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Article
Publication date: 1 March 1995

Windows of opportunity: the "loose" mandate as a mechanism for state-local negotiation

Vincent L. Marando and Alan C. Melchior

Contrary to the popular view of mandates as rigid and dictatorial mechanisms, this article advances a view of mandates as mechanisms for cooperation and negotiation. The…

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Abstract

Contrary to the popular view of mandates as rigid and dictatorial mechanisms, this article advances a view of mandates as mechanisms for cooperation and negotiation. The relationship between several state and local actors is investigated in Maryland, particularly within the context of the development of a "loosely" mandated public health program, the Targeted Funding Program (TFP). An analysis of the TFP and the actors involved in the program's development demonstrates how this program is designed to achieve much more than increased fiscal responsibility. The TFP is designed, and continues to be redesigned, to meet the political and professional objectives of various elected and appointed officials at the state and local levels.

Details

Journal of Public Budgeting, Accounting & Financial Management, vol. 7 no. 3
Type: Research Article
DOI: https://doi.org/10.1108/JPBAFM-07-03-1995-B004
ISSN: 1096-3367

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Article
Publication date: 20 April 2012

Public health implications of healthcare‐associated infections: Problems and prospects

Anthony Tellez‐Marfin

From the symposium keynote address, this paper aims to explore how healthcare‐associated infections (HAIs) have been transformed from being only a hospital concern to a…

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Abstract

Purpose

From the symposium keynote address, this paper aims to explore how healthcare‐associated infections (HAIs) have been transformed from being only a hospital concern to a much broader public health concern.

Design/ methodology/ approach

The paper is a narrative review.

Findings

HAIs have the characteristics that define issues as public health problems. As a result, public health departments can become important partners in the evolving hospital infection control field. However, whether all state health departments can afford to add HAI experts and whether current public health department HAI activities will be effective in preventing HAIs remain important questions.

Practical implications

Public health agencies must be selective about focusing limited resources into areas where they can protect and improve the public's health; whether HAIs are such an area remains to be seen. Although HAIs have historically been the focus of hospitals and hospital‐based services, public health involvement has been mandated through state and federal legislation. In theory, the new mandate is appropriate; in practice, its impact and value need to be comprehensively assessed.

Originality/value

The interdisciplinary team required to evaluate HAI mandatory public reporting comprehensively needs to start from an understanding of the history and concepts underlying public health practice.

Details

Clinical Governance: An International Journal, vol. 17 no. 2
Type: Research Article
DOI: https://doi.org/10.1108/14777271211220808
ISSN: 1477-7274

Keywords

  • Healthcare‐associated infections
  • Public health
  • Health care

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Book part
Publication date: 16 July 2015

Using Public-Private Partnerships to Mitigate Disparities in Access to Genetic Services: Lessons from Wisconsin

Laura Senier, Matthew Kearney and Jason Orne

This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.

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Abstract

Purpose

This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.

Methodology/approach

We show the geographic distribution, funding patterns, and utilization trends for outreach clinics over a 20-year period. Interviews with program planners and outreach clinic staff show how external and internal constraints limited the program’s capacity. We compare clinic operations to the conceptual models guiding program design.

Findings

Our findings show that state health officials had to scale back financial support for outreach clinic activities while healthcare providers faced increasing pressure from administrators to reduce investments in charity care. These external and internal constraints led to a decline in the overall number of patients served. We also find that redistribution of clinics to the Milwaukee area increased utilization among Hispanics but not among African-Americans. Our interviews suggest that these patterns may be a function of shortcomings embedded in the planning models.

Research/Policy Implications

Planning models have three shortcomings. First, they do not identify the mitigation of health disparities as a specific goal. Second, they fail to acknowledge that partners face escalating profit-seeking mandates that may limit their capacity to provide charity services. Finally, they underemphasize the importance of seeking trusted partners, especially in working with communities that have been historically marginalized.

Originality/Value

There has been little discussion about equitably leveraging genetic advances that improve healthcare quality and efficacy. The role of State Health Agencies in mitigating disparities in access to genetic services has been largely ignored in the sociological literature.

Details

Genetics, Health and Society
Type: Book
DOI: https://doi.org/10.1108/S1057-629020150000016010
ISBN: 978-1-78350-581-4

Keywords

  • State health agencies
  • public health
  • public-private partnerships
  • rural health services
  • genetic services
  • health inequalities

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Article
Publication date: 1 February 1989

THE UNRAVELLING OF THE NONPROFIT SERVICE SECTOR IN THE U.S.

