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The purpose of this paper is to explore English and Finnish paramedic perceptions of the healthcare blame culture, its relationship to complaints, the use of defensive practice and if this impacts on paramedic practice and clinical care.

Participants were recruited from English and Finnish ambulance services that have similar organisational and professional scopes of practice. The aim was to gain insight into the similarities and differences between the countries regarding the existence of a blame culture in paramedic practice. Semi-structured focus groups and interviews involving 20 English and Finnish paramedics were undertaken. Qualitative perceptions concerning the reality of a blame culture in paramedic practice and its impact on professional roles were sought.

Three major themes that were identified in the thematic analysis included: blame culture and its influences; the impact of complaints against paramedics; and the use of defensive practice within their roles. These data themes were similar for both groups of participants. The majority of participants thought the healthcare blame culture to be widespread and believed that this was likely to directly influence paramedics’ working practices.

Whilst the impact of blame culture and complaints on the medical profession has previously been examined, this study makes an important contribution by exploring the factors that impact on paramedics’ lives and their practice, within two European countries. The inappropriate use of social media by some members of the public in both countries was a disturbing issue for many participants and was identified as an area for further research.

This study formulates a new archetypical model that describes and re-interprets the patient–physician relationship from the perspective of two widespread phenomena in the healthcare delivery process: value co-creation (VCC) and defensive medicine (DM).

Grounded in the existing literature on VCC and DM, the authors designed and conducted 20 in-depth interviews with doctors (and patients) about their past relationships with patients (and doctors). After putting the recorded interviews through qualitative analysis with a three-level coding activity, the authors built an empirically informed model to classify patient–physician relationships.

The authors identified four archetypes of patient–physician relationships. Each archetype is described along with its representing characteristics and explained in terms of its consequences as they relate to VCC and DM.

This research contributes to the literature on both VCC in healthcare and DM, in addition to the patient–physician's relationship literature.

Being aware of patient–physician relationship mechanics, building long-term relations with patients and investing in service personalization and patient-centred care can effectively mitigate the risks of DM behaviours on one side while increasing the likelihood of VCC actualization on the other.

Although strictly linked to the interactions between patients and doctors, VCC and DM are typically considered disentangled. In this research paper, the authors identified four archetypes of patient–physician relationships in relation to these two phenomena.

Despite societal investment in providing health information to young parents, little is known about the health information practices of young parents themselves. The purpose of this paper is to explore young parents’ health information practices in context.

This constructivist grounded theory study investigates the health information practices of young mothers and fathers (age 16-23) in Greater Vancouver, Canada. Data were collected over 16 months via individual interviews with 39 young parents (37 mothers, 2 fathers) and observations at young parent programs. Inductive analysis was iterative with data collection.

Young parent health information practices emerged, clustering around concepts of information seeking, assessment, and use, with sharing conceptualised as a form of use. Many young parents were sophisticated information seekers, and most were highly networked using mobile technology. While access to information was rarely a barrier, assessment of the large quantity of health-related information posed challenges.

These findings are not generalisable to all populations. Newly identified information-seeking practices such as defensive and subversive seeking should be explored further in future research.

Rather than focusing on quantity of information, health and information professionals trying to reach young parents should focus on fostering information literacy skills and building relationships as trusted information providers.

Young parent experiences of social marginalisation influenced their information practices and should be taken into consideration.

This first investigation of young parent information practices can guide services and resources for young parents, suggests that sharing might be conceptualised as a subset of use, and highlights new information-seeking practices by marginalised individuals, such as defensive and subversive seeking.

In healthcare, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouse concerns about possible implications for patients’ health, and for the healthcare system in terms of both costs and access to medical care. Medical liability plays a dominant role among the elements that can affect these deviations. Therefore, a remarkable economic literature studies how medical decisions are influenced by different levels of liability. In particular, identifying the relation between liability and treatments selection, as well as disentangling the effect of liability from other incentives that might be in place, is a task for sound empirical research. Several studies have already tried to tackle this issue, but much more needs to be done. In this chapter, we offer an overview of the state of the art in the study of the relation between liability and treatments selection. First, we reason on the theoretical mechanisms underpinning the relationship under investigation by presenting the main empirical predictions of the related literature. Second, we provide a comprehensive summary of the existing empirical evidence and its main weaknesses. Finally, we conclude by offering guidelines for further research.

Supporting and nurturing effective communication between healthcare professionals is vital to protect patients from harm. However, not all forms of employee voice are effective. Fear can lead to defensive voice, while the role of other emotions to drive voice behaviour is less well understood. This paper aims to understand what role the broader range of emotions, including compassion and shame, experienced by healthcare professionals following patient safety incidents (PSI) play in the subsequent enactment of prosocial voice, a positive and other-oriented form of communication.

This study is based on data from a single English NHS hospital: interviews with healthcare professionals involved in PSIs (N = 40), observations at quality and risk committees and meetings (N = 26 h) and review of investigative documents (N = 33). Three recent PSIs were selected for cross-case analysis based upon organisational theory related to professional hierarchy, employee voice and literature on emotions.

Among three cases, the authors found variance in context, emotional experience and voice behaviour. Where professionals feared blame and repercussion, voice was defensive. Meanwhile where they experienced shame and compassion, prosocial voice was enacted to protect patients.

