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The purpose of this paper is to measure the turnover (or stability in employment) of village clinicians in rural China over the past decade. The authors also want to provide quantitative evidence on the individual characteristics of the clinicians who provide health care to villagers in rural China and whether we should expect these individuals to be interested in continuing to supply quality health care in China’s villages in the coming years.

This paper uses data from a survey of rural China’s village clinicians conducted in five provinces, 25 counties, and 101 villages in 2005 and 2012. This paper also uses qualitative data from interviews with 31 village clinicians. Using a mixed methods approach, this study describes the turnover of village clinicians and the main factors that impact the career decisions of clinicians.

Turnover of China’s village doctors, while not trivial (about 25 percent of village doctors exited their field between 2005 and 2012), is still not overly high. Only five out of 101 villages did not have village clinicians in 2012. Of those that lost village doctors between 2005 and 2012, nearly all of them still had a village doctor in 2012 (either taken over by another local clinician or the position was taken by a newcomer). The authors find that three main sets of factors are correlated with the career decisions of village clinicians: village clinicians’ opportunity cost, the profitability of running a village clinic, and commitment to the field of medicine. In general, clinicians who left the village faced a much higher opportunity cost, had been running a clinic that was not profitable, and had fewer ties to the field of medicine. Newcomers over the same period had higher levels of education, went to higher profit clinics between 2005 and 2012, and had a stronger commitment to the field.

This study makes use of a data set with a large and nationally representative sample to provide a new perspective to better understand clinician turnover at village clinics, the career decisions of clinicians, and the implied trends for the quality and access to rural health care services in the future.

This chapter explores the Three-Block Model of inclusive education, which is situated in the framework of Universal Design for Learning (UDL). The chapter demonstrates how the model informs both instructional design and social-emotional learning objectives focused on fostering community through celebrating diversity, and explores the essential role of parents as collaborators. Examples are provided of IEP development through shared examination of goals, strategies, and assessment, and of innovative learning processes and outcomes associated with incorporating parent involvement in children’s education.

This article explores issues of trust in narratives of interpreted consultations in primary health care.

The paper is based on empirical data from a qualitative study of accounts of interpreted consultations in UK primary care, undertaken in three north London boroughs. In a total of 69 individual interviews and two focus groups, narratives of interpreted consultations were sought from 18 service users, 17 professional interpreters, nine family member interpreters, 13 general practitioners, 15 nurses, eight receptionists, and three practice managers. The study collected and analysed these using a grounded theory approach and taking the story as the main unit of analysis. It applies a theoretical model that draws on three key concepts: Greener's taxonomy of trust based on the different “faces” of power in medical consultations; Weber's notion of bureaucratic vs traditional social roles; and Habermas' distinction between communicative and strategic action.

Trust was a prominent theme in almost all the narratives. The triadic nature of interpreted consultations creates six linked trust relationships (patient‐interpreter, patient‐clinician, interpreter‐patient, interpreter‐clinician, clinician‐patient and clinician‐interpreter). Three different types of trust are evident in these different relationships – voluntary trust (based on either kinship‐like bonds and continuity of the interpersonal relationship over time, or on confidence in the institution and professional role that the individual represents), coercive trust (where one person effectively has no choice but to trust the other, as when a health problem requires expert knowledge that the patient does not have and cannot get) and hegemonic trust (where a person's propensity to trust, and awareness of alternatives, is shaped and constrained by the system so that people trust without knowing there is an alternative). These different types of trust had important implications for the nature of communication in the consultation and on patients' subsequent action.

The methodological and analytic approach, potentially, has wider applications in the study of other trust relationships in health and social care.

Quality in the interpreted consultation cannot be judged purely in terms of accuracy of translation. The critical importance of voluntary trust for open and effective communication, and the dependence of the latter on a positive interpersonal relationship and continuity of care, should be acknowledged in the design and funding of interpreting services and in the training of both clinicians, interpreters and administrative staff.

This is the first study in which interpreted consultations have been analysed from a perspective of critical sociology with a particular focus on trust and power relations.

The connection between women’s empowerment and health has been a growing concern among demographers and other social scientists, who theorize that empowering women – or enhancing their ability to define and make strategic life choices – will improve their reproductive health (Kabeer, 1999). The importance of empowering women became a central theme at the International Conference on Population and Development (ICPD) held in Cairo in 1994. The Cairo policy document codified the notion that women must be empowered in order for them and societies as a whole reach their reproductive health goals, including lowering fertility and population growth, stemming the spread of sexually transmitted diseases (STDs) and HIV/AIDS, and ensuring healthy pregnancy and delivery (Hodgson & Watkins, 1997; Sen & Batliwala, 2000).

After five years of medical education and a somewhat longer period of practical training before obtaining a consultant post, or partnership in general practice, the British clinician can be excused a measure of despair when being told that he or she now has to grapple with alien concepts like ‘value for money’. After all, the majority of one's training has been directed at improving one's clinical competence with the general aim of serving patients better. The clinician's concern is therefore with improving the quality of care, not with securing more value for money. In any case, what are all those National Health Service managers doing?

Improving Global Health is a one year leadership scheme which places trainee doctors and more experienced nurses, midwives and AHPs in a developing country (Cambodia or Tanzania) to develop leadership and quality improvement skills while contributing to Millennium goals in the developing countries. The purpose of this paper is to report on an independent evaluation of the programme, with the purpose of highlighting lessons learned to inform other leadership development initiatives, and in particular to highlight the vital importance of a receptive NHS environment if maximum value is to be gained from investment in clinical leadership.

