36 CFR 1012.2 - What is the Presidio Trust's policy on granting requests for employee testimony or Presidio Trust...

Science.gov (United States)

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What is the Presidio Trust's policy on granting requests for employee testimony or Presidio Trust records? 1012.2 Section 1012.2 Parks, Forests, and Public Property PRESIDIO TRUST LEGAL PROCESS: TESTIMONY BY EMPLOYEES AND PRODUCTION OF RECORDS General Information § 1012.2 What...

Older Adults’ Perceptions of Supporting Factors of Trust in a Robot Care Provider

Directory of Open Access Journals (Sweden)

Rachel E. Stuck

2018-01-01

Full Text Available The older adult population is increasing worldwide, leading to an increased need for care providers. An insufficient number of professional caregivers will lead to a demand for robot care providers to mitigate this need. Trust is an essential element for older adults and robot care providers to work effectively. Trust is context dependent. Therefore, we need to understand what older adults would need to trust robot care providers, in this specific home-care context. This mixed methods study explored what older adults, who currently receive assistance from caregivers, perceive as supporting trust in robot care providers within four common home-care tasks: bathing, transferring, medication assistance, and household tasks. Older adults reported three main dimensions that support trust: professional skills, personal traits, and communication. Each of these had subthemes including those identified in prior human-robot trust literature such as ability, reliability, and safety. In addition, new dimensions perceived to impact trust emerged such as the robot’s benevolence, the material of the robot, and the companionability of the robot. The results from this study demonstrate that the older adult-robot care provider context has unique dimensions related to trust that should be considered when designing robots for home-care tasks.

Can trust in politicians explain individuals' support for climate policy? The case of CO2 tax

International Nuclear Information System (INIS)

Hammar, Henrik; Jagers, Sverker C.

2006-01-01

This article provides an analysis of the support for public policies from a trust perspective. The empirical focus is on the use of a tax on carbon dioxide (CO 2 ), a policy tool aimed at coordinating national emissions targets in Sweden. Among economists and experts in the field of climate policy, a CO 2 tax is viewed as a cost-effective policy. The policy problem is that public support for CO 2 taxes is very low, leaving policy makers with high-cost options. Apart from traditional explanatory variables such as demographic factors, level of education, ideology and self-interest, what can explain this public opposition? Using individual level data, we analyse whether support for increases in the CO 2 tax on gasoline can be explained by citizens' generalized trust in other individuals (who they do not necessarily know) or by their trust in politicians. We find that only the latter measure gains support in a regression analysis. Moreover, when splitting the sample into high-trusting and low-trusting individuals, we find that high-trusting individuals who have access to a car (compared with those without access) are statistically no more likely to resist increases in CO 2 taxes than people without access to a car. Rather, it is individuals with access to a car and who do not trust their politicians who are likely to resist CO 2 taxes. (Author)

Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals.

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Erasmus, Ermin; Gilson, Lucy; Govender, Veloshnee; Nkosi, Moremi

2017-09-15

organisational culture and trust, which are key aspects of the organisational context that can profoundly influence policies. In addition to implementation "hardware" such as putting in place necessary staff and resources, it emphasises "software" implementation tasks such as relationship management and the negotiation of values, where equity-oriented policies might be interpreted as challenging health workers' status and values, and paying careful attention to how policies are practically framed and translated into practice, to ensure key equity aspects are not neglected.

Transforming dementia care in an NHS trust.

Science.gov (United States)

Robinson, Jennifer; Longden, Jane; Murphy, Jayne

2015-02-01

Walsall Healthcare NHS Trust was one of nine trusts selected to take part in the RCN development programme transforming dementia care in hospitals during 2013. The programme aimed to improve the experience of care for people with dementia and their carers in hospital. This article outlines a two-day training programme delivered to staff on two pilot wards with a larger cohort of adults with dementia than other wards in Manor Hospital. A range of staff were trained including nurses, clinical support workers and allied health professionals and also, in a bespoke format, housekeepers, porters and security staff. The programme has led to a noticeable cultural change and significantly improved care and management of patients with cognitive impairment and/or dementia on the two pilot wards. As a result, the training programme has been implemented more widely across the hospital.

