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Article
Publication date: 1 July 2001

Graham Barnes

Addresses the problem of psychotherapy coming to understand itself formally as a conversation in which healing of distortions and breakdowns in communication occurs. The…

Abstract

Addresses the problem of psychotherapy coming to understand itself formally as a conversation in which healing of distortions and breakdowns in communication occurs. The paper proposes making concepts the basis for the psychotherapy conversation by linking psychotherapy to second‐order cybernetics and utilizing Pask’s conversation theory. The first part describes cybernetics as the context for the study of the distortions and breakdowns in communication. The second part discusses conversation theory as a formal description of the procedures of psychotherapy, as a way to converse in psychotherapy, as a way to talk about psychotherapy and as a way to change the conversation of psychotherapy. The final part discusses four distinctive characteristics of the evolving conversation of psychotherapy where psychotherapy composes itself as a conversation. These characteristics are what psychotherapy is (its definition), what it is about (its object), how it proceeds (its methods), and what it is for (its value).

Details

Kybernetes, vol. 30 no. 5/6
Type: Research Article
ISSN: 0368-492X

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Article
Publication date: 12 November 2018

Shelagh Ferguson

This paper aims to elucidate health-related transformations experienced by an individual. Building from personal experience offers an understanding of the relational…

Abstract

Purpose

This paper aims to elucidate health-related transformations experienced by an individual. Building from personal experience offers an understanding of the relational dynamics at play within health transformations, which makes a contribution to realising and facilitating the agency of the patient in systems of integrated care.

Design/methodology/approach

Introspection can be used as a methodology to elucidate messy and personal affective experiences. The author’s introspection is an 18-month catalogue and analysis from diagnosis of breast cancer through significant stages of rehabilitation. Reflexive introspection has gained traction in health research due to its cathartic benefits, whilst this approach offers much; a key challenge for integrated care is translating deeply personal and subjective introspections into strategic-level application.

Findings

Using Turner’s (1969) concept of liminality, this research explicates key relational dynamics of health-related transformations experienced by an individual. By recognising changes in affective being as a pivotal point in rehabilitation, this work links embodied transformation as a critical antecedent to a patient’s willingness to engage his/her agency in their rehabilitation.

Originality/value

Whilst recognising that integrated care is patient-centred and seeks to incorporate the patient’s voice, this research gives insight into how the author, as a patient, engaged her agency in her rehabilitation through building her own transformed personal ontologies of health.

Details

European Journal of Marketing, vol. 52 no. 11
Type: Research Article
ISSN: 0309-0566

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Book part
Publication date: 24 July 2020

Soo-Hoon Lee, Thomas W. Lee and Phillip H. Phan

Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on…

Abstract

Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.

Details

Research in Personnel and Human Resources Management
Type: Book
ISBN: 978-1-80043-076-1

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Article
Publication date: 7 March 2016

Angela Towle, Christine Farrell, Martha E Gaines, William Godolphin, Gabrielle John, Cathy Kline, Beth Lown, Penny Morris, Jools Symons and Jill Thistlethwaite

The purpose of this paper is to present a statement about the involvement of patients in the education of health and social care professionals developed at an…

Abstract

Purpose

The purpose of this paper is to present a statement about the involvement of patients in the education of health and social care professionals developed at an international conference in November 2015. It aims to describe the current state and identify action items for the next five years.

Design/methodology/approach

The paper describes how patient involvement in education has developed as a logical consequence of patient and public participation in health care and health research. It summarizes the current state of patient involvement across the continuum of education and training, including the benefits and barriers. It describes how the conference statement was developed and the outcome.

Findings

The conference statement identifies nine priorities for action in the areas of policy, recognition and support, innovation, research and evaluation, and dissemination and knowledge exchange.

Originality/value

The conference statement represents the first time that an international and multidisciplinary group has worked together to assemble in a single document specific priorities for action to embed the patient’s voice in health professional education.

Details

International Journal of Health Governance, vol. 21 no. 1
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 23 May 2011

Colin Pritchard, Malcolm Cox, Lesley Foulkes and Kenneth Lindsay

Successive governments have called for greater “empowerment” of the patient, reflected in the chief medical officer's call for more patient‐related outcome measures…

Abstract

Purpose

Successive governments have called for greater “empowerment” of the patient, reflected in the chief medical officer's call for more patient‐related outcome measures (PROM). This paper aims to bring together three‐linked studies.

