measures in intensive care settings in respect to the European Pressure Ulcer Advisory Panel (EPUAP) and Agency for Health Care Policy and Research (AHCPR) guidelines for pressure ulcer prevention. Design, The design of this study was a cross-sectional study (point prevalence). Setting, The study setting was intensive care units. The sample consisted of 169 patients , 60 patients from surgical wards, 59 from interdisciplinary wards and 50 from medical intensive care wards. Results, The study results revealed that pressure reducing devices like mattresses (alternating pressure air, low air loss and foam) are applied for 58 (36.5%) patients, and all of these patients are at risk for pressure ulcer development. Most patients receive more than one nursing intervention, especially patients at risk. Nursing interventions applied are skin inspection, massage with moisture cream, nutrition and mobility (81.8%, 80.5%, 68.6% and 56.6%) respectively. Moreover, all applied pressure ulcer preventive measures in this study are in line with the guidelines of the EPUAP and AHCPR except massage which is applied to 8.8% of all patients. Conclusions, The use of pressure reducing devices and nursing interventions in intensive care patients are in line with international pressure ulcer guidelines. Only massage, which is also being used, should be avoided according to the recommendation of national and international guidelines. [source]


    The Managed Care Backlash: Perceptions and Rhetoric in Health Care Policy and the Potential for Health Care Reform

    THE MILBANK QUARTERLY, Issue 1 2001
    David Mechanic
    The focus on managed care and the managed care backlash divert attention from more important national health issues, such as insurance coverage and quality of care. The ongoing public debate often does not accurately convey the key issues or the relevant evidence. Important perceptions of reduced encounter time with physicians, limitations on physicians' ability to communicate options to patients, and blocked access to inpatient care, among others, are either incorrect or exaggerated. The public backlash reflects a lack of trust resulting from cost constraints, explicit rationing, and media coverage. Inevitable errors are now readily attributed to managed care practices and organizations. Some procedural consumer protections may help restore the eroding trust and refocus public discussion on more central issues. [source]


    The Politics of Social Harmony: Ruling Strategy and Health Care Policy in Hu's China

    ASIAN POLITICS AND POLICY, Issue 2 2009
    Bin Yu
    This study seeks to explain the causes of social welfare policy change in a single-party authoritarian system. Using the evolution of Chinese health care policy as an example, it discerns why the Hu Jintao administration opted for a compensation-oriented welfare policy paradigm in the absence of adequate interest articulation and apparent electoral accountability, despite the virtual collapse of the Chinese social welfare system during the 1990s. I explore the hypothesis that a high level of political pressure, coupled with a high degree of economic openness, drove the Chinese Communist Party to alter its ruling strategy, a political paradigm that best ensures its monopoly on political power and consequently produces distinct implications for public policy outputs. This study suggests that authoritarian regimes can and do compensate the citizenry under certain circumstances. Further, it also reveals a self-adaptation process initiated by a single-party authoritarian system. [source]


    Learning from Japanese Experience in Aged Care Policy

    ASIAN SOCIAL WORK AND POLICY REVIEW, Issue 1 2007
    Guat Tin Ng
    Like Singapore, Japan is projected to age rapidly. Japan is the first country in the world where more than 20% of the total population is over 65. Even as Japan adapts from western Europe and America where population ageing is more advanced up till now, it has been pioneering its own aged care policy, given the differences in sociocultural and political contexts. Of particular interest is its introduction of long-term care insurance and its effectiveness in meeting the needs of the long-term care of the aged and their family caregivers. In this article I seek to compare and contrast Singapore and Japan in terms of their demographic changes leading to rapid ageing, and their respective policy and program responses to a rapidly ageing population, drawing lessons from the Japanese experience. [source]


    The Use of Health Care Policy to Facilitate Evidence-based Knowledge Translation in Emergency Medicine