Establishing contact and gaining trust : an exploratory study of care avoidance

NARCIS (Netherlands)

Schout, Gert; de Jong, Gideon; Zeelen, Jacques

Title. Establishing contact and gaining trust: an exploratory study of care avoidance. Aim. This paper is a report of a study conducted to explore the competencies especially deep-rooted personal qualities - of care providers who succeed in making contact and gaining trust with clients who are

Analyzing mass perceptions of nuclear politics: Puzzling over trust

International Nuclear Information System (INIS)

Jenkins-Smith, H.C.; Pratt, D.A.; Bassett, G.W. Jr.

1994-01-01

The juxtaposition of public values, trust, and beliefs is at the core of policy-making in democratic political systems, and an accurate understanding of nuclear politics requires that researchers untangle and carefully think about the web of psychological and social influences that shape citizens' preferences. In this paper, we offer some tentative answers about several pieces of the trust open-quotes puzzleclose quotes. First, we reconsider what is meant by open-quotes trustclose quotes and how it is to be measured. We then use telephone survey data to explore the relationship between trust and citizens' nuclear policy preferences. The data lend support to the conclusion that trust is more mutable than previous research has shown, and besides the traditional measure of competence includes aspects of believability and fiduciary competence. The data further indicate that it is a mistake to think in terms of a single open-quotes publicclose quotes when exploring the link between trust and nuclear policies. A number of dissimilar open-quotes publicsclose quotes based on shared open-quotes worldviewsclose quotes or political cultures are apparent in the data analyzed here. These open-quotes publicsclose quotes appear to think about trust differently from one another and rely on different dimensions of trust when determining nuclear policy preferences. Policy-makers must recognize the different open-quotes publicsclose quotes coexisting within the U.S. nuclear policy arena, and the relative import that these publics place on different dimensions of trust

Understanding Older Adult's Perceptions of Factors that Support Trust in Human and Robot Care Providers.

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Stuck, Rachel E; Rogers, Wendy A

2017-06-01

As the population of older adults increase so will the need for care providers, both human and robot. Trust is a key aspect to establish and maintain a successful older adult-care provider relationship. However, due to trust volatility it is essential to understand it within specific contexts. This proposed mixed methods study will explore what dimensions of trust emerge as important within the human-human and human-robot dyads in older adults and care providers. First, this study will help identify key qualities that support trust in a care provider relationship. By understanding what older adults perceive as needing to trust humans and robots for various care tasks, we can begin to provide recommendations based on user expectations for design to support trust.

25 CFR 1200.3 - What is the Department's policy on tribal management of trust funds?

Science.gov (United States)

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false What is the Department's policy on tribal management of..., DEPARTMENT OF THE INTERIOR AMERICAN INDIAN TRUST FUND MANAGEMENT REFORM ACT General Provisions § 1200.3 What is the Department's policy on tribal management of trust funds? (a) We will give tribes as much...

Demographic indicators of trust in federal, state and local government: implications for Australian health policy makers.

Science.gov (United States)

Meyer, Samantha B; Mamerow, Loreen; Taylor, Anne W; Henderson, Julie; Ward, Paul R; Coveney, John

2013-02-01

To provide baseline findings regarding Australians' trust in federal, state and local government. A computer-assisted telephone interviewing (CATI) survey was administrated during October to December 2009 to a random sample (n=1109) across Australia (response rate 41.2%). Binary logistic regression analyses were carried out by means of SPSS. Age, household size, household income, IRSD and ARIA were found to be significant indicators for trust in federal, state and local government. Trust in state government is lower for older respondents and respondents living in inner and outer regional areas. Trust in local council is lower in respondents living in inner regional areas, respondents living in disadvantaged areas, and respondents in the income bracket of $60001 to $100000. Trust in federal government is lower for older respondents and respondents living in disadvantaged areas. Of note is diminished trust in government among older, regional and lower income ($30001-$60000) respondents. Trust in all levels of government was found to be the lowest in population groups that are identified by empirical research and media to have the poorest access to government services. As a consequence, improved access to services for these populations may increase trust in health policy. Increased trust in health governance may in turn, ensure effective dissemination and implementation of health policies and that existing inequities are not perpetuated through distrust of health information and policy initiatives.

