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The issue of medical education and SIFTR (Special Incentive for Teaching and Research) within the framework of the internal market and the purchaser/ provider separation is discussed. It is proposed that medical education be treated in the same way as the rest of the NHS and that resources follow medical students. The problems of concentrating medical student teaching within “teaching” hospitals and the resulting injustices arising from SIFTR are explored. It is proposed that in order to improve medical education some academic staff concentrate on teaching rather than research, that their performance indicators are similarly related and that SIFTR is abolished and the money distributed more equitably.

The new NHS White Paper (DoH, 1997) provides for a new legal duty of quality for chief executives in Trusts. Clinical governance is seen as a central tenant of this legal duty which is designed to raise clinical quality to the same level of importance as corporate governance.

The purpose of this paper is to explore the way “hybrid” clinical managers in Kenyan public hospitals interpret and enact hybrid clinical managerial roles in complex healthcare settings affected by professional, managerial and practical norms.

The authors conducted a case study of two Kenyan district hospitals, involving repeated interviews with eight mid-level clinical managers complemented by interviews with 51 frontline workers and 6 senior managers, and 480 h of ethnographic field observations. The authors analysed and theorised data by combining inductive and deductive approaches in an iterative cycle.

Kenyan hybrid clinical managers were unprepared for managerial roles and mostly reluctant to do them. Therefore, hybrids’ understandings and enactment of their roles was determined by strong professional norms, official hospital management norms (perceived to be dysfunctional and unsupportive) and local practical norms developed in response to this context. To navigate the tensions between managerial and clinical roles in the absence of management skills and effective structures, hybrids drew meaning from clinical roles, navigating tensions using prevailing routines and unofficial practical norms.

Understanding hybrids’ interpretation and enactment of their roles is shaped by context and social norms and this is vital in determining the future development of health system’s leadership and governance. Thus, healthcare reforms or efforts aimed towards increasing compliance of public servants have little influence on behaviour of key actors because they fail to address or acknowledge the norms affecting behaviours in practice. The authors suggest that a key skill for clinical managers in managers in low- and middle-income country (LMIC) is learning how to read, navigate and when opportune use local practical norms to improve service delivery when possible and to help them operate in these new roles.

The authors believe that this paper is the first to empirically examine and discuss hybrid clinical healthcare in the LMICs context. The authors make a novel theoretical contribution by describing the important role of practical norms in LMIC healthcare contexts, alongside managerial and professional norms, and ways in which these provide hybrids with considerable agency which has not been previously discussed in the relevant literature.

This issue is a selected bibliography covering the subject of leadership.

BOOKS and Libraries for the Blind form the subject of a paper by Dr. Robert C. Moon in the May Library Journal. The writer is the son of William Moon, the inventor of the system of embossed writing bearing his name. He describes the systems of writing for the blind in use, and the various agencies for circulating literature. After examining the existing departments for the blind in Public Libraries, he comes to the conclusion that “all the libraries need more books, and if they are to reach and teach the adult blind they must have a fair proportion of them in the Moon type. All Public Libraries should possess a few works printed in the various types, care being taken to have a good supply of those embossed in the special type which is taught in the schools for the blind of the immediate locality, in order that the pupils in vacation time, and the graduates of the schools may be provided with reading matter, but the infirm and aged blind will be found in almost all communities, and for them books printed in the Moon type are indispensable. Alice S. Tyler describes the League of Library Commissions. “The success of the experiment in co‐operation which was inaugurated in 1901 by the library commissions of Wisconsin, Minnesota, and Iowa, whereby printed matter of common interest and equal necessity and value to these commissions was issued jointly, led to the suggestion that a national organization might more economically carry forward these and other lines of co‐operative work, leaving to the overcrowded state commission workers more time and money for the peculiar problems of each state.” This suggestion was brought up at the St. Louis conference, and resulted in an organization being formed under the title of the League of Library Commissions, consisting of one representative from each of the commissions included. The particular directions in which the League will promote co‐operative work are: carefully prepared lists of books for first purchase for small libraries; lists of new books which, upon examination, had been found desirable ; handbook of suggestions and direction as to the organization and management of small libraries; printed statement regarding the aims and methods of state library commissions, with comparison of their laws; definite help and suggestions on the subject of library buildings, especially floor‐plans arranged for economic administration, growing out of the experience of the library commissions in connection with the erection of Carnegie and other library buildings within the last few years; united effort to bring to the attention of book publishers the urgent need of good, durable binding, adequate indexing, &c.

Increasing attention is being placed on clinical trials as a source of evidence. Presents thoughts about the advantages and disadvantages of clinical trials and their influence on thinking and clinical practice.

The purpose of this paper is to assess the extent of empathy in paramedic students across seven Australian universities.

A cross‐sectional study was carried out using a paper‐based questionnaire employing a convenience sample of first, second, and third year undergraduate paramedic students. Student empathy levels were measured using a standardised self‐reporting instrument: the Jefferson Scale of Physician Empathy‐Health Profession Students (JSPE‐HPS).

A total of 783 students participated in the study, of which 57 per cent were females. The overall JSPE‐HPS mean score was 106.74 (SD=14.8). Females had greater mean empathy scores than males 108.69 v 103.58 (p=0.042). First year undergraduate paramedic mean empathy levels were the lowest, 106.29 (SD=15.40) with second year's the highest at 107.17 (SD=14.90).

The overall findings provide a framework for educators to begin constructing guidelines focusing on the need to incorporate, promote and instil empathy into paramedic students in order to better prepare them for future out‐of‐hospital healthcare practice.

The paper discusses how a decision analytic framework has been used by an English health authority in relation to the commissioning of ambulance cardiac services. Strategies for the management by ambulance personnel of victims of cardiac arrest and persons with acute chest pain of cardiac origin were modelled in a decision‐event tree, and a bibliographic database established. The international research literature prior to 1997 was searched in order to derive probability values for the tree. However, after checking whether the sub‐groupings of results in the papers were in accordance with the variables in the tree, the number of useful papers on acute chest pain was found to be only two. In the almost complete absence of information ‐ even from small observational studies ‐ on the management of the great majority of patients with cardiac symptoms transported by ambulance, the local ambulance service and the main providers of hospital services in the district are now collaborating in field studies of cardiac care in order to improve the inputs into the model.

The influx of refugees and asylum-seekers over the past decade into the European Union creates challenges to the health systems of receiving countries in the preparedness and requisite adjustments to policy addressing the new needs of the migrant population. This study aims to examine and compare policies for access to health care and the related health outcomes for refugees and asylum-seekers settling both in the UK and Germany as host countries.

The paper conducted a scoping review of academic databases and grey literature for studies within the period 2010-2017, seeking to identify evidence from current policies and service provision for refugees and asylum-seekers in Germany and the UK, distilling the best practice and clarifying gaps in knowledge, to determine implications for policy.

Analysis reveals that legal entitlements for refugees and asylum-seekers allow access to primary and secondary health care free of charge in the UK versus a more restrictive policy of access limited to acute and emergency care during the first 15 months of resettlements in Germany. In both countries, many factors hinder the access of this group to normal health care from legal status, procedural hurdles and lingual and cultural barriers. Refugees and asylum-seeker populations were reported with poor general health condition, lower rates of utilization of health services and noticeable reliance on non-governmental organizations.

This paper helps to fulfill the need for an extensive research required to help decision makers in host countries to adjust health systems towards reducing health disparities and inequalities among refugees and asylum-seekers.