Search results

Deliberative procedures can be useful when researchers need (a) an informed opinion that is difficult to obtain using other methods, (b) individual opinions that will benefit from group discussion and insight, and/or (c) group judgments because the issue at hand affects groups, communities, or citizens qua citizens. Deliberations generally gather non-professional members of the public to discuss, deliberate, and learn about a topic, often forming a policy recommendation or casting an informed vote. Researchers can collect data on these recommendations, and/or individuals’ preexisting or post hoc knowledge or opinions. This chapter presents examples of deliberative methods and how they may inform bioethical perspectives and reviews methodological issues deserving special attention.

Content analysis is a family of systematic, rule-guided techniques used to analyze the informational contents of textual data (Mayring, 2000). It is used frequently in nursing research, and is rapidly becoming more prominent in the medical and bioethics literature. There are several types of content analysis including quantitative and qualitative methods all sharing the central feature of systematically categorizing textual data in order to make sense of it (Miles & Huberman, 1994). They differ, however, in the ways they generate categories and apply them to the data, and how they analyze the resulting data. In this chapter, we describe a type of qualitative content analysis in which categories are largely derived from the data, applied to the data through close reading, and analyzed solely qualitatively. The generation and application of categories that we describe can also be used in studies that include quantitative analysis.

To meet the multidimensional needs of patients, health services are increasingly implementing complex programmes of care through partnerships between public, private and voluntary sector organisations. The purpose of this paper is to explore the implementation process of a complex, multi-innovative regional health and social care partnership to coordinate end-of-life care in the South East of England.

The study adopted a pragmatic, pluralist design using primarily qualitative methods including observations, interviews, focus group and document review. Implementation theory provided the research framework.

While progress was made towards greater collaboration in the provision of end-of-life care, regional coordination of care among the 13 partner organisations was not achieved as envisioned. Low engagement stemming from national health system changes delayed decision making and shifted partners’ priorities. Individual stakeholder interest and motivation carried the elements that were successful.

The external political and economic environment hindered the involvement of some of the partners and suggests that a concept of “project resiliency” is particularly important for complex, multi-organisational projects which are implemented over time and by multiple stakeholders from different sectors. Future research should look further at what contributes to project resiliency and whether it might be operationalized so that projects can develop resilient factors for success.

Project resiliency is a new concept that bridges a gap in understanding how time-limited multi-organisational projects function amid a changing environment.

In recent years, concerns over how to use the results of scientific advances, changing expectations of how medical decisions are made, and questions about the implications of demographic changes have raised ethical challenges regarding allocation of resources, justice, and patient autonomy. Bioethics – no longer the singular purview of moral philosophy – is now accepted as a legitimate field in the academic health sciences and is helping to guide policy and clinical decision-making. To achieve its full potential, it must seamlessly integrate the methods of the humanities, social sciences and medical sciences.

The purpose of this study is to understand virtual care use (e.g. telephone and video visits) during the COVID-19 pandemic across three hospital-based ambulatory clinics (i.e. mental health, renal and respiratory care) and to describe associated patient and provider experiences.

A mixed-methods convergent study was conducted including quantitative electronic medical records data on virtual care use, electronic surveys assessing domains of experience (e.g. satisfaction, acceptance and technology use) among patient and providers and semi-structured interviews exploring the associated barriers and facilitators of virtual care adoption.

Virtual care adoption rates and relative modality use (telephone vs video) varied across specialty clinics. Mental health clinics) showed the greatest use of virtual care and greater use of video over telephone, as compared to renal and respiratory care, where telephone was used almost exclusively. Patients and providers reported an overall good satisfaction and acceptance of virtual care (60–72%) across clinics, but commonly observed barriers (technical problems, behavioral adaptations needed and inequity) persisted. Good value propositions, tech support and the presence of early adopters who can support others in workflow re-design and highlight value propositions of virtual care were listed as adoption facilitators.

The study provides a unique opportunity to compare the rate of virtual care adoption before and during the COVID-19 pandemic across distinct specialties that operate within the same organizational and political setting. This study showed that the nature of the condition (e.g. mental health conditions) and the characteristics of the users (e.g. younger patients) may drive models of care with higher rate of video use. Focusing on removing common barriers, like providing tech support and ensuring equitable access to patients, continues to be important even in the context of high virtual care adoption rates during the pandemic.

This study examines key adaptations that occurred in the Zimbabwean Results-Based Financing (RBF) programme between 2010 and 2017, locating the endogenous and exogenous factors that required adaptive response and the processes from which changes were made.

The study is based on a desk review and thematic analysis of 64 policy and academic literatures supplemented with 28 multi-stakeholder interviews.

The programme experienced substantive adaption between 2010 and 2017, demonstrating a significant level of responsiveness towards increasing efficiency as well as to respond to unforeseen factors that undermined RBF mechanisms. The programme was adaptive due to its phased design, which allowed revision competencies and responsive adaptation, which provide useful insights for other low-and-middle income countries (LMICs) settings where graduated scale-up might better meet contextualised needs. However, exogenous factors were often not systematically examined or reported in RBF evaluations, demonstrating that adaptation could have been better anticipated, planned, reported and communicated, especially if RBF is to be a more effective health system reform tool.

RBF is an increasingly popular health system reform tool in LMICs. However, there are questions about how exogenous factors affect RBF performance and acknowledgement that unforeseen endogenous programme design and implementation factors also greatly affect the performance of RBF. As a result, a better understanding of how RBF operates and adapts to programme level (endogenous) and exogenous (external) factors in LMICs is necessary.