Development and testing of the Multidimensional Trust in Health Care Systems Scale.

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Egede, Leonard E; Ellis, Charles

2008-06-01

To describe the development and psychometric testing of the Multidimensional Trust in Health Care Systems Scale (MTHCSS). Scale development occurred in 2 phases. In phase 1, a pilot instrument with 70 items was generated from the review of the trust literature, focus groups, and expert opinion. The 70 items were pilot tested in a sample of 256 students. Exploratory factor analysis was used to derive an orthogonal set of correlated factors. In phase 2, the final scale was administered to 301 primary care patients to assess reliability and validity. Phase 2 participants also completed validated measures of patient-centered care, health locus of control, medication nonadherence, social support, and patient satisfaction. In phase 1, a 17-item scale (MTHCSS) was developed with 10 items measuring trust in health care providers, 4 items measuring trust in health care payers, and 3 items measuring trust in health care institutions. In phase 2, the 17-item MTHCSS had a mean score of 63.0 (SD 8.8); the provider subscale had a mean of 40.0 (SD 6.2); the payers subscale had a mean of 12.8 (SD 3.0); and the institutions subscale had a mean of 10.3 (SD 2.1). Cronbach's alpha for the MTHCSS was 0.89 and 0.92, 0.74, and 0.64 for the 3 subscales. The MTHCSS was significantly correlated with patient-centered care (r = .22 to .62), locus of control-chance (r = .42), medication nonadherence (r = -.22), social support (r = .25), and patient satisfaction (r = .67). The MTHCSS is a valid and reliable instrument for measuring the 3 objects of trust in health care and is correlated with patient-level health outcomes.

Public trust in Dutch health care.

NARCIS (Netherlands)

Straten, G.F.M.; Friele, R.D.; Groenewegen, P.P.

2002-01-01

This article describes the development of a valid and reliable instrument to measure different dimensions of public trust in health care in the Netherlands. This instrument is needed because the concept was not well developed, or operationalized in earlier research. The new instrument will be used

Can trust in politicians explain individuals' support for climate policy? The case of CO{sub 2} tax

Energy Technology Data Exchange (ETDEWEB)

Hammar, Henrik [Goeteborg Univ., Dept. of Economics, Goeteborg (Sweden); National Inst. of Economic Research (NIER), Stockholm (Sweden); Jagers, Sverker C. [Goeteborg Univ., Dept. of Polital Science, Goeteborg (Sweden)

2006-07-01

This article provides an analysis of the support for public policies from a trust perspective. The empirical focus is on the use of a tax on carbon dioxide (CO{sub 2}), a policy tool aimed at coordinating national emissions targets in Sweden. Among economists and experts in the field of climate policy, a CO{sub 2} tax is viewed as a cost-effective policy. The policy problem is that public support for CO{sub 2} taxes is very low, leaving policy makers with high-cost options. Apart from traditional explanatory variables such as demographic factors, level of education, ideology and self-interest, what can explain this public opposition? Using individual level data, we analyse whether support for increases in the CO{sub 2} tax on gasoline can be explained by citizens' generalized trust in other individuals (who they do not necessarily know) or by their trust in politicians. We find that only the latter measure gains support in a regression analysis. Moreover, when splitting the sample into high-trusting and low-trusting individuals, we find that high-trusting individuals who have access to a car (compared with those without access) are statistically no more likely to resist increases in CO{sub 2} taxes than people without access to a car. Rather, it is individuals with access to a car and who do not trust their politicians who are likely to resist CO{sub 2} taxes. (Author)

Application of the Reina Trust and Betrayal Model to the experience of pediatric critical care clinicians.