Healthcare organisations seeking to foster prosocial voice should: (1) be more considerate of professionals' emotional experiences post-PSI and ensure adequate support for recovery (2) establish norms for professionals to share their struggles with others (3) reward professionals who demonstrate caring behaviour (4) buffer professionals from workplace pressures.

The authors’ study highlights how emotional experiences, such as shame and compassion, can mediate blame and defensiveness and lead to the enactment of prosocial voice in the professional hierarchy.

In his influential study The Presentation of Self in Everyday Life (1971 [1959]), Erving Goffman provides an insightful account of the formation of social selves. Goffman’s work has been extensively discussed in the sociological literature. Yet, the presuppositional underpinnings, let alone the socio-ontological implications, of his conception of personhood have not been rigorously scrutinized.

The main reason for the lack of methodical engagement with the principal assumptions that lie at the heart of Goffman’s theory of the self is that his approach is widely regarded as an eclectic narrative that, while drawing on different sociological traditions, does not make any claim to universal validity.

The persuasiveness of the contention that Goffman’s analysis of the self cannot be reduced to a general theory of human personhood appears to be confirmed by the fact that both supporters and detractors of his sociological project tend to agree that it would be erroneous to deduce a foundational framework of investigation from his numerous studies concerned with the interaction between self and society.

Attention will be drawn to several controversial issues that arise when faced with the task of assessing both the strengths and the weaknesses of Goffman’s understanding of the self.

The aim of this paper is to challenge the aforementioned contention by demonstrating that Goffman provides a fairly systematic account of human personhood. More significantly, this enquiry suggests that a fine-grained examination of his key concepts permits us to propose an outline of a general theory of the human self.

The chapter explores how different theoretical traditions address the gaps between talk (symbolic communication practices) and actions (substantive performance) in organisations. The chapter details the main theoretical approaches in greenwashing research, namely legitimacy theory, attribution theory, institutional theory, signaling theory, impression management approaches and constructivist approaches. Among these latter, Communicative Constitution of Organizations (CCO) challenges the dominant view in literature and suggests abandoning the traditional dichotomy of talk versus action. The different approaches to studying greenwashing are presented along with main questions and research methods used in each field and sub-field of study. For each theoretical approach the main research trends and novel research questions are proposed. Researchers, doctoral and post-graduate students may appreciate this as standalone contribution to guide their future studies in this area, by designing their research avenues based on the best practices in the field.

The fundamental concern of this research study is to learn the quality and efficiency of US healthcare services. It seeks to examine the impact of quality and efficiency on various stakeholders to achieve the best value for each dollar spent for healthcare. The study aims to offer insights on quality reformation efforts, contemporary healthcare policy and a forthcoming change shaped by the Federal healthcare fiscal policy and to recommend the improvement objective by comparing the US healthcare system with those of other developed nations.

The US healthcare system is examined utilizing various data on recent trends in: spending, budgetary implications, economic indicators, i.e. GDP, inflation, wage and population growth. Process maps, cause and effect diagrams and descriptive data statistics are utilized to understand the various drivers that influence the rising healthcare cost. A proposed cause and effect diagram is presented to offer potential solutions, for significant improvement in US healthcare.

At present, the US healthcare system is of vital interest to the nation's economy and government policy (spending). The US healthcare system is characterized as the world's most expensive yet least effective compared with other nations. Growing healthcare costs have made millions of citizens vulnerable. Major drivers of the healthcare costs are institutionalized medical practices and reimbursement policies, technology‐induced costs and consumer behavior.

Reviewing many articles, congressional reports, internet websites and related material, a simplified process map of the US healthcare system is presented. The financial process map is also created to further understand the overall process that connects the stakeholders in the healthcare system. Factors impacting healthcare are presented by a cause and effect diagram to further simplify the complexities of healthcare. This tool can also be used as a guide to improve efficiency by removing the “waste” from the system. Trend analyses are presented that display the crucial relationship between economic growth and healthcare spending.

There are many articles and reports published on the US healthcare system. However, very few articles have explored, in a comprehensive manner, the links between the economic indicators and measures of the healthcare system and how to reform this system. As a result of the US healthcare system's complex structure, process map and cause‐effect diagrams are utilized to simplify, address and understand. This study linked top‐level factors, i.e. the societal, government policies, healthcare system comparison, potential reformation solutions and the enormity of the recent trends by presenting serious issues associated with US healthcare.

Self‐determination is widely regarded as a core social work value and as central to work in adult protection. However, it is not unproblematic and raises difficult questions about how to balance empowerment and protection, or rights and risks. Inter‐agency procedures and the recent publication of policy guidance may reflect these difficult questions rather than assist practitioners and managers to resolve practice dilemmas they encounter.

Knowledge Management is now one of the major driving forces of organizational change and wealth creation. This paper reviews some of the major concepts and approaches as discussed at a recent international congress on the subject. Beginning with an examination of some of the factors propelling the global knowledge economy, the paper then explores knowledge‐based organizational strategy, illustrated by a number of case studies from leading practitioners, including British Petroleum, Glaxo Wellcome, ICL, Nokia Telecommunications, the UK Post Office and Zeneca Pharmaceuticals. The concept of intellectual capital lies at the heart of Knowledge Management. Some companies define intellectual capital in terms of value creation, for others it is value extraction. The two different approaches, illustrated by Skandia and the Dow Chemical Company, are reviewed, along with a new tool for measuring intellectual capital.