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The purpose of this study is to present a quality improvement approach titled “Picture-Understanding-Action” used in Ireland to enhance the role of healthcare boards in the oversight of healthcare quality and its improvement.

The novel and practical “Picture-Understanding-Action” approach was implemented using the Model for Improvement to iteratively introduce changes across three quality improvement projects. This approach outlines the concepts and activities used at each step to support planning and implementation of processes that allow a board to effectively achieve its role in overseeing and improving quality. This approach matured over three quality improvement projects.

The “Picture” included quantitative and qualitative aspects. The quantitative “Picture” consisted of a quality dashboard/profile of board selected outcome indicators representative of the health system using statistical process control (SPC) charts to focus discussion on real signals of change. The qualitative picture was based on the experience of people who use and work in health services which “people-ised” the numbers. Probing this “Picture” with collective grounding, curiosity and expert training/facilitation developed a shared “Understanding”. This led to “Action(s)” from board members to improve the “Picture” and “Understanding” (feedback action), to ask better questions and make better decisions and recommendations to the executive (feed-forward action). The Model for Improvement, Plan-Do-Study-Act cycles and a co-design approach in design and implementation were key to success.

To the authors’ knowledge, this is the first time a board has undertaken a quality improvement (QI) project to enhance its own processes. It addresses a gap in research by outlining actions that boards can take to improve their oversight of quality of care.

Clinical governance (CG) is an important foundation for a high-performing health care system, with many countries supporting its development. CG policy may be developed and implemented nationally, or devolved to a local level, with implications for the overall approach to implementation and policy uptake. However, it is not known whether one of these two approaches is more effective. The purpose of this paper is to probe this question. Its setting is Ireland and New Zealand, two broadly comparable countries with similar CG policies. Ireland’s was nationally led, while New Zealand’s was devolved to local districts. This leads to the question of whether these different approaches to implementation make a difference.

Data from surveys of health professionals in both countries were used to compare performance with CG development.

The study showed that Ireland’s approach produced a slightly better performance, raising questions about the merits of devolving responsibility for policy implementation to the local level.

The Irish and New Zealand surveys both had lower-than-desirable response rates, which is not uncommon for studies of health professionals such as this. The low response rates mean the findings may be subject to selection bias.

Despite the importance of the question of whether a national or local approach to policy implementation is more effective, few studies specifically focus on this, meaning that this study provides a new contribution to the topic.

Dealing with the needs of asylum seekers and refugees presents a challenge to local health services, and mental health has been identified as the main health issue for this group. This paper reports the findings of a quantitative and qualitative study of the mental health care needs of asylum seekers and refugees in Newcastle upon Tyne. Primary and mental health services were found not to be meeting the needs of this group. In some practices, attitudes to asylum seekers among both GPs and other patients were reported as stigmatising. But there is evidence that many of the mental health problems of asylum seekers are related to post‐migration stress arising from practical and economic difficulties and experience of racism and other discrimination, highlighting the need to build support and social connections and include the needs of asylum seekers in local mental health promotion strategies.

Patient and user involvement is central to current government thinking on the NHS. More comprehensive approaches to organised community participation and community development have received less support and examples of effective and genuine participation in key areas such as primary care decision‐making are rare. The initiative described in this paper was established in Newcastle upon Tyne in 1995 to promote community participation in decision‐making about local health services. It has particular relevance to current concerns about addressing social exclusion and tackling health inequalities since it operates in an area of social disadvantage with a significant black and ethnic minority population (6 percent). This case study is based on an independent evaluation which used multiple research methods, including interviews, questionnaire surveys and direct observation, to assess the project’s practice and impact. Describes a community development approach to public participation. An emphasis on inclusive practices has facilitated meaningful involvement of minority groups such as ethnic minority residents and those with disabilities who tend to be marginalised in public debate. Argues that the project has made a significant impact on the ways in which local health services are planned and delivered.

The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.

A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.

Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations

The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.

The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.

Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

Almost all libraries collect fiction. Of course the nature, scope, and organization of the collection varies with the type of library and its clientele. In this column scholars, fans, and just plain readers of diverse fiction formats, types, and genres will explore their specialty with a view to the collection building needs of various types of libraries. In addition to lists of “good reads,” authors not to be missed, rising stars, and rediscovered geniuses, columnists will cover major critics, bibliographies, relevant journals and organizations, publishers, and trends. Each column will include a genre overview, a discussion of access to published works, and a core collection of recommended books and authors. Janice M. Bogstad leads off with a discussion of science fiction. In the next issue of Collection Building, Ian will focus her discussion on the growing body of feminist science fiction with an article entitled, “Redressing an Interval Balance: Women and Science Fiction, 1965–1983.” Issues to follow will feature Kathleen Heim on thrillers, and Rhea Rubin reviewing short story collection building. Should you care to suggest an area or aspect of fiction collection building for discussion or try your hand as a columnist contact the column editor through Neal‐Schuman Publishers.

The purpose of this paper is to investigate the emergence and endurance of the Institute of Chartered Accountants in Ireland (ICAI) as an all‐Ireland body formed in the context of political and religious upheaval. It seeks to explore the motives for the north‐south accounting alliance and the strategies adopted by the institute to negotiate the destructive and divisive forces of the wider socio‐political environment.

A multitude of archival material is used to reconstruct the post‐formation activities of the ICAI. Sources were drawn from: the ICAI archive in Dublin: Minute Books 1 and 2 covering the period from 1888 to 1921, Annual Reports, 1888‐1922; minute books of other contemporary English accountancy bodies; contemporary professional press and census records stored at the National Library of Ireland in Dublin and the Public Records Office of Northern Ireland in Belfast.

The early ICAI was an overwhelmingly Protestant/Unionist dominated body seeking to maintain Protestant hegemony at a time when the power of this class was being gradually eroded. Cognizant of the likely vulnerability of such a body existing in the catholic‐nationalist south, and the need to strengthen such a position through a northern alliance, the ICAI from its inception was envisaged by its southern architects as an all Ireland institution. The fact that there were only a relatively small number of members acted as an inducement, particularly for Protestant members, to maintain unity.

The professionalization of accountancy in Ireland has been relatively under‐researched and the debates about the diffusion of the English professional model have virtually bypassed it.

Compiled by K.G.B. Bakewell covering the following journals published by MCB University Press: Facilities Volumes 8‐18; Journal of Property Investment & Finance Volumes 8‐18; Property Management Volumes 8‐18; Structural Survey Volumes 8‐18.

Index by subjects, compiled by K.G.B. Bakewell covering the following journals: Facilities Volumes 8‐18; Journal of Property Investment & Finance Volumes 8‐18; Property Management Volumes 8‐18; Structural Survey Volumes 8‐18.

Compiled by K.G.B. Bakewell covering the following journals published by MCB University Press: Facilities Volumes 8‐18; Journal of Property Investment & Finance Volumes 8‐18; Property Management Volumes 8‐18; Structural Survey Volumes 8‐18.