Science.gov (United States)

Rushton, Cynda Hylton; Reina, Michelle L; Francovich, Christopher; Naumann, Phyllis; Reina, Dennis S

2010-07-01

Trust is essential in the workplace, yet no systematic studies of trust among pediatric critical care professionals have been done. To determine the feasibility of measuring trust in a pediatric intensive care unit by using established scales from the corporate world and to determine what behaviors build, break, and rebuild trust. The Reina Trust and Betrayal Model was used to explore contractual, competence, and communication trust. Nurses and physicians in a pediatric intensive care unit completed online surveys to measure organizational, team, and patient trust. Quantitative data from 3 standard survey instruments and qualitative responses to 3 open-ended questions were analyzed and compared. Quantitative data from all 3 instruments indicated moderate to high levels of trust; scores for competence and contractual trust were higher than scores for communication trust. Scores indicated agreement on behaviors that build trust, such as pointing out risky situations to each other, actively striving to build supportive and productive relationships, and giving and receiving constructive feedback. Foremost among trust-breaking behaviors was gossip, which was more troublesome to respondents with longer experience in critical care. Responses to the open-ended questions underscored these themes. The most frequently cited items included encouraging mutually serving intentions, sharing information, and involving and seeking the input of others. The Reina trust scales and open-ended questions are feasible and applicable to pediatric critical care units, and data collected with these instruments are useful in determining what behaviors build, break, and rebuild trust among staff.

Public Trust in Health Information Sharing: A Measure of System Trust.

Science.gov (United States)

Platt, Jodyn E; Jacobson, Peter D; Kardia, Sharon L R

2018-04-01

To measure public trust in a health information sharing in a broadly defined health system (system trust), inclusive of health care, public health, and research; to identify individual characteristics that predict system trust; and to consider these findings in the context of national health initiatives (e.g., learning health systems and precision medicine) that will expand the scope of data sharing. Survey data (n = 1,011) were collected in February 2014. We constructed a composite index of four dimensions of system trust-competency, fidelity, integrity, and trustworthiness. The index was used in linear regression evaluating demographic and psychosocial predictors of system trust. Data were collected by GfK Custom using a nationally representative sample and analyzed in Stata 13.0. Our findings suggest the public's trust may not meet the needs of health systems as they enter an era of expanded data sharing. We found that a majority of the U.S. public does not trust the organizations that have health information and share it (i.e., the health system) in one or more dimensions. Together, demographic and psychosocial factors accounted for ~18 percent of the observed variability in system trust. Future research should consider additional predictors of system trust such as knowledge, attitudes, and beliefs to inform policies and practices for health data sharing. © Health Research and Educational Trust.

Trust matters: A narrative literature review of the role of trust in health care systems in sub-Saharan Africa.

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Østergaard, Lise Rosendal

2015-10-01

This article makes a contribution to the debate about health service utilisation and the role of trust in fostering demand for health services in sub-Saharan Africa. It is framed as a narrative literature review based on a thematic analysis of nine empirical, qualitative studies. For the purposes of this article trust is defined as a voluntary course of action, which involves the optimistic expectation that the trustee will do no harm to the trustor and is increasingly perceived as an important influence on health system functioning. The article looks at trust issues in interpersonal, intergroup and institutional situations. The findings of the review point to four elements that are important for trust to develop in health sector relationships: the sensitive use of discretionary power by health workers, perceived empathy by patients of the health workers, the quality of medical care and workplace collegiality. When trust works in health sector encounters, it reduces the social complexity and inherent uneven distribution of power between clients and providers. The article concludes that understanding and supporting trust processes between patients and providers, as well as between co-workers and managers, will improve health sector collaboration and stimulate demand for health care services.

Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.

