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This chapter explores the ethical dilemmas that emerged in situ from an ethnographic study in collaboration with Latin American children and youngsters. It was developed in the challenging conditions of isolation and lockdown, during the COVID-19 pandemic. In such times, a group of eight researchers from different geographical locations in the Americas looked into the ways children reorganise, reconstruct and reinterpret their daily lives in social isolation. The methodological approach, which enabled dialogue and conversation, began through a system of correspondence – in oral, written, recorded, drawn, photographed and audiovisual forms – among Latin American children. The expectations about the viability of this fieldwork modality brought, from the beginning, ethical challenges that required continuous adjustments, agreements, rectifications, adaptations and explicit reflection on such ethical aspects. Here we focus on three challenges that we analyse individually, although in practice they were interconnected. The first one was the dilemma regarding perception and use of time. The second ethical challenge is based on the fact that we recruited the young participants through friendships and kinship networks that each of the eight researchers previously had. The third challenge was connected to the decision to communicate through letters (a markedly confessional, private and intimate epistolary genre) that were both intervened by our ‘special’ position and also taken as ethnographic documents. In our fieldwork, in the specific spatial and temporal situations we worked, we understand the self as emerging from intersubjectivity and knowledge relations as co-created between researcher and researched. Thus, ethical decisions are made during the research process itself and, for us, in situ ethics entails a reciprocal commitment, between children, youth and adults as co-researchers, to adjust themselves to the developments and boundaries of the ethnographic field. This also allowed the participants to manage the adjustments in this specific and situated context that circumscribed everybody, seeking answers in conversations and paying careful attention to the situation.

In this final chapter, I offer some conclusions relating to the issues discussed across the volume as a whole. Drawing together common as well as contrasting themes from the different empirical accounts that have been presented by the different authors, I argue for a reflexive and necessarily unpredictable mode of research ethics in the context of ethnographies of education.

This chapter outlines the history of ethical regulation and considers how the position of ethics has shifted. The intent of this book is to explore novice and accomplished ethnographers ‘everyday, real-life’ ethical challenges and considerations against a backdrop of theoretical and ethical guideline scrutiny.

Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the United States. Provider administrators, however, question the strategic value of participation in health information exchanges (HIEs) and remain reluctant to participate. Existing research fails to adequately illuminate the potential value derived from HIEs by participating organizations. This paper addresses this gap by developing a conceptual model informed by the complementary theoretical perspectives of the relational view and systems theory to specify both a provider organizationʼs internal conditions and the HIE structure necessary for both financial accrual and quality improvement. This two-sided model can assist policymakers as they attempt to encourage HIE development, as well as provider and HIE leadership that seek to benefit from HIEs. The propositions developed from this model can also help guide researchers as they evaluate the impact of HIEs.

Through a systematic review of the literature, this study analyzes the empirical literature on the adoption of environmental sustainability strategies in order to identify (i) the main conceptual aspects by which environmental sustainability strategies can be conceived of, (ii) the main determinants of the adoption of such strategies, (iii) the expected impacts on the company’s international performance, as well as (iv) the mechanisms that mediate the effect of environmental sustainability strategies on international performance. This study thereby offers propositions about the relationships between environmental sustainability strategies, their determinants (both in relation to the institutional environment and to the company’s domain), and their performance implications.

The purpose of this paper is to explore the relationship between hospitals’ electronic health record (EHR) adoption characteristics and their patient safety cultures. The “Meaningful Use” (MU) program is designed to increase hospitals’ adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated.

Providers’ perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality’s surveys on patient safety culture (level 1) and the American Hospital Association’s survey and healthcare information technology supplement (level 2).

The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers’ perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research.

Relating EHR MU and providers’ care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.

Sharing patient health information (PHI) among hospitals has been much slower than the adoption of health record systems. This paper aims to investigate if privacy regulation (PR) or security measures (SMs) influence hospitals’ use of health information exchange (HIE) to share PHI with other providers (e.g. physicians, labs, hospitals). The study specifically focuses on how multiple PRs can impede and a strong national security infrastructure (NSI) can support HIE.

The study uses secondary data from a multi-national and multi-hospital survey administered by the European Union. The multi-level structure of the cross-sectional panel data is used to test the influence of both hospital-level (e.g. PR) and national-level variables (e.g. NSI) on HIE. A total of nine types of HIE, three types of PRs, nine SMs and other relevant control variables are considered. This study uses a two-level random intercept generalized linear model to test the hypothesis proposed in the study.

