History Matters: The Critical Contribution of Historical Analysis to Contemporary Health Policy and Health Care
AbstractHistory is popular with health policymakers, if the regularity with which they invoke historical anecdotes to support policy change is used as an indicator. Yet the ways in which they ‘use’ history vary enormously, as does its impact. This paper explores, from the perspective of a UK academic historian, the development of ‘applied’ history in health policy. It draws on personal experience of different types and levels of engagement with policymakers, and highlights mechan isms through which this dialogue and partnership can be made more efficient, effective, and intellectually rewarding for all involved. (S...
Source: Health Care Analysis - June 1, 2018 Category: Health Management Source Type: research
Improvement Science Meets Improvement Scholarship: Reframing Research for Better Healthcare
AbstractIn this editorial essay I explore the possibilities of ‘improvement scholarship’ in order to set the scene for the theme of, and the other papers in, this issue. I contrast a narrow conception of quality improvement (QI) research with a much broader and more inclusive conception, arguing that we should greatly extend the existing dialogue between ‘ problem-solving’ and ‘critical’ currents in improvement research. I have in mind the potential for building a much larger conversation between those people in ‘improvement science’ who are expressly concerned with tackling the problems facing healthcare a...
Source: Health Care Analysis - June 1, 2018 Category: Health Management Source Type: research
Exacerbating Inequalities? Health Policy and the Behavioural Sciences
AbstractThere have been calls for some time for a new approach to public health in the United Kingdom and beyond. This is consequent on the recognition and acceptance that health problems often have a complex and multi-faceted aetiology. At the same time, policies which utilise insights from research in behavioural economics and psychology ( ‘behavioural science’) have gained prominence on the political agenda. The relationship between the social determinants of health (SDoH) and behavioural science in health policy has not hitherto been explored. Given the on-going presence of strategies based on findings from behavio...
Source: Health Care Analysis - April 11, 2018 Category: Health Management Source Type: research
In Defence of Moral Pluralism and Compromise in Health Care Networks
AbstractThe organisation of health care is rapidly changing. There is a trend to move away from individual health care institutions towards transmural integrated care and interorganizational collaboration in networks. However, within such collaboration and network there is often likely to be a pluralism of values as different health care institutions often have very different values. For this paper, we examine three different models of how we believe institutions can come to collaborate in networks, and thus reap the potential benefits of such collaboration, despite having different moral beliefs or values. A first way is ...
Source: Health Care Analysis - March 29, 2018 Category: Health Management Source Type: research
Evidence, Emotion and Eminence: A Qualitative and Evaluative Analysis of Doctors ’ Skills in Macroallocation
AbstractIn this analysis of the ethical dimensions of doctors ’ participation in macroallocation we set out to understand the skills they use, how they are acquired, and how they influence performance of the role. Using the principles of grounded moral analysis, we conducted a semi-structured interview study with Australian doctors engaged in macroallocation . We found that they performed expertise as argument, bringing together phronetic and rhetorical skills founded on communication, strategic thinking, finance, and health data. They had made significant, purposeful efforts to gain skills for the role. Our findings cha...
Source: Health Care Analysis - March 24, 2018 Category: Health Management Source Type: research
Health Without Care? Vulnerability, Medical Brain Drain, and Health Worker Responsibilities in Underserved Contexts
AbstractThere is a consensus that the effects of medical brain drain, especially in the Sub-Saharan African countries, ought to be perceived as more than a simple misfortune. Temporary restrictions on the emigration of health workers from the region is one of the already existing policy measures to tackle the issue —while such a restrictive measure brings about the need for quite a justificatory work. A recent normative contribution to the debate by Gillian Brock provides a fruitful starting point. In the first step of her defence of emigration restrictions, Brock provides three reasons why skilled workers themselves wo...