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Shan, Linghan; Li, Ye; Ding, Ding; Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

2016-01-01

Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The

A new methodology for cost-effectiveness studies of domestic radon remediation programmes: Quality-adjusted life-years gained within Primary Care Trusts in Central England

International Nuclear Information System (INIS)

Coskeran, Thomas; Denman, Antony; Phillips, Paul; Gillmore, Gavin; Tornberg, Roger

2006-01-01

Radon is a naturally occurring radioactive gas, high levels of which are associated with geological formations such as those found in Northamptonshire and North Oxfordshire in the UK. The UK's National Radiological Protection Board have designated both districts as radon Affected Areas. Radiation levels due to radon, therefore, exceed 200 Bq m -3 , the UK's domestic Action Level, in over one percent of domestic properties. Because of radon's radioactivity, exposure to the gas can potentially cause lung cancer, and has been linked to some 2000 deaths a year in the UK. Consequently, when radiation levels exceed the Action Level, remediation against radon's effects is recommended to householders. This study examines the cost-effectiveness of remediation measures in Northamptonshire and North Oxfordshire by estimating cost per quality-adjusted life-year gained in four Primary Care Trusts, organisations that play a key public health policy role in the UK's National Health Service. The study is the first to apply this approach to estimating the cost-effectiveness of radon remediation programmes. Central estimates of cost per quality-adjusted life-year in the four Primary Care Trusts range from Pounds 6143 to Pounds 10 323. These values, when assessed against generally accepted criteria, suggest the remediation programmes in the trusts were cost-effective. Policy suggestions based on the estimates, and designed to improve cost-effectiveness further, are proposed for the four Primary Care Trusts and the UK's National Health Service

How trust and emotions influence policy acceptance: The case of the Irish water charges.

Science.gov (United States)

Rodriguez-Sanchez, Carla; Schuitema, Geertje; Claudy, Marius; Sancho-Esper, Franco

2018-02-01

The introduction of new policies can evoke strong emotional reactions by the public. Yet, social-psychological research has paid little attention to affective determinants of individual-level policy acceptance. Building on recent theoretical and empirical advances around emotions and decision-making, we evaluate how people's trust and integral emotions function as important antecedents of cognitive evaluations, and subsequent acceptance of policies. We test our hypotheses within a sample of Irish citizens (n = 505), who were subject to the introduction of water charges in 2015. In line with our hypotheses, results show that general trust in government shapes emotions regarding water charges, which in turn, directly and via expected costs and benefits, influence policy acceptance. Additionally, we find that negative emotions have a larger direct effect on policy acceptance than positive emotions. Specifically, 'anger' was the main negative emotion that influenced the acceptance of the water charge. We conclude by discussing directions for future research around emotions and policy acceptance. © 2018 The British Psychological Society.

Healthcare staff attitudes towards the use of electronic cigarettes ('e-cigarettes') compared with a local trust policy.

Science.gov (United States)

Pippard, Benjamin J; Shipley, Mark D

2017-07-01

E-cigarette use has risen dramatically in recent years, despite uncertainty over long-term health effects and concerns regarding efficacy as a smoking cessation device. Currently, there is no legislation prohibiting use in public, though many trusts have extended the NHS Smokefree policy to include e-cigarettes. The successful implementation of such policy is, however, unclear. This study examined staff attitudes towards the use of e-cigarettes in a hospital environment with respect to enforcement of a local trust smoking policy. A total of 79 healthcare professionals working at South Tyneside District Hospital, South Shields, completed a written questionnaire regarding use of e-cigarettes, particularly views on use in public and on hospital premises. Factors influencing the likelihood of individuals to challenge the use of e-cigarettes were assessed. In all, 45% of respondents thought that e-cigarettes should be allowed in public places, though a majority (62%) favoured use on hospital grounds compared to within hospital buildings (18%). Over 50% of respondents were unaware of trust policy relating to e-cigarettes and only 25% had ever challenged someone using a device. Roughly, one-third reported that they would still not challenge someone in future, despite being informed of trust policy. Fear of abuse was the most cited reason for not challenging. Expressed concerns of e-cigarette use related to fire risk, 'normalising' smoking behaviour and uncertainty of long-term effects. Most staff do not enforce trust policy regarding e-cigarette use. This reflects variation in opinion over use, poor awareness of the policy itself and perceived barriers to implementation, including fear of abuse. Addressing these issues through staff education sessions may help successful future implementation.

Trust information-based privacy architecture for ubiquitous health.