Design/methodology/approach

First study: in 1999, the neurosurgical patient was seen as “expert” to identify PROM outcomes, based upon a patient and carer‐designed self‐administered postal questionnaire in a regional two‐year retrospective survey of subarachnoid haemorrhage (SAH) patients with a 77 per cent response rate, designated treatment‐as‐usual (TAU) cohort (n=142).Second study: in the same region, following the implementing of the specialist neuro‐vascular nurse (SNVN), the SNVN recommendation was evaluated in a two‐year prospective study (n=184) that provided family‐specific psychosocial support and a continuity of care linking hospital and community; the response rate was 87 per cent. Third study: A re‐analysis of the national SAH study (n=2,380), by projecting the TAU and SNVN results onto clinically matched patients within the National cohort to estimate the potential “savings” if all 34 neurosurgical units had an SNVN type service.

Findings

First study: respondents identified many psychosocial and fiscal problems but recommended a SNVN to reduce these difficulties. Second study: the TAU and SNVN patient's were a close clinical match and using the TAU as a control group, it was found that there were major psychosocial and fiscal benefits for SNVN patients and carers, who more speedily re‐established their lives.Third study: it was estimated that this would have produced major financial benefits, e.g. 4,165 fewer bed occupancy days, saving £2.5million; reduced time‐off work for patients and carers, saving £8.1million; and, after deducting cost of a national SNVN service, a combined saving for the service and families of an estimated £9.83 million p.a. Thus, addressing PROM outcomes, through an integrated psychosocial service in neurosurgery was cost‐effective, benefited families, the service, and the wider economy and should be a factor when considering pressurised departmental budgets.

Originality/value

Overall, what the two regional studies and the re‐analysis of the national study showed was that there are benefits from treating the “patient as expert” and taking on board their agendas. There is a need for a more integrated approach to treatment and care that is of value to the service, patients, families and the wider economy.

Details

Social Care and Neurodisability, vol. 2 no. 2
Type: Research Article
ISSN: 2042-0919

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Article
Publication date: 28 October 2014

Cristiano Storni

The purpose of this paper is to raise issues about the design of personal health record systems (PHRs) and self-monitoring technology supporting self-care practices of an…

Abstract

Purpose

The purpose of this paper is to raise issues about the design of personal health record systems (PHRs) and self-monitoring technology supporting self-care practices of an increasing number of individuals dealing with the management of a chronic disease in everyday life. It discusses the results of an ethnographic study exposing to analysis the intricacies and practicalities of managing diabetes “in the wild”. It then describe and discuss the patient-centric design of a diabetes journaling platform that followed the analysis.

Design/methodology/approach

The study includes ethnometodological investigation based on in depth interviews, observations in a support group for adults with type 1 diabetes, home visits, shadowing sessions and semi-structured interviews with a series of medical experts (endocrinologists, general practitioners and diabetes nurses). Findings informed the design of a proof-of-concept PHR called Tag-it-Yourself (TiY): a mobile journaling platform that enables the personalization of self-monitoring practices. The platform is thoroughly described along with an evaluation of its use with real users.

Findings

The investigation sheds light on a series of general characters of everyday chronic self-care practices, and how they ask to re-think some of the assumptions and connotations of the current medical model and the traditional sick role of the patient – often unreflectively assumed also in the design of personal technologies (e.g. PHR) to be used by patients in clinically un-controlled settings. In particular, the analysis discusses: the ubiquitous nature of diabetes that is better seen as a lifestyle, the key role of lay expertises and different forms of knowledge developed by the patient in dealing with a disease on a daily basis, and the need of more symmetrical interactions and collaborations with the medical experts.

Research limitations/implications

Reported discussions suggest the need of a more holistic view of self-management of chronic disease in everyday life with more attention being paid on the perspective of the affected individuals. Findings have potential implications on the way PHR and systems to support self-management of chronic disease in everyday life are conceived and designed.

Practical implications

The paper suggests designers and policy makers to look at chronic disease not as a medical condition to be disciplined by a clinical perspective but rather as a complex life-style where the medical cannot be separated by other aspects of everyday life. Such shift in the perspective might suggest new forms of collaborations, new ways of creative evidence and new form of knowledge creation and validation in chronic self-care.

Social implications

The paper suggests re-thinking the role of the patient in chronic-disease self-management. In particular, it suggests giving more room to the patient voice and concerns and suggest how these can enrich rather than complicate the generation of knowledge about self-care practices, at least in type 1 diabetes.

Originality/value

The paper sheds light on everyday intricacies and practicalities of dealing with a chronic disease. Studies of self-care practices that shed light on the patient perspectives are sporadic and often assume a clinical perspective, its assumptions (e.g. biomedical knowledge is the only one available to improve health outcome, doctors know best) and implications (e.g. compliance, asymmetry between the specialist and the patient).

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Article
Publication date: 19 November 2018

Maja Nemec, Tomaž Kolar and Borut Rusjan

The purpose of this paper is to analyse whether internet forums are an appropriate source for identification of causes of dissatisfaction of patients with non-medical…

Abstract

Purpose

The purpose of this paper is to analyse whether internet forums are an appropriate source for identification of causes of dissatisfaction of patients with non-medical aspects of healthcare services.