Source: Health Care Analysis - March 1, 2018 Category: Health Management Source Type: research
If You ’re a Rawlsian, How Come You’re So Close to Utilitarianism and Intuitionism? A Critique of Daniels’s Accountability for Reasonableness
AbstractNorman Daniels ’s theory of ‘accountability for reasonableness’ is an influential conception of fairness in healthcare resource allocation. Although it is widely thought that this theory provides a consistent extension of John Rawls’s general conception of justice, this paper shows that accountability for reasonableness has important points of contact with both utilitarianism and intuitionism, the main targets of Rawls’s argument. My aim is to demonstrate that its overlap with utilitarianism and intuitionism leaves accountability for reasonableness open to damaging critiques. The important role tha t util...
Source: Health Care Analysis - March 1, 2018 Category: Health Management Source Type: research
How Much Care is Enough? Carer ’s Guilt and Bergsonian Time
AbstractDespite devoting their time to another person ’s needs, many carers paradoxically experience guilt during their caregiving tenure concerning whether they are providingenough care. When discussing the “enough” of anything, what is at stake is that thing’s quantification. Given that there are seemingly no quantifiable units of care by which to measure the role, concerns regarding whether enough care is being provided often focus on what constitutesenough time as a carer. In exploring this aspect of the carer ’s experience, two key parameters emerge; (1) guilt, and, (2) quantified time. The guilt that carers...
Source: Health Care Analysis - March 1, 2018 Category: Health Management Source Type: research
Improvement Science Meets Improvement Scholarship: Reframing Research for Better Healthcare
AbstractIn this editorial essay I explore the possibilities of ‘improvement scholarship’ in order to set the scene for the theme of, and the other papers in, this issue. I contrast a narrow conception of quality improvement (QI) research with a much broader and more inclusive conception, arguing that we should greatly extend the existing dialogue between ‘ problem-solving’ and ‘critical’ currents in improvement research. I have in mind the potential for building a much larger conversation between those people in ‘improvement science’ who are expressly concerned with tackling the problems facing healthcare a...
Source: Health Care Analysis - December 21, 2017 Category: Health Management Source Type: research
“ Don’t Mind the Gap!” Reflections on Improvement Science as a Paradigm
AbstractResponding to this issue ’s invitation to bring new disciplinary insights to the field of improvement science, this article takes as its starting point one of the field’s guiding metaphors: the imperative to “mind the gap”. Drawing on insights from anthropology, history, and philosophy, the article reflects on the o rigins and implications of this metaphoric imperative, and suggests some ways in which it might be in tension with the means and ends of improvement. If the industrial origins of improvement science in the twentieth century inform a metaphor of gaps, chasms, and spaces of misalignment as invaria...
Source: Health Care Analysis - November 17, 2017 Category: Health Management Source Type: research
Speaking Out and Being Heard Residents ’ Committees in Quebec’s Residential Long-Term Care Centre
AbstractResidents ’ councils in Quebec’s residential and long-term care centres have the mandate to promote the improvement of living conditions for residents, to assess their level of satisfaction, and to defend their rights. Based on two studies on the autonomy of councils, we examined how committees can expres s themselves on topics other than those the management is already aware of, to reveal various previously unknown aspects of the services, and to voice unexpressed concerns. We are especially interested in what makes management receptive, or not, to what the committee members say. The councils’ abi lity to ex...
Source: Health Care Analysis - October 25, 2017 Category: Health Management Source Type: research
Am I My Brother ’s Keeper? Moral Dimensions of Informal Caregiving in a Neoliberal Society
AbstractWithin the current Dutch policy context the role of informal care is revalued. Formal care activities are reduced and family and friends are expected to fill this gap. Yet, there is little research on the moral ambivalences that informal care for loved ones who have severe and ongoing mental health problems entails, especially against the backdrop of neoliberal policies. Giving priority to one ’s own life project or caring for a loved one with severe problems is not reconciled easily. Using a case study we illustrate the moral ambivalences that persons may experience when they try to shape their involvement and c...
Source: Health Care Analysis - October 25, 2017 Category: Health Management Source Type: research