Science.gov (United States)

Ruotsalainen, Pekka Sakari; Blobel, Bernd; Seppälä, Antto; Nykänen, Pirkko

2013-10-08

Ubiquitous health is defined as a dynamic network of interconnected systems that offers health services independent of time and location to a data subject (DS). The network takes place in open and unsecure information space. It is created and managed by the DS who sets rules that regulate the way personal health information is collected and used. Compared to health care, it is impossible in ubiquitous health to assume the existence of a priori trust between the DS and service providers and to produce privacy using static security services. In ubiquitous health features, business goals and regulations systems followed often remain unknown. Furthermore, health care-specific regulations do not rule the ways health data is processed and shared. To be successful, ubiquitous health requires novel privacy architecture. The goal of this study was to develop a privacy management architecture that helps the DS to create and dynamically manage the network and to maintain information privacy. The architecture should enable the DS to dynamically define service and system-specific rules that regulate the way subject data is processed. The architecture should provide to the DS reliable trust information about systems and assist in the formulation of privacy policies. Furthermore, the architecture should give feedback upon how systems follow the policies of DS and offer protection against privacy and trust threats existing in ubiquitous environments. A sequential method that combines methodologies used in system theory, systems engineering, requirement analysis, and system design was used in the study. In the first phase, principles, trust and privacy models, and viewpoints were selected. Thereafter, functional requirements and services were developed on the basis of a careful analysis of existing research published in journals and conference proceedings. Based on principles, models, and requirements, architectural components and their interconnections were developed using system

Incomplete Markets and Imperfect Institutions: Some Challenges Posed by Trust for Contemporary Health Care and Health Policy.

Science.gov (United States)

Schlesinger, Mark; Gray, Bradford H

2016-08-01

As contemporary health policy promotes evidence-based practices using targeted incentives, policy makers may lose track of vital aspects of care that are difficult to measure. For more than a half century, scholars have recognized that these latter aspects play a crucial role in high-quality care and equitable health system performance but depend on the potentially frail reed of providers' trustworthiness: that is, their commitment to facets and outcomes of care not easily assessed by external parties. More recently, early experience with pay for performance in health settings suggests that enhancing financial rewards for the measurable undermines providers' commitment to the unmeasurable, degrading the trustworthiness of their practices. Reformers have looked to revised professional norms or reorganized practice arrangements to bolster the intrinsic motivations required for trustworthiness. We suggest here that these responses are likely to prove inadequate. We propose that they be complemented by a renewed policy-making commitment to nonprofit ownership among health care providers, insurers, and integrated delivery systems. We identify some of the concerns raised in the past with ownership-based policies and propose a set of responses. If these are pursued in combination, they hold the promise of a sustainable ownership-based policy reform for the United States. Copyright © 2016 by Duke University Press.

Is whistleblowing now mandatory? The impact of mandatory reporting law on trust relationships in health care.

Science.gov (United States)

Hewitt, Jayne

2013-09-01

Trust is vital for promoting positive health care relationships aimed at achieving positive patient outcomes. Patients, as well as the broader society, trust that health care practitioners who have been granted authority by the state to provide safe and beneficial health care are competent to do so. Recent instances where patients have been harmed as the result of treatment that fell below the accepted standard of competence have negatively impacted on trust. As the state has a responsibility to protect the public from this type of harm, legislation that mandates reporting of certain instances where the behaviour of health care professionals has fallen below the acceptable standard has been introduced. While this may have been designed to restore public trust, this article argues that it has the potential to diminish trust on the basis that mandatory reporting may be equivalent to mandatory whistleblowing.

[Personalized nursing care in hospital and its effects on the patient-nurse trust relationship].

