Search results

The purpose of this paper is to describe how clinical registers were designed and used to serve multiple purposes in three health systems, in order to contribute practical experience for building learning healthcare systems.

Case description and comparison of the development and use of clinical registries, drawing on participants’ experience and published and unpublished research.

Clinical registers and new software systems enable fact-based decisions by patients, clinicians, and managers about better care, as well as new and more economical research. Designing systems to present the data for users’ daily work appears to be the key to effective use of the potential afforded by digital data.

The case descriptions draw on the experience of the authors who were involved in the development of the registers, as well as on published and unpublished research. There is limited data about outcomes for patients or cost-effectiveness.

The cases show the significant investments which are needed to make effective use of clinical register data. There are limited skills to design and apply the digital systems to make the best use of the systems and to reduce their disadvantages. More use can be made of digital data for quality improvement, patient empowerment and support, and for research.

Patients can use their data combined with other data to self-manage their chronic conditions. There are challenges in designing and using systems so that those with lower health and computer literacy and incomes also benefit from these systems, otherwise the digital revolution may increase health inequalities.

The paper shows three real examples of clinical registers which have been developed as part of their host health systems’ strategies to develop learning healthcare systems. The paper gives a simple non-technical introduction and overview for clinicians, managers, policy-advisors and improvers of what is possible and the challenges, and highlights the need to shape the design and implementation of digital infrastructures in healthcare services to serve users.

A conceptual model of health care, a theory of quality improvement in health care and the role of patient, physician and employee judgements as part of organisation‐wide improvement are introduced. The conceptual model of health care shows how the practitioner, the locus of care‐giving and the social context interact to meet the needs of patients and highlights potential sources of unwanted variation in outcomes. This theory of quality improvement stresses the continuous improvement of processes throughout the entire organisation to meet the needs and expectations of customers. Basic building blocks for continuous improvement ‐ knowledge of customers, knowledge of work as processes, and statistical and scientific thinking ‐ are discussed along with the need to transform the entire organisation. A method for gaining customer knowledge and for monitoring hospital quality, based on measuring quality from patients′, physicians′, and employees′ judgements of quality, is introduced. The method, called the Hospital Quality Trend (HQT) family of quality measures, is described and its uses to promote organisation‐wide quality improvement are illustrated. Health care work is complex and unique. Careful analysis of the way that work is done and knowledge of the customers in defining and improving quality is essential for achieving better quality and value from the health care system.

Recognition of the importance and difficulty of engaging physicians in organisational change has sparked an explosion of literature. The social identity approach, by considering engagement in terms of underlying group identifications and intergroup dynamics, may provide a framework for choosing among the plethora of proposed engagement techniques. This paper seeks to address this issue.

The authors examined how four disparate organisations engaged physicians in change. Qualitative methods included interviews (109 managers and physicians), observation, and document review.

Beyond a universal focus on relationship-building, sites differed radically in their preferred strategies. Each emphasised or downplayed professional and/or organisational identity as befit the existing level of inter-group closeness between physicians and managers: an independent practice association sought to enhance members' identity as independent physicians; a hospital, engaging community physicians suspicious of integration, stressed collaboration among separate, equal partners; a developing integrated-delivery system promoted alignment among diverse groups by balancing “systemness” with subgroup uniqueness; a medical group established a strong common identity among employed physicians, but practised pragmatic co-operation with its affiliates.

The authors cannot confirm the accuracy of managers' perceptions of the inter-group context or the efficacy of particular strategies. Nonetheless, the findings suggested the fruitfulness of social identity thinking in approaching physician engagement.

Attention to inter-group dynamics may help organisations engage physicians more effectively.

This study illuminates and explains variation in the way different organisations engage physicians, and offers a theoretical basis for selecting engagement strategies.

This study aims to ascertain the forms of social enterprises created for public services and the dimensions of community-based management of public facilities. It seeks to understand how community-based facilities management (CbFM) can apply to the management of public services created by social enterprises in developing communities.

The study examines research studies on CbFM through a scoping review of papers published between 1997 and 2022.

The scoping review revealed that there are five dimensions of CbFM for developing communities: CbFM, urban facilities management, sustainable CbFM, urban infrastructure management and management of community hubs. It also revealed that social enterprises have been used to manage services, and for social inclusion, and to increase the efficiency of tangible infrastructure in communities.

The scoping review included literature from 1997 to 2022 to understand the development trends in CbFM in developing communities. It is possible that literature from a broader timeframe could have produced more in-depth understanding of the subject investigated.

The paper articulates a framework of CbFM models for public services in developing communities and developed a database of the relevant studies, which can further guide future researchers, stakeholders and policymakers in this area.

The comprehensive review produced a framework for community management of public services. It also identified that there is a paucity of literature on social infrastructure. It highlighted the need for skillsets to support community-based enterprises. There are limited studies that touch on the development of performance indicators for developing communities.

We contend that the international strategy adopted by and the international experience of top executives in parent firms, as well as the embeddedness of foreign subsidiaries in host countries, moderate the impact of institutional distance between home and host countries on the divergence of isomorphic pressures experienced by foreign subsidiary managers. We further suggest that diverging isomorphic pressures are more likely to spur foreign subsidiary managers to deinstitutionalize organizational routines from parent firms when these managers possess knowledge‐based power, the subsidiary’s performance is declining, or social controls are lacking from the parent firm. Implications for research and practice are discussed.

This study uses parametric hazard models to investigate duration dependence in US stock market cycles over the January 1929 through December 1992 period. Market cycles are determined using the Beveridge‐Nelson (1981) approach to the decomposition of economic time series. The results show that both real and nominal cycles exhibit positive duration dependence. The implication of this finding is that actual prices revert to their permanent or trend level in a non‐random manner as the cyclical component dissipates over time. This process is consistent with mean reversion in price and suggests that predictable periodicity in market cycles may exist. Only limited evidence is obtained that discrete shifts or trends in mean cycle duration exist. The length of market cycles appears not to have changed over the 1929–92 period.

Communications regarding this column should be addressed to Mrs. Cheney, Peabody Library School, Nashville, Tenn. 37203. Mrs. Cheney does not sell the books listed here. They are available through normal trade sources. Mrs. Cheney, being a member of the editorial board of Pierian Press, will not review Pierian Press reference books in this column. Descriptions of Pierian Press reference books will be included elsewhere in this publication.

The school-to-prison pipeline is a term used to describe the pathway traveled by students from public schools to incarceration in secure juvenile detention and correctional programs. It begins with students who are marginalized by the education system because of their academic and behavioral issues. The pipeline leads from school failure and disciplinary exclusion to involvement with the juvenile justice system. Youth who are ethnic minorities (especially those who are African-American or Hispanic) as well as those with educational disabilities (especially those with learning and behavioral disorders) are significantly overrepresented in data sets representing key points along the pipeline (e.g., students with poor academic achievement, high rates of suspension, expulsion, and dropout) as well as their high rates of incarceration. From his personal perspective and experience with the juvenile justice system, the author attempts to explicate the pipeline, and to describe efforts to impact it positively.