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
    Charlene B. Irvin MD
    Health care policy can facilitate emergency medicine knowledge translation (KT). Because of this, the 2007 Academic Emergency Medicine Consensus Conference on KT identified a specific theme regarding issues of health care policy and KT. Six months before the Consensus Conference, international experts in the area were invited to communicate on health care policies regarding all areas of KT via e-mail and "Google groups." From this communication, and using available evidence, specific recommendations and research questions were developed. At the Consensus Conference, additional comments were incorporated. This report summarizes the results of this collaborative effort and provides a set of recommendations and accompanying research questions to guide development, implementation, and evaluation of health care policies intended to promote KT in emergency medicine. The recommendations are to 1a) involve appropriate stakeholders in the health care policy process; 1b) collaborate with policy makers when health care policy focus areas are being developed; 2) use previously validated clinical practice guideline development tools; 3) address implementation issues during the development of health care policies; 4) monitor outcomes with performance measures appropriate to different practice environments; and 5) plan periodic reviews to uncover new clinical evidence, new methods to improve KT, and new technologies. To advance the further development of these recommendations, a research agenda is proposed. [source]


    Non-medical palliative care and education to improve end-of-life care at geriatric health services facilities: A nationwide questionnaire survey of chief nurses

    GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2007
    Yoshihisa Hirakawa
    Background: Geriatric health services facilities (GHSF) are expected to assume a growing role in caring for the dying elderly. However, research in this area has so far been scant. The purpose of the present study is to reveal the status of non-medical palliative care and staff education aiming at improving and enhancing end-of-life care at GHSF. Methods: The subjects were 2876 chief nurses of GHSF. Data was collected through a mailed questionnaire in 2003. The questionnaire covered the following: (i) staff perception of end-of-life care policies; (ii) staff education; and (iii) available non-medical care. To evaluate the factors correlated with end-of-life care policies at GHSF, we divided the facilities into two groups. Results: We analyzed the answers collected from 313 facilities with a progressive policy toward end-of-life care (PP group) and 818 with a regressive policy toward it (RP group). It was found that staff training was conducted more frequently among PP facilities. Generally, nurses in the PP facilities were more confident that they could provide comprehensive on-site end-of-life care and grieving support, but did not feel so sure about their ability to provide better end-of-life environments for dying residents and family by organizing outside support from voluntary and/or governmental organizations and religious organization for healing and to pursue appropriately a written follow-up communication with the bereaved family. Conclusions: Our results suggest that providing GHSF staff with education about end-of-life issues or setting up collaboration with the outside is an important factor to enhance overall end-of-life care at these facilities. [source]


    ASH Position Paper: Adherence and Persistence With Taking Medication to Control High Blood Pressure

    JOURNAL OF CLINICAL HYPERTENSION, Issue 10 2010
    Martha N. Hill RN
    J Clin Hypertens (Greenwich). 2010;12:757-764. © 2010 Wiley Periodicals, Inc. Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now. [source]


    Colonialism and Health Policy Affecting Workers in Sri Lanka's Plantation Sector

    ANTHROPOLOGY OF WORK REVIEW, Issue 3 2006
    Ramani Hettiarachchi
    Abstract One of the major problems that European colonizers faced in Asia was the reluctance of indigenous agricultural societies to respond to their large-scale labor requirement. This article focuses on plantation owners and managers in Sri Lanka (then Ceylon) during the height of nineteenth-century coffee plantation production, and the strategies they used to control indentured workers from India in Ceylon. In particular, caste distinctions were perpetuated among the workforce; this legacy has implications for social life on the estates in current Sri Lanka, engaged in an ethnic conflict between the political minority Tamil and political majority Sinhala populations. This article focuses especially on health and sanitation issues for workers during the colonial plantation era, and the need for government intervention,that was not forthcoming,on behalf of the workers. This research is part of a larger project (cf. Hettiarachchi 1989) drawing on the archival methods of history and the ethnographic methods of anthropology to document conditions for plantation workers. Attention to historical strategies of worker control can provide insights into the current relationship between states, low-wage labor forces, and health care policies. [source]