Design/methodology/approach

Based on the guidelines of netnography qualitative research the authors identify relevant posts or comments on selected online forums in which web users show their dissatisfaction with healthcare services. Five popular Slovenian forums representing different interest communities have been chosen and 42 forums’ topics have been reviewed.

Findings

Online communities have an important role in exploring patient dissatisfaction. Through content analysis comments were coded into meaningful categories and subcategories.

Research limitations/implications

Some comments were more explicit, while others have provided general and looser reasons for dissatisfaction, and in such cases coding and content analysis of comments was more difficult.

Practical implications

Contents expressed within online communities are helpful in designing improvement activities since they enable determination of concrete relevant measures aiming at eliminating and preventing the established causes of discontent, such as instituting new policies, introducing training programs, determining desired changes in culture.

Originality/value

Usefulness of the netnography as a qualitative method of research is confirmed through confirmation that causes of dissatisfaction of Slovenian patients, which have been identified in the authors research are similar to those identified in previous research in the field of patient satisfaction conducted in Slovenia. Results constitute a new form of researching patient dissatisfaction and expose the specific causes of patient dissatisfaction with healthcare services in Slovenia.

Details

Journal of Health Organization and Management, vol. 32 no. 8
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 13 May 2019

Waleed Al Nadabi, Bryan McIntosh, Tracy McClelland and Mohammed Mohammed

The purpose of this paper is to summarize studies that have examined patient safety culture in maternity units and describe the different purposes, study designs and tools…

Abstract

Purpose

The purpose of this paper is to summarize studies that have examined patient safety culture in maternity units and describe the different purposes, study designs and tools reported in these studies while highlighting gaps in the literature.

Design/methodology/approach

Peer-reviewed studies, published in English during 1961–2016 across eight electronic databases, were subjected to a narrative literature review.

Findings

Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: assessing intervention effects on PSC (n=17), and assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Interventions varied from a single action lasting five weeks to a more comprehensive four year package. The time between baseline and follow-up assessment varied from 6 to 24 months. No study reported measurement or intervention costs, and none incorporated the patient’s voice in assessing PSC.

Practical implications

Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs and find ways to incorporate the patient’s voice.

Originality/value

This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 4 May 2010

Kimiko Katsuyama, Yuichi Koyama, Yasushi Hirano, Kenji Mase, Ken Kato, Satoshi Mizuno and Kazunobu Yamauchi

Measurements of the quality of physician‐patient communication are important in assessing patient outcomes, but the quality of communication is difficult to quantify. The…

Abstract

Purpose

Measurements of the quality of physician‐patient communication are important in assessing patient outcomes, but the quality of communication is difficult to quantify. The aim of this paper is to develop a computer analysis system for the physician‐patient consultation process (CASC), which will use a quantitative method to quantify and analyze communication exchanges between physicians and patients during the consultation process.

Design/methodology/approach

CASC is based on the concept of narrative‐based medicine using a computer‐mediated communication (CMC) technique from a cognitive dialog processing system. Effective and ineffective consultation samples from the works of Saito and Kleinman were tested with CASC in order to establish the validity of CASC for use in clinical practice. After validity was confirmed, three researchers compared their assessments of consultation processes in a physician's office with CASCs. Consultations of 56 migraine patients were recorded with permission, and for this study consultations of 29 patients that included more than 50 words were used.

Findings

Transcribed data from the 29 consultations input into CASC resulted in two diagrams of concept structure and concept space to assess the quality of consultation. The concordance rate between the assessments by CASC and the researchers was 75 percent.

Originality/value

In this study, a computer‐based communication analysis system was established that efficiently quantifies the quality of the physician‐patient consultation process. The system is promising as an effective tool for evaluating the quality of physician‐patient communication in clinical and educational settings.

Details

International Journal of Health Care Quality Assurance, vol. 23 no. 4
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 December 2001

Ed B. Peile and Wendy Briner

New ways of working predicate new ways of learning. Reports on a workshop which examined facilitated case history discussions as a means whereby a team could share and…

Abstract

New ways of working predicate new ways of learning. Reports on a workshop which examined facilitated case history discussions as a means whereby a team could share and extend their learning around the common focus of interest – the patient. Discussion in the workshop focused on “how‐to” aspects of small group facilitation. A question stimulated subsequent enquiry about “privileging voices”. Examines how the facilitation enabled interactive, inter‐professional education through an informal form of discourse analysis on the transcripts of the case discussions. The concept of “privileging voices” is demonstrable in the way the authors worked to facilitate the case history discussions.

Details

Career Development International, vol. 6 no. 7
Type: Research Article
ISSN: 1362-0436

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