Science.gov (United States)

García-Juárez, María del Rosario; López-Alonso, Sergio R; Moreno-Verdugo, Ana; Guerra-González, Sara; Fernández-Corchero, Juana; Márquez-Borrego, M José; Orozco-Cózar, M José; Ramos-Bosquet, Gádor

2013-01-01

To determine the level of implementation of an inpatient personalized nursing care model in four hospitals of the Andalusian Health Service, and to determine if there is an association between this model and the perception of trust in the nurse by the patient. An observational cross-sectional study included the patients discharged during a period of 12 months from hospital wards that used the Inpatient Personalized Nursing Care Model of the Andalusian Health Service (based on Primary Nursing Model). The level of implemention was evaluated using the Nursing Care Personalized Index (IPC), made by «patient report» methodology, and the nurse-patient trust relationship was evaluated at the same time as the IPC. Statistical analysis included descriptive data analysis, Chi-squared test, and bivariate and multivariate logistic regression, with and without stratifying by hospitals wards. A total of 817 patient were included. The implementation of the inpatient personalized nursing care model varied between 61 and 79%. The IPC values showed a strong association with the nurse-patient trust relationship, and that for each point increase in the IPC score, the probability of a nurse-patient trust relationship increased between 50 and 130% (0.120.58). The implementation of a personalized nursing care model in the wards studied was higher in the surgicals wards and at regular level in medical wards. Furthermore, the influence of the inpatient personalized nursing care model on the nurse-patient trust relationship has been demonstrated using the IPC model. This trust is the main component for the establishment of a therapeutic relationship. Copyright © 2013 Elsevier España, S.L. All rights reserved.

The Effects of Advertising Strategies on Consumer Trust: A Case of Skin Care Products in Taiwan

Directory of Open Access Journals (Sweden)

Velly Anatasia

2016-09-01

Full Text Available The main aim of this study was to develop advertising strategies in order to increase consumer trust. Four advertising elements: celebrity endorsement, branding, product attribute, and third party certification were investigated. Data were collected to answer two research questions: (1 To investigate the advertising strategies of skin care products leading to consumer trust, (2 To know the effects of advertising strategies in skin care products on consumer trust. A 5-point Likert scale survey was distributed to the female population in Taipei area. Via online and personal approaches, 266 questionnaires were returned. Targeting on 18-30 years old female skin care product users who stay in Taipei area more than six months, 240 qualified questionnaires were analyzed. The four independent variables are found having a significant relationship with trust in skin care advertising, in which branding has the greatest influence on increasing consumer trust. The control variable which is financial status is not found having statistically significant effect on consumer trust. To conclude, this study is dedicated to the communities in order to optimize their marketing strategies.

People's responses to risks of electromagnetic fields and trust in government policy: the role of perceived risk, benefits and control

NARCIS (Netherlands)

Dongen, D.; Claassen, L.; Smid, T.; Timmermans, D.R.M.

2013-01-01

Trust in government policy affects the way people perceive and handle risks. In our study, we investigated the relationships between trust in government policy regarding electromagnetic fields (EMF), perceived risk and perceived benefits of public and personal EMF sources, perceived control over

Authentic leadership and organisational citizenship behaviour in the public health care sector: The role of workplace trust

Directory of Open Access Journals (Sweden)

Lynelle Coxen

2016-10-01

Full Text Available Orientation: The orientation of this study was towards authentic leadership and its influence on workplace trust and organisational citizenship behaviour in the public health care sector. Research purpose: The aim of this study was to investigate the influence of authentic leadership on organisational citizenship behaviour, through workplace trust among public health care employees in South Africa. The objective was to determine whether authentic leadership affects organisational citizenship behaviour through workplace trust (conceptualised as trust in the organisation, immediate supervisor and co-workers. Motivation for the study: Employees in the public health care industry are currently being faced with a demanding work environment which includes a lack of trust in leadership. This necessitated the need to determine whether authentic leadership ultimately leads to extra-role behaviours via workplace trust in its three referents. Research design, approach and method: A quantitative cross-sectional survey design was used with employees the public health care sector in South Africa (N = 633. The Authentic Leadership Inventory, Workplace Trust Survey and Organisational Citizenship Behaviour Scale were administered to these participants. Main findings: The results indicated that authentic leadership has a significant influence on trust in all three referents, namely the organisation, the supervisor and co-workers. Both trust in the organisation and trust in co-workers positively influenced organisational citizenship behaviour. Conversely, authentic leadership did not have a significant influence on organisational citizenship behaviour. Finally, authentic leadership had a significant indirect effect on organisational citizenship behaviour through trust in the organisation and trust in co-workers. Trust in the organisation was found to have the strongest indirect effect on the relationship between authentic leadership and organisational citizenship

Can consumer choice replace trust in the National Health Service in England? Towards developing an affective psychosocial conception of trust in health care.