    The Use of Health Care Policy to Facilitate Evidence-based Knowledge Translation in Emergency Medicine

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
    Charlene B. Irvin MD
    Health care policy can facilitate emergency medicine knowledge translation (KT). Because of this, the 2007 Academic Emergency Medicine Consensus Conference on KT identified a specific theme regarding issues of health care policy and KT. Six months before the Consensus Conference, international experts in the area were invited to communicate on health care policies regarding all areas of KT via e-mail and "Google groups." From this communication, and using available evidence, specific recommendations and research questions were developed. At the Consensus Conference, additional comments were incorporated. This report summarizes the results of this collaborative effort and provides a set of recommendations and accompanying research questions to guide development, implementation, and evaluation of health care policies intended to promote KT in emergency medicine. The recommendations are to 1a) involve appropriate stakeholders in the health care policy process; 1b) collaborate with policy makers when health care policy focus areas are being developed; 2) use previously validated clinical practice guideline development tools; 3) address implementation issues during the development of health care policies; 4) monitor outcomes with performance measures appropriate to different practice environments; and 5) plan periodic reviews to uncover new clinical evidence, new methods to improve KT, and new technologies. To advance the further development of these recommendations, a research agenda is proposed. [source]


    FS13.3 Development of risk reduction strategies for preventing dermatitis

    CONTACT DERMATITIS, Issue 3 2004
    Terry Brown
    Introduction:, A recent survey of the UK printing industry found a prevalence of 11% of occupational contact dermatitis (OCD), much higher than previously identified. Objective:, This pilot study aimed to evaluate risk reduction strategies derived from recommendations of a literature review of preventive intervention studies and a series of focus groups of printers and observations of printers undertaking their normal duties. Methods:, Four interventions were evaluated: (1) Provision of gloves of the correct size/type, plus use of an after-work skin cream; (2) Provision of information; (3) Provision of skin checks; (4) Development of best practice skin care policy. Each intervention was evaluated in two companies over a three-month period, at the end of which printers and managers were interviewed as to the effectiveness and acceptability of each intervention. Results:, Although this pilot study was short, all interventions were acceptable to some extent. The prevalence of frank dermatitis fell over the study period, particularly in intervention (3). Intervention (1) achieved an improvement of awareness in both management and workforce and an increase in the use of both gloves and cream. Intervention (2) highlighted problems of dissemination and the need for relevant information in an appropriate format. However. no single intervention was completely effective. Conclusions:, This qualitative research approach forms an essential first stage to improving understanding of ways in which OCD may be reduced among workers in the printing industry, and points towards the need for further testing of preventive strategies in larger-scale intervention trials, in printing and other industries. [source]


    Accounting, Modernity and Health Care Policy

    FINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 4 2001
    Irvine Lapsley
    The National Health Service of the United Kingdom has been the subject of many reforms since it was established in 1948. This paper examines the process of reform in relation to significant changes to the NHS in recent decades. This reform process places ideas of the modern at the heart of these various initiatives. This paper also examines the intended or actual role of accounting in this modernisation process to examine its significance in the making of health care policy. [source]


    Research use and support needs, and research activity in social care: a cross-sectional survey in two councils with social services responsibilities in the UK

    HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2008
    Cooke Jo BNurs MA RGN HV cert NDN
    Abstract The purpose of this study was to investigate the level of research activity, research use, research interests and research skills in the social care workforce in two UK councils with social service responsibilities (CSSRs). A cross-sectional survey was conducted of the social care workforce in two CSSRs (n = 1512) in 2005. The sample was identified in partnership with the councils, and included employees with professional qualifications (social workers and occupational therapists); staff who have a role to assess, plan and monitor care; service managers; commissioners of services; and those involved with social care policy, information management and training. The survey achieved a response rate of 24% (n = 368). The Internet was reported as an effective source of research information; conversely, research-based guidelines were reported to have a low impact on practice. Significant differences were found in research use, by work location, and postgraduate training. Most respondents saw research as useful for practice (69%), and wanted to collaborate in research (68%), but only 11% were planning to do research within the next 12 months. Having a master's degree was associated with a greater desire to lead or collaborate in research. A range of research training needs, and the preferred modes of delivery were identified. Support to increase research activity includes protected time and mentorship. The study concludes that a range of mechanisms to make research available for the social care workforce needs to be in place to support evidence-informed practice. Continual professional development to a postgraduate level supports the use and production of evidence in the social care workforce, and promotes the development of a research culture. The term research is used to include service user consultations, needs assessment and service evaluation. The findings highlight a relatively large body of the social care workforce willing to collaborate and conduct research. Councils and research support systems need to be developed to utilise this relatively untapped potential. [source]


    Measurement in Veterans Affairs Health Services Research: Veterans as a Special Population

    HEALTH SERVICES RESEARCH, Issue 5p2 2005
    Robert O. Morgan
    Objective. To introduce this supplemental issue on measurement within health services research by using the population of U.S. veterans as an illustrative example of population and system influences on measurement quality. Principal Findings. Measurement quality may be affected by differences in demographic characteristics, illness burden, psychological health, cultural identity, or health care setting. The U.S. veteran population and the VA health system represent a microcosm in which a broad range of measurement issues can be assessed. Conclusions. Measurement is the foundation on which health decisions are made. Poor measurement quality can affect both the quality of health care decisions and decisions about health care policy. The accompanying articles in this issue highlight a subset of measurement issues that have applicability to the broad community of health services research. It is our hope that they stimulate a broad discussion of the measurement challenges posed by conducting "state-of-the-art" health services research. [source]


    ASH Position Paper: Adherence and Persistence With Taking Medication to Control High Blood Pressure

    JOURNAL OF CLINICAL HYPERTENSION, Issue 10 2010
    Martha N. Hill RN
    J Clin Hypertens (Greenwich). 2010;12:757-764. © 2010 Wiley Periodicals, Inc. Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now. [source]


    Embedding nursing and therapy consultantship: the case of stroke consultants

    JOURNAL OF CLINICAL NURSING, Issue 2 2009
    Christopher R Burton
    Aims and objectives., As the basis for the design of career development opportunities for current and aspiring nursing and therapy consultants, we aimed to explore the factors that shape how these roles have embedded in UK stroke services. Background., The non-medical consultant role has been introduced into UK health care services to provide opportunities for experienced practitioners to progress their careers in clinical practice. Whilst there have been evaluations of the impact of the role on service delivery, little attention has been paid to the pathways towards consultantship. Design., An exploratory design, incorporating focus group discussions, was used to address the research questions. Participating consultants, both nurses and allied health professionals, worked in stroke services, although it is anticipated that the results will have wider application. Methods., Two focus groups were held with non-medical consultants in stroke from across the UK. Participants had the opportunity to comment on an interim paper prior to publication of the results. Thirteen consultants took part in the study. Results., A lack of consensus about the nature of clinical expertise and a diverse range of pathways towards consultantship were identified. Health care policy had presented the opportunity for consultants to be entrepreneurial in the development of stroke services, although this had limited the scope for the development of professional knowledge. Inflexible programmes to support aspiring consultants may limit the opportunities to develop these entrepreneurial skills. Conclusions., This study challenges health care organizations and the education and research departments that support them to think creatively in the way that the non-medical consultant role is embedded, and that this should draw on the commitment of existing consultants to support succession planning. Relevance to clinical practice., The identification of those aspects of career pathways that current consultants have found to be helpful will be useful in designing opportunities for aspiring consultants. [source]


