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A healthcare system in any country is rarely the product of one logical policy-making experience, but rather a manifestation of many years of historical development. The purpose of this paper is to examine the characteristics, components, and variables of South Africa’s healthcare system in the context of global patterns. It leverages a dynamic period in South Africa since 1994, and applies a comparative health systems analysis to explain where the country’s healthcare system is, and where it is potentially going.

This paper reviews literature related to South Africa’s healthcare system, outlines its historical development, and discusses three fundamental challenges experienced in the country. This paper also reviews the literature on healthcare system typologies and identifies three framework models that have been used to categorise national healthcare systems since the 1970s. This paper then discusses the categorisation of South Africa’s healthcare system in these models, in comparison to Canada and the USA.

This paper finds that the framework models are useful tools for comparative analysis of healthcare systems. However, any use of such typologies should be done with the awareness that national healthcare systems are not isolated entities because they function within a larger context. They are not static, since they are constantly evolving with many nuances, even with very similar healthcare system categorisations.

This paper charts the trajectory of change in the South African healthcare system, and demonstrates that the change process must keep internal conditions in mind if the outcome is to be successful. Imitating policies of countries with well-functioning systems, without regard to local realities, may not work, as the government attempts to usher in changes within a short span of time.

This paper aims to explore how historical context influences the content and selection of rhetorical legitimation strategies. Using case study method, this paper will focus on how insurance companies and labor tried to defend their legitimacy in the context of enactment of Medicare in the USA. What factors influenced the strategic (rhetorical) decisions made by insurance companies and labor unions in their institutional work?

The study is empirically grounded in archival research, involving an analysis of over 9,000 pages of congressional hearings on Medicare covering the period 1958–1965.

The authors show that rhetorical legitimation strategies depend significantly on the specific historical circumstances in which those strategies are used. The historical context lent credibility to certain arguments and organizations are forced to decide either to challenge widely held assumptions or take advantage of them. The authors show that organizations face strong incentives to pursue the latter option. Here, both the insurance companies and labor unions tried to show that their positions were consistent with classical liberal ideology, because of high respect of classical liberal principles among different stakeholders (policymakers, voters, etc.).

It is uncertain how much the results of the study could be generalized. More information about the organizations whose use of rhetorics the authors studied could have strengthened our conclusions.

The practical relevancy of the revised paper is that the authors should not expect hegemony challenging rhetorics from organizations, which try to influence legislators (and perhaps the larger public). Perhaps (based on the findings), this kind of rhetorics is not even very effective.

The paper helps to understand better how organizations try to advance their interests and gain acceptance among the stakeholders.

In this paper, the authors show how historical context in practice influence rhetorical arguments organizations select in public debates when their goal is to influence the decision-making of their audience. In particular, the authors show how dominant ideology (or ideologies) limit the options organizations face when they are choosing their strategies and arguments. In terms of the selection of rhetorical justification strategies, the most pressing question is not the “real” broad based support of certain ideologies. Insurance company and labor union representatives clearly believed that they must emphasize liberal values (or liberal ideology) if they wanted to gain legitimacy for their positions. In existing literature, it is often assumed that historical context influence the selection of rhetorical strategies but how this in fact happens is not usually specified. The paper shows how interpretations of historical contexts (including the ideological context) in practice influence the rhetorical strategies organizations choose.

While known by many names, qualifying exams function as gatekeepers to graduate student advancement to PhD candidacy, yet there has been little formal study on best qualifying exam practices particularly in biomedical and related STEM PhD programs. The purpose of this study is to examine the current state of qualifying exams through an examination of the literature and exploration of university-wide policies.

The authors conducted a literature review of studies on qualifying exams and completed an external evaluation of peer institutions’ and internal institutional qualifying exam requirements to inform our discussion of qualifying exams practices in PhD training at a research-intensive US institutions.

This study identified the need for more research on qualifying exams to establish evidence-based best practices. The authors found a wide variety of qualifying exam formats, with little evidence in support for specific formats. The authors also found little evidence that student expectations are made clear. The lack of evidence-based best practices coupled with insufficient clarity for students has a real potential to disadvantage PhD students, particularly first generation, underrepresented minority, international and/or other trainees who are not privileged or socialized to navigate training environments with vague landmarks such as the qualifying exams.

