Found 11318 matches for
Being 'rational' and being 'human': How National Health Service rationing decisions are constructed as rational by resource allocation panels
© The Author(s) 2013. The English National Health Service Constitution states that patients have the right to expect all decisions about access to medicines and treatments to be made 'rationally'. Rationality in health care can be framed as instrumental, institutional or practical. In this article, we present a case example from an ethnographic study of the work of 'Individual Funding Request' panels to explore how rationality is enacted and accounted for in deliberations about the rationing of health care in the National Health Service. Our rhetorical analysis highlights how an embodied, practical rationality emerges as a significant aspect of rationality in practice, but at the same time has a problematic status in formal accounts of decision-making. We suggest that being both 'human' and 'rational' is a 'delicate balance' and creates a dilemma for Individual Funding Request panels. Aristotle's notion of phronesis provides a useful lens for theorising our observation of panel deliberations, and we argue for greater attention to the value of narrative ethics in helping us understand the challenges faced by resource allocators.
A recent Cochrane review found that school feeding programmes significantly improve the growth and cognitive performance of disadvantaged children. Trisha Greenhalgh,Elizabeth Kristjansson, and Vivian Robinson look more closely at the highly heterogeneous trials to see what works, for whom, and in what circumstances. © 2007, BMJ Publishing Group Ltd. All rights reserved.
"Not a university type": Focus group study of social class, ethnic, and sex differences in school pupils' perceptions about medical school
Objective: To investigate what going to medical school means to academically able 14-16 year olds from different ethnic and socioeconomic backgrounds in order to understand the wide socioeconomic variation in applications to medical school. Design: Focus group study. Setting: Six London secondary schools. Participants: 68 academically able and scientifically oriented pupils aged 14-16 years from a wide range of social and ethnic backgrounds. Main outcome measures: Pupils' perceptions of medical school, motivation to apply, confidence in ability to stay the course, expectations of medicine as a career, and perceived sources of information and support. Results: There were few differences by sex or ethnicity, but striking differences by socioeconomic status. Pupils from lower socioeconomic groups held stereotyped and superficial perceptions of doctors, saw medical school as culturally alien and geared towards "posh" students, and greatly underestimated their own chances of gaining a place and staying the course. They saw medicine as having extrinsic rewards (money) but requiring prohibitive personal sacrifices. Pupils from affluent backgrounds saw medicine as one of a menu of challenging career options with intrinsic rewards (fulfilment, achievement). All pupils had concerns about the costs of study, but only those from poor backgrounds saw costs as constraining their choices. Conclusions: Underachievement by able pupils from poor backgrounds may be more to do with identity, motivation, and the cultural framing of career choices than with low levels of factual knowledge. Policies to widen participation in medical education must go beyond a knowledge deficit model and address the complex social and cultural environment within which individual life choices are embedded.
This fifth edition has been fully updated with new examples and references to reflect recent developments and current practice.
This is a systematic review on how innovations in health service practice and organisation can be disseminated and implemented. This is an academic text, originally commissioned by the Department of Health from University College London and University of Surrey, using a variety of research methods. The results of the review are discussed in detail in separate chapters covering particular innovations and the relevant contexts. The book is intended as a resource for health care researchers and academics. © 2005 by Blackwell Publishing Ltd.
Sharing stories: Complex intervention for diabetes education in minority ethnic groups who do not speak English
Objective: To develop and refine a complex intervention for diabetes support and education in minority ethnic groups, delivered through bilingual health advocates. Design: Action research framework-a variety of methods used in an emergent and developmental manner, in partnership with clinicians, managers, and service users, drawing especially but not exclusively on narrative methods. Setting: Deprived inner London district Interventions: Development and evaluation of three components of the complex intervention: a group based learning set for bilingual health advocates, in which stories about clients with diabetes formed the basis for action learning; advocate led support and education groups for people with diabetes, which used personal stories as the raw material for learning and action; organisational support to help to develop these new models and embed them within existing services. Results: Both advocate groups and user groups were popular and well evaluated. Through storytelling, advocates identified and met their own educational needs in relation to diabetes and the unmet needs of service users. In the advocate led user groups, story fragments were exchanged in a seemingly chaotic way that the research team initially found difficult to facilitate or follow. Stories were not so much told as enacted and were often centred on discussion of "what to do." Whereas some organisations welcomed, successfully implemented, and sustained the advocate led groups, others failed to do so. A key component of the complex intervention was organisational support. Conclusions: An action research approach allowed engagement with an underserved group of health service staff and with hard to reach service users. The study produced subjective benefits to these groups locally as well as a worked-up complex intervention that will now be formally tested in a randomised controlled trial.
Transferability of principles of evidence based medicine to improve educational quality: Systematic review and case study of an online course in primary health care
The success of evidence based medicine has led to pressure to make medical education more evidence based. Greenhalgh and colleagues tested the transferability, of these principles when developing a postgraduate course.
How can the needs and perspective of patients be incorporated in the design and redesign of health services?. Health organizations are focusing more and more on patients - and requiring their employees to practise patient focused care. The Modernisation Initiative described in this book explores in three health service areas (kidney, stroke and sexual health services) how patients' and carers' involvement may inform and shape quality improvement work. This book guides you through the issues and challenges that teams seeking to involve users in changing health services are likely to face. It offers a wealth of practical knowledge about involving users. Those undertaking similar programmes, whether in primary care or hospital based, will find ideas and examples in this book to inspire and guide them. © 2011 Blackwell Publishing Ltd.
How to read a paper: Statistics for the non-statistician. II: 'Significant' relations and their pitfalls
It is possible to be seriously misled by taking the statistical competence (and/or the intellectual honesty) of authors for granted. Some common errors committed (deliberately or inadvertently) by the authors of papers are given in the final box.
Objectives: To explore the process of knowledge exchange in an informal email network for evidence based health care, to illuminate the value of the service and its critical success factors, and to identify areas for improvement. Design: Illuminative evaluation. Setting: Targeted email and networking service for UK healthcare practitioners and researchers. Participants: 2800 members of a networking service. Main outcome measures: Tracking of email messages, interviews with core staff, and a qualitative analysis of messages, postings from focus groups, and invited and unsolicited feedback to the service. Results: The informal email network helped to bridge the gap between research and practice by serving as a rich source of information, providing access to members' experiences, suggestions, and ideas, facilitating cross boundary collaboration, and enabling participation in networking at a variety of levels. Ad hoc groupings and communities of practice emerged spontaneously as members discovered common areas of interest. Conclusion: This study illuminated how knowledge for evidence based health care can be targeted, personalised, and made meaningful through informal social processes. Critical success factors include a broad based membership from both the research and service communities; a loose and fluid network structure; tight targeting of messages based on members' interests; the presence of a strong network identity and culture of reciprocity; and the opportunity for new members to learn through passive participation.