    The limitations of randomized controlled trials in predicting effectiveness

    JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2010
    Nancy Cartwright PhD FBA
    Abstract What kinds of evidence reliably support predictions of effectiveness for health and social care interventions? There is increasing reliance, not only for health care policy and practice but also for more general social and economic policy deliberation, on evidence that comes from studies whose basic logic is that of JS Mill's method of difference. These include randomized controlled trials, case,control studies, cohort studies, and some uses of causal Bayes nets and counterfactual-licensing models like ones commonly developed in econometrics. The topic of this paper is the ,external validity' of causal conclusions from these kinds of studies. We shall argue two claims. Claim, negative: external validity is the wrong idea; claim, positive: ,capacities' are almost always the right idea, if there is a right idea to be had. If we are right about these claims, it makes big problems for policy decisions. Many advice guides for grading policy predictions give top grades to a proposed policy if it has two good Mill's-method-of difference studies that support it. But if capacities are to serve as the conduit for support from a method-of-difference study to an effectiveness prediction, much more evidence, and much different in kind, is required. We will illustrate the complexities involved with the case of multisystemic therapy, an internationally adopted intervention to try to diminish antisocial behaviour in young people. [source]


    Developing interdisciplinary maternity services policy in Canada.

    JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2010
    Evaluation of a consensus workshop
    Abstract Context, Four maternity/obstetrical care organizations, representing women, midwives, obstetricians and family doctors conducted interdisciplinary policy research under auspices of four key stakeholder groups. These projects teams and key stakeholders subsequently collaborated to develop consensus on strategies for improved maternity services in Ontario. Objectives, The objective of this study is to evaluate a 2-day research synthesis and consensus building conference to answer policy questions in relation to new models of interdisciplinary maternity care organizations in different settings in Ontario. Methods, The evaluation consisted of a scan of individual project activities and findings as were presented to an invited audience of key stakeholders at the consensus conference. This involved: participant observation with key informant consultation; a survey of attendees; pattern processing and sense making of project materials, consensus statements derived at the conference in the light of participant observation and survey material as pertaining to a complex system. The development of a systems framework for maternity care policy in Ontario was based on secondary analysis of the material. Findings, Conference participants were united on the importance of investment in maternity care for Ontario and the impending workforce crisis if adaptation of the workforce did not take place. The conference participants proposed reforming the current system that was seen as too rigid and inflexible in relation to the constraints of legislation, provider scope of practice and remuneration issues. However, not one model of interdisciplinary maternity/obstetrical care was endorsed. Consistency and coherence of models (rather than central standardization) through self-organization based on local needs was strongly endorsed. An understanding of primary maternity care models as subsystems of networked providers in complex health organizations and a wider social system emerged. The patterns identified were incorporated into a complexity framework to assist sense making to inform policy. Discussion, Coherence around core values, holism and synthesis with responsiveness to local needs and key stakeholders were themes that emerged consistent with complex adaptive systems principles. Respecting historical provider relationships and local history provided a background for change recognizing that systems evolve in part from where they have been. The building of functioning relationships was central through education and improved communication with ongoing feedback loops (positive and negative). Information systems and a flexible improved central and local organization of maternity services was endorsed. Education and improved communication through ongoing feedback loops (positive and negative) were central to building functioning relationships. Also, coordinated central organization with a flexible and adaptive local organization of maternity services was endorsed by participants. Conclusions, This evaluation used an approach comprising scoping, pattern processing and sense making. While the projects produced considerable typical research evidence, the key policy questions could not be addressed by this alone, and a process of synthesis and consensus building with stakeholder engagement was applied. An adaptive system with local needs driving a relationship based network of interdisciplinary groupings or teams with both bottom up and central leadership. A complexity framework enhanced sense making for the system approaches and understandings that emerged. [source]


