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National clinical guidelines can provide a way for health professionals, patients and users of services to work together to make decisions about care. For guidelines to have a positive impact on the quality of care, however, it is important that they are valid. The validity of a guideline is determined by its evidence base. Patients and users of services can contribute evidence about the quality of care and its outcomes which can be used to enhance a guideline's validity. Patient evidence can be accessed from existing research studies, from studies designed expressly to examine patient views or from the direct contribution of patients and users of services to guideline development. A seminar was held to debate the timing and ways in which patients and users of services are most effectively, and to the satisfaction of all, involved in developing clinical guidelines. They key factors influencing the success of health care professionals, patients and users of services collaborating to develop guidelines were identified. These include: deciding who should represent an identified patient community, supporting patient representatives by ensuring that more than one representative joins a group, ensuring there are links with patient representative groups, and that all participants feel prepared and so on. The seminar also identified questions about collaborative working requiring further research.

The current interest in involving all members of the health care team in the evaluation and improvement of care has grown to include patients and recipients of care. Although much is written about how important it is to involve patients there is less information available about how this might be achieved. Even the term ‘involvement’ is itself open to various interpretations and this may result in involving patients in quality improvement remaining in the realms of rhetoric rather than reality. In this article we outline the benefits obtained from the active collaboration of patients with health care professionals in making decisions about their care. We examine ways in which patients’ views about the quality of the care that they receive can be heard and suggest that clinical guidelines might be one way of bridging the knowledge gap between health care professionals and patients so that joint decision‐making becomes more effective.

The Department of Health has suggested that organizations should develop mechanisms to ensure successful input from patients and carers into clinical audit processes, advocating the involvement of consumers at all stages of the audit cycle. Two national surveys, of Trust Clinical Audit Committees and Medical Audit Advisory Groups respectively, explored the extent to which audit committees involve users, either as committee members or in relation to other methods of involvement in the audit process. The results indicate limited but increasing involvement of users as audit committee members, but there are benefits, limitations and barriers to user membership. Other reported activities suggest that the most widespread method of involving users is in user satisfaction surveys with little systematic evidence of input to the decision‐making stage and negotiation of topics for audit. The research suggests that guidance is needed on how to involve users effectively at different stages in the audit cycle.

Reports on an audit of service organizations, clinical care and casemix. The sample included up to 40 consecutive cases of acute stroke (1CD10 161‐164) from each trust, admitted from 1 January to 31 March 1998 and 1 August to 31 October 1999. Feedback consisted of individualized reports showing participants’ own results compared to the national data, and regional multidisciplinary workshops between audit rounds. A total of 197 (81 per cent) trusts (6,894 cases) in England, Wales and Northern Ireland participated in the first round, and 175 (72 per cent) (5,823 cases) in the second. Of the 38 organisational standards, 29 improved between 1998 and 1999 (range 1‐20 per cent, median 5 per cent); 64 of the 71 process standards improved (range 1‐20 per cent, median 8 per cent). Inter‐rater reliability was good with kappa scores of 0.49 to 0.87. National multidisciplinary, cross sector audit is feasible and can promote service improvements. Comparison of participants’ results to national data is a useful way of identifying areas needing change at local level.

Purpose – The burgeoning literature on gender and immigration has largely abandoned atavistic conceptualizations of gender. Instead, migration scholars have integrated an understanding of gender that is relational, contextual, and mutually constitutive with migration. Most of this research has focused on the ways in which migration shapes gender relations, with much less focus on the ways in which gender relations contribute to migration flows. Additionally, the integration of gender analysis in migration studies has contributed significantly to our understanding of migration but has not informed gender theory to nearly the same extent. In this chapter, we synthesize the extant literature on gender and migration, as it relates to the dynamics that precipitate migration.

Methodology/approach – We conducted a review and synthesis of the extant literature that examines the relationship between gender and the decisions and opportunities to migrate.

Findings – Through this synthesis, we identified four gendered institutions that precipitate migration: (1) global labor markets, (2) family and care work, (3) social networks, and (4) violence.

Practical implications – We contribute to the development of gender theory by examining the structural dimensions of gender, thus illuminating the connections between gender relations operating at macro and micro levels.

Originality/value of paper – Although other scholars have reviewed the literature on gender and migration, previous reviews (and most empirical studies) have focused on how migration has shaped gender relations. No reviews to date have focused on how gender relations shape migration. Additionally, most scholars fail to recognize the relationship of gendered violence to other precipitates of migration.