Carroll L. Estes and Linda A. Bergthold

In the mid 1980s, amidst a massive restructuring of U.S. capital and a retrenchment of the welfare state, little attention has been paid to the ill‐defined “nonprofit” or…

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Abstract

In the mid 1980s, amidst a massive restructuring of U.S. capital and a retrenchment of the welfare state, little attention has been paid to the ill‐defined “nonprofit” or “voluntary” service sector in the American economy. The Filer Commission on Private Philanthropy and Public Needs characterised it in 1975 in the following way:

Details

International Journal of Sociology and Social Policy, vol. 9 no. 2/3
Type: Research Article
DOI: https://doi.org/10.1108/eb013068
ISSN: 0144-333X

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Article
Publication date: 1 October 2006

Turning Point: implications for collaborative governance

Ray M. Nicola

The purpose of this paper is to show how the Turning Point Initiative to improve the health of populations by improving the USA public health system has many lessons on…

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Abstract

Purpose

The purpose of this paper is to show how the Turning Point Initiative to improve the health of populations by improving the USA public health system has many lessons on collaboration for governance systems.

Design/methodology/approach

The article synthesizes published literature outlining the results of a Robert Wood Johnson Foundation/W.K. Kellogg Foundation grant program to 21 USA states and 43 communities and relationships to administrative practice.

Findings

Turning Point's creation of a formalized network of public health partners across the USA has led to innovations in collaboration, increased system capacity, and alternative structures for improving health.

Originality/value

Turning Point's efficacy in community health system improvement can be mirrored in clinical governance. A major potential for improvement in clinical delivery systems is available by re‐thinking key partners, organizational structures, and system administrative capacity.

Details

Clinical Governance: An International Journal, vol. 11 no. 4
Type: Research Article
DOI: https://doi.org/10.1108/14777270610708828
ISSN: 1477-7274

Keywords

  • Public health
  • Health services
  • United States of America

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Article
Publication date: 1 April 2014

Law as a tool to promote healthcare safety

Tara Ramanathan

The purpose of this paper is to inform healthcare providers and healthcare facility leadership about the statutory, administrative, criminal, and tort law implications…

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Abstract

Purpose

The purpose of this paper is to inform healthcare providers and healthcare facility leadership about the statutory, administrative, criminal, and tort law implications related to preventable harms from unsafe injection practices.

Design/methodology/approach

Review of legal theory and precedents.

Findings

The law can address disputes over unsafe injection practices in a variety of ways. Administrative agencies may hold a provider or facility responsible for preventable harms according to specific statutory and regulatory provisions governing licensure. State courts can compensate victims of certain actions or inactions based on tort law, where a breach of a legal duty caused damages. Prosecutors and the public can turn to criminal law to punish defendants and deter future actions that result in disability or death.

Research limitations/implications

The state law findings in this review are limited to legal provisions and court cases that are available on searchable databases. Due to the nature of this topic, many cases are settled out of court, and those records are sealed from the public and not available for review.

Practical implications

Preventable harm continues to occur from unsafe injection practices. These practices pose a significant risk of disease or even death for patients and could result in legal repercussions for healthcare providers and facility leadership.

Originality/value

This article reviews emerging law and potential legal implications for health care and public health related to unsafe medical practices related to needle, syringe, and vial use.

Details

Clinical Governance: An International Journal, vol. 19 no. 2
Type: Research Article
DOI: https://doi.org/10.1108/CGIJ-03-2014-0015
ISSN: 1477-7274

Keywords

  • Quality
  • Health policy
  • Safety culture
  • Adverse incidents and hospital acquired infection
  • Environment of clinical practice
  • Patient litigation

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Book part
Publication date: 24 October 2019

The Ethical Significance of Migrating Health Professionals’ Legitimate Expectations: Canadian and Australian Pathways to Nowhere?

Hugh Breakey, William Ransome and Charles Sampford

This chapter explores the ethics of a critical vulnerability suffered by migrant health professionals (MHPs): the problem of ‘pathways to nowhere’. This problem arises…

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Abstract

This chapter explores the ethics of a critical vulnerability suffered by migrant health professionals (MHPs): the problem of ‘pathways to nowhere’. This problem arises from dynamic change in the processes, practices and policies governing how migrant professionals achieve accreditation, training and employment in destination countries, whereby established pathways to professional practice are unexpectedly altered or removed. The authors detail the significance of this phenomenon in Australian and Canadian contexts. Drawing on the literature on legitimate expectations and the rule of law, the authors outline the ethical stakes and responsibilities that attach to states creating and then disappointing people’s legitimate expectations, and discuss how these considerations apply to destination countries’ treatment of MHPs.