    Working conditions and the possibility of providing good care

    JOURNAL OF NURSING MANAGEMENT, Issue 4 2002
    Gunvor Lövgren RN
    Background,An open and tolerant climate characterized by joy in work where the personnel can mature as people and develop their professional competence was postulated as essential to working conditions under which good care can be provided in line with a care policy accepted for healthcare in a northern Swedish county. Aim, This study aimed to examine working conditions before and 3 years after the implementation of the care policy. Method, All personnel working on four hospital wards in the county described their experiences in questionnaires in a baseline measure in 1995 (n = 119) and a follow-up measure in 1998 (n = 106). Findings, Lower ratings for working conditions were found in many respects in the follow-up measure. Fewer respondents from three wards expressed satisfaction with their current work situation. More respondents in one of these wards expressed, in addition, an inability to keep up with their work and fewer also evaluated their immediate superiors as good leaders. More of the respondents from one ward expressed the intention of looking for alternative employment and wanted to have another job. More respondents in two wards reached scores indicating burnout risk or burnout, and lower means were seen in two to 10 work climate dimensions per ward, out of 10 possible, in the follow-up measure compared with the baseline. Conclusion, The working conditions seen as requisite for the possibility of providing good care seem to have deteriorated in a number of respects on the wards studied over a three-year period and improvements are needed if the care offered is to be in line with the stated care policy. A concurrent study investigating patient satisfaction of the care quality in the same county showed a deterioration in their assessments between measurements carried through with a three-year interval, implying a relationship between the working conditions of the personnel and the patients' experiences of care. [source]


    Ethnography and the ethics of undertaking research in different mental healthcare settings

    JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2010
    H. ALLBUTT rgn ba msc phd
    Accessible summary ,,We report our experiences of seeking regulatory approval to undertake a qualitative research study using observation and interviews in three different mental healthcare settings. ,,All users of mental health services are classified as ,vulnerable' research participants by UK regulatory research systems. We argue that this is both disempowering to users and also at odds with current health care policy to promote service user involvement in research processes. ,,Access to mental healthcare sites was difficult in spite of agreement by senior area managers. Front-line team leaders acted as gatekeepers to influence which service users could be approached to take part in the study. This type of intervention may bias research samples and dilute the knowledge claims researchers can make from research undertaken in practice settings. Abstract This paper draws on our experiences of seeking research ethics and management approval for a 1-year ethnographic research study in three mental health settings. We argue that the increased bureaucratization of research governance in the UK is paternalistic and unfit for qualitative, non-interventionist study designs. The classification of all mental health services users as ,vulnerable' is also disempowering and contrary to government calls to increase user involvement in research processes. We relate our difficulties in accessing National Health Service sites to undertake our study despite endorsement by senior managers. The current research ethics system reinforces the gatekeeping role of front-line National Health Service staff but this may work to bias samples in favour of ,amenable' service users and exclude others from having their views and experiences represented in studies over the long-term. [source]


    Using interprofessional team-based learning to develop health care policy

    MEDICAL EDUCATION, Issue 5 2008
    Elizabeth A Rider
    No abstract is available for this article. [source]


    Beyond Policy Community , the Case of the GP Fundholding Scheme

    PUBLIC ADMINISTRATION, Issue 3 2001
    Adrian Kay
    The paper examines the conception, implementation and abolition of the GP fundholding scheme, all within 10 years, for evidence of a changed style of health care policy-making. A health care policy community, in which the interests of the medical profession were prominent, existed between 1948 and the mid-1980s. The paper highlights the important factors in the breakdown of the policy community and traces the effect through to the negotiation, implementation and abolition of the GP fundholding scheme. In particular, the role of evidence in health care policy-making has changed significantly. A consequence of the collapse of the policy community has been that a ,folk psychology' rather than evaluative evidence has guided some aspects of health care policy since the 1990s. [source]


    ,Healthy Prisons': A Contradiction in Terms?

    THE HOWARD JOURNAL OF CRIMINAL JUSTICE, Issue 4 2000
    Catrin Smith
    Recent developments in prison health care promise enhanced health benefits for prisoners and the promotion of health has become a central feature of prison health care policy. This article presents the background to these changes and considers what they are likely to mean in practice. It provides a description of the emergence of health promotion within the prison setting, locating prison-based initiatives within the context of the wider political drive towards health promotion in society at large. Finally, it raises questions about the fundamental philosophies underpinning current models of prison health care where the benevolent aims of health promotion may become extremely punitive. [source]


    Will Embryonic Stem Cells Change Health Policy?