There are very few studies that evaluate qualifying exams in US doctoral education, particularly in STEM fields, and to the authors’ knowledge, there has been no analysis of campus-wide policies on qualifying exams reported. The lack of evidence for best practices and the need for to evaluate the implementation and effectiveness of qualifying exams are discussed.

The purpose of this article is to clarify the social burden of Japan’s three major diseases including Long-term Care (LTC) burden.

A modification of the Cost of Illness (COI)—the Comprehensive-COI (C-COI) was utilized to estimate three major diseases: cancer, heart disease, and cerebrovascular diseases (CVD). The C-COI consists of five parts: medical direct cost, morbidity cost, mortality cost, formal LTC cost and informal LTC cost. The latter was calculated by two approaches: opportunity cost approach (OC) and replacement approach (RA), which assumed that informal caregivers were substituted by paid caregivers.

The C-COI of cancer, heart disease and CVD in 2017 amounted to 10.5 trillion JPY, 5.2 trillion JPY, and 6.7 trillion JPY, respectively (110 JPY= 1 US$). The mortality cost was preponderant for cancer (61 percent) and heart disease (47.9 percent); while the informal LTC cost was preponderant for CVD (27.5 percent). The informal LTC cost of the CVD in OC amounted to 1.8 trillion JPY; while the RA amounted to 3.0 trillion JPY.

The LTC burden accounted for a significant proportion of the social burden of chronic diseases. The informal care was maintained by unsustainable structures such as the elderly providing care for the elderly. This result can affect health policy decisions.

The C-COI is more appropriate for estimating the social burden of chronic diseases including the LTC burden and can be calculated using governmental statistics.

Process facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention.

The present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence.

The analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence.

It is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases.

The facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities.

This study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.

Research and experience show that evidence-based practice (EBP), i.e. using the best available knowledge in daily professional work, is difficult to achieve in social services. The purpose of this study is to understand the development of organizational EBP learning processes in daily work through workplace education for staff and managers of supported homes for people with cognitive disabilities. The authors examine how the EBP model and new knowledge are understood and made actionable in the workplace, applying theories of organizational learning.

The authors used empirical material collected from an EBP workplace education pilot in Sweden, as well as documents on national EBP implementation in Swedish social services. Before the pilot, a focus group interview was conducted with regional senior managers. Participating managers and staff were individually interviewed two to three years after the pilot.

The study illustrates how knowledge-based action emerged from education where EBP was interpreted, understood, reflected on, and tested, supported by codified EBP tools in the work context. The participants, when supervised, and when observing and questioning their own behaviors in practice, contributed to double-loop learning (DLL) processes. Codification of EBP knowledge into useful tools and socialization processes during education and workplace meetings was crucial in developing individual and group DLL and knowledge-based actions.

The bottom-up approach to EBP development and the adaptive contextual learning at the workplace gave new insights into organizational learning in social service workplaces.

The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of care.

Through a review of the theoretical literature on professions and documentary analysis of key public inquiry documents and reports in the UK National Health Service (NHS) the authors examine how the misconduct of doctors can be understood using the metaphor of professional wrongdoing as a product of bad apples, bad barrels or bad cellars.

The wrongdoing literature tends to present an uncritical assumption of increasing sophistication in analysis, as the focus moves from bad apples (individuals) to bad barrels (organisations) and more latterly to bad cellars (the wider system). This evolution in thinking about wrongdoing is also visible in public inquiries, as analysis and recommendations increasingly tend to emphasise cultural and systematic issues. Yet, while organisational and systemic factors are undoubtedly important, there is a need to keep in sight the role of individuals, for two key reasons. First, there is growing evidence that a small number of doctors may be disproportionately responsible for large numbers of complaints and concerns. Second, there is a risk that the role of individual professionals in drawing attention to wrongdoing is being neglected.

To the best of the authors’ knowledge this is the first theoretical and empirical study specifically exploring the role of NHS inquiries in holding the medical profession to account for failings in professional practice.