Details

Ethics in a Crowded World: Globalisation, Human Movement and Professional Ethics
Type: Book
DOI: https://doi.org/10.1108/S1529-209620190000022003
ISBN: 978-1-83867-008-5

Keywords

  • Migration
  • health professionals
  • legitimate expectations
  • rule of law
  • pathways to nowhere
  • adaptive preferences

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Article
Publication date: 1 December 1998

Justice, rights and health care: a discussion of the report of the commission on social justice

Hugh V. McLachlan

Raises some questions on moral and legal rights to health care, referring to various claims contained within the report of the UK’s Commission on Social Justice – “Social…

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Abstract

Raises some questions on moral and legal rights to health care, referring to various claims contained within the report of the UK’s Commission on Social Justice – “Social Justice: Strategies for National Renewal” (1994). Explores the relationship between needs and rights – rights of action and rights of recipience, moral rights and legal rights. Proceeds to delve into the role the state plays in providing services such as health care and whether or not people have a moral right to good health and good health care. Questions if the state should provide health care and, if so, should it be provided as a legal right to citizens? Concludes that the Commission on Social Justice fails to defend the National Health Service on the grounds of justice and moral rights.

Details

International Journal of Sociology and Social Policy, vol. 18 no. 11/12
Type: Research Article
DOI: https://doi.org/10.1108/01443339810788588
ISSN: 0144-333X

Keywords

  • Health care
  • Moral responsibility
  • National health service

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Book part
Publication date: 1 January 2004

EMBODIED HEALTH MOVEMENTS AND CHALLENGES TO THE DOMINANT EPIDEMIOLOGICAL PARADIGM

Stephen Zavestoski, Rachel Morello-Frosch, Phil Brown, Brian Mayer, Sabrina McCormick and Rebecca Gasior Altman

Health social movements address several issues: (a) access to, or provision of, health care services; (b) disease, illness experience, disability and contested illness;…

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Abstract

Health social movements address several issues: (a) access to, or provision of, health care services; (b) disease, illness experience, disability and contested illness; and/or (c) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality. These movements have challenged a variety of authority structures in society, resulting in massive changes in the health care system. While many other social movements challenge medical authority, a rapidly growing type of health social movement, “embodied health movements” (EHMs), challenge both medical and scientific authority. Embodied health movements do this in three ways: (1) they make the body central to social movements, especially with regard to the embodied experience of people with the disease; (2) they typically include challenges to existing medical/scientific knowledge and practice; and (3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research, and expanded funding. We present a conceptual framework for understanding embodied health movements as simultaneously challenging authority structures and allying with them, and offer the environmental breast cancer movement as an exemplar case.

Details

Authority in Contention
Type: Book
DOI: https://doi.org/10.1016/S0163-786X(04)25010-8
ISBN: 978-0-76231-037-1

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Article
Publication date: 12 November 2018

Chaos theory, uncertainty, and organizational learning: What the Ebola incident in Dallas teaches us about organizations

Laura M. Keyes and Abraham David Benavides

The purpose of this paper is to juxtapose chaos theory with organizational learning theory to examine whether public organizations co-evolve into a new order or rather…

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Abstract

Purpose

The purpose of this paper is to juxtapose chaos theory with organizational learning theory to examine whether public organizations co-evolve into a new order or rather institutionalize newly gained knowledge in times of a highly complex public health crisis.

Design/methodology/approach

The research design utilizes the results from a survey administered to 200 emergency management and public health officials in the Dallas–Fort Worth metroplex.

Findings

The findings of this paper suggest that public entities were more likely to represent organizational learning through the coordination of professionals, access to quality information, and participation in daily communication. Leadership was associated with the dissemination of knowledge through the system rather than the development of new standard operating procedures (as suggested by chaos theory and co-evolution).

Research limitations/implications

There are limitations to this study given the purposive sample of emergency management and public health officials employed in the Dallas–Fort Worth metroplex.

Practical implications

The authors find that public organizations that learn how to respond to unprecedented events through reliance on structure, leadership, and culture connect decision makers to credible information resulting in organizational learning.

Social implications

As a result, public administrators need to focus and rely on their organization’s capacity to receive and retain information in a crisis.

Originality/value

This research contributes to our understanding of organizational learning in public organizations under highly complex public health situations finding decisions makers rely on both organizational structure and culture to support the flow of credible information.

Details

International Journal of Organization Theory & Behavior, vol. 21 no. 4
Type: Research Article
DOI: https://doi.org/10.1108/IJOTB-04-2018-0050
ISSN: 1093-4537

Keywords

  • Organizational learning
  • Public policy
  • Local government
  • Ebola
  • Chaos theory

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