    THE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 2 2010
    William M. Sage
    Embryonic stem cells are actively debated in political and public policy arenas. However, the connections between stem cell innovation and overall health care policy are seldom elucidated. As with many controversial aspects of medical care, the stem cell debate bridges to a variety of social conversations beyond abortion. Some issues, such as translational medicine, commercialization, patient and public safety, health care spending, physician practice, and access to insurance and health care services, are core health policy concerns. Other issues, such as economic development, technologic progress, fiscal politics, and tort reform, are only indirectly related to the health care system but are frequently seen through a health care lens. These connections will help determine whether the stem cell debate reaches a resolution, and what that resolution might be. [source]


    The Struggle over Employee Benefits: The Role of Labor in Influencing Modern Health Policy

    THE MILBANK QUARTERLY, Issue 1 2003
    David Rosner
    Health care policy has often been described as the work of political actors seeking to benefit the larger community or a particular group of individuals. In 20th-century America, those actors worked in a historical context shaped by demographic and political pressures created during a period of rapid industrial change. Whereas scholars have placed the emergence of European social welfare in such a larger frame, their analysis of movements for health insurance in the United States has largely ignored the need for a frame. If anything, their studies have focused on the lack of a radical political working-class movement in this country as an explanation for the absence of national or compulsory health insurance. Indeed, this absence has dominated analyses of the failure of health policy reform in this country, which generally ignore even these passing historical allusions to the role of class in shaping health policy. Explanations of why health care reform failed during the Clinton administration cited the lack of coverage for millions of Americans but rarely alluded to the active role of labor or other working-class groups in shaping the existing health care system. After organized labor failed to institute national health insurance in the mid-twentieth century, its influence on health care policy diminished even further. This article proposes an alternative interpretation of the development of health care policy in the United States, by examining the association of health policy with the relationships between employers and employees. The social welfare and health insurance systems that resulted were a direct outcome of the pressures brought by organized and unorganized labor movements. The greater dependency created by industrial and demographic changes, conflicts between labor and capital over the political meaning of disease and accidents, and attempts by the political system to mitigate the impending social crisis all helped determine new health policy options. [source]


    The Politics of Social Harmony: Ruling Strategy and Health Care Policy in Hu's China

    ASIAN POLITICS AND POLICY, Issue 2 2009
    Bin Yu
    This study seeks to explain the causes of social welfare policy change in a single-party authoritarian system. Using the evolution of Chinese health care policy as an example, it discerns why the Hu Jintao administration opted for a compensation-oriented welfare policy paradigm in the absence of adequate interest articulation and apparent electoral accountability, despite the virtual collapse of the Chinese social welfare system during the 1990s. I explore the hypothesis that a high level of political pressure, coupled with a high degree of economic openness, drove the Chinese Communist Party to alter its ruling strategy, a political paradigm that best ensures its monopoly on political power and consequently produces distinct implications for public policy outputs. This study suggests that authoritarian regimes can and do compensate the citizenry under certain circumstances. Further, it also reveals a self-adaptation process initiated by a single-party authoritarian system. [source]


    Learning from Japanese Experience in Aged Care Policy

    ASIAN SOCIAL WORK AND POLICY REVIEW, Issue 1 2007
    Guat Tin Ng
    Like Singapore, Japan is projected to age rapidly. Japan is the first country in the world where more than 20% of the total population is over 65. Even as Japan adapts from western Europe and America where population ageing is more advanced up till now, it has been pioneering its own aged care policy, given the differences in sociocultural and political contexts. Of particular interest is its introduction of long-term care insurance and its effectiveness in meeting the needs of the long-term care of the aged and their family caregivers. In this article I seek to compare and contrast Singapore and Japan in terms of their demographic changes leading to rapid ageing, and their respective policy and program responses to a rapidly ageing population, drawing lessons from the Japanese experience. [source]