The study finds that national-level PRs (NLPR) have the strongest positive influence on HIE in comparison to regional (RLPR) and hospital-level (HLPR) PRs. Moreover, the study finds evidence that the presence of RLPR and HLPR, on average, decreases the positive impact of NLPR by 264%. The SMs also have a significant and positive impact on HIE. Adoption of an additional SM can increase the odds of engaging in a certain type of HIE between 21% and 61%. On the other hand, a strong NSI can also amplify the positive impact of SM on certain types of HIE.

This study extends prior research on the role of PRs in enabling HIE by considering the complexities brought up by adopting multiple PRs. NLPRs have the strongest impact on HIE in comparison to RLPRs or HLPRs. Moreover, public infrastructure initiatives such as those related to secure communications can also complement SMs adopted by the providers by encouraging HIE.

Health information exchange (HIE) initiatives utilize sharing mechanisms through which health information is mostly transmitted without a patient's close supervision; thus, patient trust in the HIE is the core in this setting. Existing technology acceptance theories mainly consider cognitive beliefs resulting in adoption behavior. The study argues that existing theories should be expanded to cover not only cognitive beliefs but also the emotion provoked by the sharing nature of the technology. Based on the theory of reasoned action, the technology adoption literature, and the trust literature, we theoretically explain and empirically test the impact of perceived transparency of privacy policy on cognitive trust and emotional trust in HIEs. Moreover, the study analyzes the effects of cognitive trust and emotional trust on the intention to opt in to HIEs and willingness to disclose health information.

An online survey was conducted using data from individuals who were aware of HIEs through experience with at least one provider participating in an HIE network. Data were collected from a wide range of adult population groups in the United States.

The structural equation modeling analysis results provide empirical support for the proposed model. The model highlights the strategic role of the perceived transparency of the privacy policy in building trust in HIEs. When patients know more about HIE security measures, sharing procedures, and privacy terms, they feel more in control, more assured, and less at risk. The results also show that patient trust in HIEs may take the forms of intention to opt in to an HIE and willingness to disclose health information exchanged through HIE networks.

The findings of this study should be of interest to both academics and practitioners. The research highlights the importance of developing and using a transparent privacy policy in the diffusion of HIEs. The findings provide a deep understanding of dimensions of HIE privacy policy that should be addressed by health-care organizations to exchange personal health information in a secure and private manner.

Patient-centric exchanges, a major type of Health Information Exchange (HIE), empower patients to aggregate and manage their health information. This exchange model helps patients access, modify and share their medical information with multiple healthcare organizations. Although existing studies examine patient engagement, more research is required to investigate patients' attitudes and willingness to play an active role in patient-centered information exchange. The study's main objective is to develop a model based on the belief-attitude-intention paradigm to empirically examine the effects of patients' attitudes toward engagement in care on their willingness to participate in patient-centric HIE.

The authors conducted an online survey study to identify the antecedents and consequences of patients' attitudes toward engagement in care. To empirically test the research model, the authors collected data from a national sample (n = 357) of individuals in the United States. The data were analyzed using structural equation modeling (SEM).

The proposed model categorizes the antecedents to patients' attitudes toward engagement in patient-related and healthcare system factors. The results show that patient-related factors (perceived health literacy and perceived coping ability) and health system factors (perceived experience with the healthcare organization and perceived patient-provider interaction) significantly shape patient attitude toward care management engagement. The results indicate that patients' attitudes toward engaging in their healthcare significantly contribute to their willingness to participate in medical information sharing through patient-centric HIE initiatives. Moreover, the authors’ findings also demonstrate that the link between patient engagement and willingness to participate in HIE is stronger for individuals who perceive lower levels of privacy and security concerns.

The authors validate the proposed model explaining patients' perceptions about their characteristics and the healthcare system significantly influence their attitude toward engaging in their care. This study also suggests that patients' favorable attitude toward engagement can bring patient-centric HIE efforts onto a path to success. The authors’ research attempts to shed light on the importance of patients' roles in adopting patient-centric HIE initiatives. Theoretical and practical contributions of this study are noticeable since they could result in a deeper understanding of the concept of patient engagement and how it may affect healthcare services in an evolving digital world. The authors’ findings can help healthcare organizations provide public citizen-centric services by introducing user-oriented approaches in healthcare delivery systems.