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The “patient journey” technique is one that has been used by health care providers to investigate the strengths and weaknesses of their service delivery. The purpose of this paper is to discuss the experience of adapting this approach for use in an atypical context – the comparison of two systems for managing health care complaints and notifications. It highlights a number of relevant considerations and provides suggestions for similar studies.

The design and methods of the study are described, with commentary on the success of key aspects and challenges encountered. To enable comparison between the two systems, this study had a “paired” design, in which examples were selected from each system so that they matched on basic, prescribed, criteria. Data about each matter’s journey were then collected from administrative records.

While, overall, the technique provided rich data on the processes of the systems under investigation, the type of data collected (related to administrative/communicative events) and the study’s comparative purpose required consideration and management of a number of issues. These included the implications of using administrative records and the impact of differences between the systems on the paired design.

This paper describes an attempt to apply the “journey” approach in a context that is uncommon in two ways: first, in its focus on regulatory processes (complaint/notification handling), rather than care provision to an individual patient; and second, in its objective of comparing two different systems. It is hoped this account will assist in further development of this technique.

The aim of this study was to evaluate determinants of four diversification practises by cocoa smallholders in West Sulawesi, Indonesia: (1) growing other crops, (2) keeping livestock, (3) off-farm work for wages (4) off-farm self-employment, and the impact of diversification on welfare of community members.

Household interviews (n = 116) conducted in two subdistricts (Anreapi and Mapilli) of Polewali-Mandar District, West Sulawesi, provided quantitative data on household characteristics, crop and livestock production, income sources, expenditure and credit access. Two villages per subdistrict were included in the study, each producing cocoa as the main crop but differing in their proximity to a market town. Logistic regression was applied to identify determinants of diversification by households. Multiple linear regression (MLR) models evaluated the impact of diversification practices and other explanatory variables on two proxies of welfare (or household wealth): per capita value of durable assets (household assets other than land or livestock) and per capita expenditure for each household.

Mean per capita cocoa production in the sample was low (51 kg dry beans/annum). The mean dependency ratio (proportion of household occupants age <18 and >64) was 35%, with an average of five occupants per household. Household heads were predominantly male (95%), averaging 46 yo and 7 years of formal education. Most households (72%) depended on loans, but only 24% accessed formal loans. Significant determinants of diversification practices were access to formal credit for self-employment and subdistrict for livestock, with Mapilli subdistrict households more likely to keep livestock. Household predictors in the MLR accounted for 28% variation of the dependent, per capita value of durable goods. Off-farm self-employment and raising livestock significantly improved welfare, but growing other crops or off-farm work for wages had little effect. Other household variables demonstrated to have significant positive effects on welfare were education of the household head, proximity to a market town and land area per household.

The study was restricted to a relatively small sample size (n = 116). Studies including panel data or larger numbers of households could enable the identification of further determinants of diversification.

The study demonstrates that diversification has the potential to improve rural livelihoods, but that obstacles, especially formal credit access, may deter poorer households from diversifying their income sources.

Programs and policies that facilitate access to formal finance by smallholders could encourage diversification into small business and improve livelihoods in cocoa-dependent communities.

In the light of the decline in cocoa farm productivity in West Sulawesi, the study demonstrates the potential benefits, as well as limitations, of income diversification by smallholders.

The purpose of this paper is to explore approaches to the regulation of healthcare complaints and disciplinary processes.

A literature review was conducted across Medline, Sociological Abstracts, Web of Science, Google Scholar and the health, law and social sciences collections of Informit, using terms tapping both the complaints process and regulation generally.

A total of 118 papers dealing with regulation of health complaints or disciplinary proceedings were located. The review reveals a shift away from self-regulation towards greater external oversight, including innovative regulatory approaches including “networked governance” and flexible or “responsive” regulation. It reports growing interest in adoption of strategic and responsive approaches to health complaints governance, by rejecting traditional legal forms in favor of more strategic and responsive forms, taking account of the complexity of adverse health events by tailoring responses to individual circumstances of complainants and their local environments.

The challenge of how to collect and harness complaints data to improve the quality of healthcare at a systemic level warrants further research. Scope also exists for researching health complaints commissions and other “meta-regulatory” bodies to explore how to make these processes fairer and better able to meet the complex needs of complainants, health professionals, health services and society.

These general preservation/conservation readings are presented as an introduction to the field. They serve also as a checklist for developing a small support library.