The evaluation methodology comprised literature review; review of documentation, including on line questionnaires to Fellows; interviews with stakeholders and attendance at key scheme events in July‐September 2011. Fellows who had completed an overseas placement in either Cambodia or Tanzania during 2009‐2010 were interviewed using a semi structured questionnaire. Mentors and Steering Group members were interviewed using an amended version of the Fellows' questionnaire.

Impact was found at the level of personal development; working collaboratively; and understanding the value of audit, teaching and quality improvement. There was some impact on the NHS, however, the majority of Fellows struggled to find opportunities to apply their learning immediately on return from their overseas placement.

Resource and time constraints meant that achievements in meeting Millennium goals were excluded from the evaluation; the authors' working assumption is that only Fellows who enjoyed the Fellowship responded to the invitation to take part; judging the extent to which the Fellowship meets its goal of creating a cadre of improvement champions in the NHS will require time to elapse.

Lessons from implementation of this Fellowship scheme are transferable to the wider NHS.

The paper provides lessons on the design of leadership schemes intended to develop quality improvement skills, particularly for clinicians at an early career stage, illustrates the potential of a placement in a developing country to achieve this, and highlights the importance of a receptive NHS environment to realise maximum benefit from investment in leadership development.

The prime objective of this article is related to dignified human beings as patients in clinical interventions. The main attention of such a perception focuses on observance of humaneness in relationships among physicians, patients, family members, and community at large. This paper aims to address these issues.

The paper examines in depth, analytical deliberations concerning traditional and modern values of medical care and healthcare knowledge and practices.

Therefore, we need to attest that we live in a global village in which multicultural people must live side‐by‐side, if they desire to peacefully coexist. We must assume that human values are based upon general agreements about ethical issues. Such agreements rely on a framework of equitable treatments of all mankind. Medical ethics is about committed codes and oaths of professional medical authorities to protect natural rights, human rights, and civil rights of patients in clinical interventions. It strives to achieve professional objectives to facilitate patients to be recovered from pain and suffering and regain their health in order to live the good life.

This paper is devoted to define the notions relevant to the philosophies of quality of life, ethical, and moral problems concerning clinical medicine, and preventive care systems. It analyzes certain ethical and moral distinctions between medical care and healthcare services, and indicates that cautions should be observed in discussing these notions within the context of preventive care and clinical care systems.

This paper explores the following questions: What is the meaning of a psychosomatic normal life? How life should be respected? What are the meta‐medical practices? What should be the logical and philosophical foundations for medical care and healthcare ethics? How should clinicians and practitioners respect not only cost‐benefit analysis but also consider cost‐effectiveness analysis in providing and promoting medical care and healthcare services for patients?

The purpose of this article is to discuss the policy developments of integration and personalisation within the context of Primary Care, specifically an innovative Memory Service provided within a General Practice. It examines how these policies work together in this context to deliver a high quality service that is responsive to individual needs in an area of care: memory disorder or dementia, which has often relied heavily on secondary care services.

The article is a case study analysis of integration and personalisation in Primary Care, allowing for examination and elaboration of both concepts as applied in this setting; and their contribution to a better quality care Memory Service. The analysis is produced by independent researchers (MC and NM), background and facts by service personnel (IG, NG and DJ).

The innovative Memory Service operates as a person‐centred facility, integrating into the surgery, expertise that would traditionally be locked into secondary care health services. It makes maximum use of locally available knowledge of the patient, their family and formal and informal sources of support and therapy through links which cross agency boundaries. These links are identified and utilised in tailored support for individuals by the practice‐based Dementia Advisor. Outcomes include improved dynamics of identification, diagnosis and after care, high satisfaction amongst patients and families and reduced utilisation and expenditure of other healthcare facilities.

Personalisation and integration can be united in the development of innovative and improved Memory Services centred in Primary Care.

Maintaining a focus on the needs of people within their social contexts (being person‐centred) is a powerful means of driving better integrated care in Primary Care for people living with dementia and related disorders.

This is the first examination of personalisation and integration as coupled concepts to lead the improvement of care, specifically a Memory Service, in Primary Care.

Branching Out is a 12‐week ecotherapy programme for clients who use mental health services within the Greater Glasgow and Clyde area. Over the course of a year 110 clients attended the programme, of whom 77 (70%) completed the course. In order to ascertain the outcomes of the programme and the elements that appeared to facilitate change, semi‐structured interviews with clients (n=28) and two focus groups with clinicians (n=5 and n=3) from the referring services were conducted.The data gathered therein was analysed using interpretive phenomenological analysis (IPA). From the results, five themes emerged as client outcomes. These were: improvements to mental well‐being, improvements to physical health, provision of daily structure and routine, transferable knowledge and skill acquisition, and increased social networking and social skills development. Three themes pertaining to the service logistics (team building and social inclusion, contrast of environments and work and recognition) emerged as potential explanations for the client outcomes. There was a perception among clients and clinicians that Branching Out represented a ‘stepping stone to further community engagement’. The results reflect a recovery‐oriented approach to health care. The limitations of the evaluation and implications for the future are discussed.