Science.gov (United States)

Fotaki, Marianna

2014-11-01

Trust has long been regarded as a vitally important aspect of the relationship between health service providers and patients. Recently, consumer choice has been increasingly advocated as a means of improving the quality and effectiveness of health service provision. However, it is uncertain how the increase of information necessary to allow users of health services to exercise choice, and the simultaneous introduction of markets in public health systems, will affect various dimensions of trust, and how changing relations of trust will impact upon patients and services. This article employs a theory-driven approach to investigate conceptual and material links between choice, trust and markets in health care in the context of the National Health Service in England. It also examines the implications of patient choice on systemic, organisational and interpersonal trust. The article is divided into two parts. The first argues that the shift to marketisation in public health services might lead to an over-reliance on rational-calculative aspects of trust at the expense of embodied, relational and social attributes. The second develops an alternative psychosocial conception of trust: it focuses on the central role of affect and accounts for the material and symbolic links between choice, trust and markets in health care. © 2014 The Author. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Trust in physicians and racial disparities in HIV care.

Science.gov (United States)

Saha, Somnath; Jacobs, Elizabeth A; Moore, Richard D; Beach, Mary Catherine

2010-07-01

Mistrust among African Americans is often considered a potential source of racial disparities in HIV care. We sought to determine whether greater trust in one's provider among African-American patients mitigates racial disparities. We analyzed data from 1,104 African-American and 201 white patients participating in a cohort study at an urban, academic HIV clinic between 2005 and 2008. African Americans expressed lower levels of trust in their providers than did white patients (8.9 vs. 9.4 on a 0-10 scale; p African Americans were also less likely than whites to be receiving antiretroviral therapy (ART) when eligible (85% vs. 92%; p = 0.02), to report complete ART adherence over the prior 3 days (83% vs. 89%; p = 0.005), and to have a suppressed viral load (40% vs. 47%; p = 0.04). Trust in one's provider was not associated with receiving ART or with viral suppression but was significantly associated with adherence. African Americans who expressed less than complete trust in their providers (0-9 of 10) had lower ART adherence than did whites (adjusted OR, 0.40; 95% CI, 0.25-0.66). For African Americans who expressed complete trust in their providers (10 of 10), the racial disparity in adherence was less prominent but still substantial (adjusted OR, 0.59; 95% CI, 0.36-0.95). Trust did not affect disparities in receipt of ART or viral suppression. Our findings suggest that enhancing trust in patient-provider relationships for African-American patients may help reduce disparities in ART adherence and the outcomes associated with improved adherence.

Antibiotic policies in acute English NHS trusts: implementation of 'Start Smart-Then Focus' and relationship with Clostridium difficile infection rates.

Science.gov (United States)

Llewelyn, Martin J; Hand, Kieran; Hopkins, Susan; Walker, A Sarah

2015-04-01

The objective of this study was to establish how antibiotic prescribing policies at National Health Service (NHS) hospitals match the England Department of Health 'Start Smart-Then Focus' recommendations and relate to Clostridium difficile infection (CDI) rates. Antibiotic pharmacists were surveyed regarding recommendations for empirical treatment of common syndromes ('Start Smart') and antimicrobial prescription reviews ('Focus') at their hospital trusts. If no response was provided, policy data were sought from trust websites and the MicroGuide app (Horizon Strategic Partners, UK). Empirical treatment recommendations were categorized as broad spectrum (a β-lactam penicillin/β-lactamase inhibitor, cephalosporin, quinolone or carbapenem) or narrow spectrum. CDI rates were gathered from the national mandatory surveillance system. Data were obtained for 105/145 English acute hospital trusts (72%). β-Lactam/β-lactamase inhibitor combinations were recommended extensively. Only for severe community-acquired pneumonia and pyelonephritis were narrow-spectrum agents recommended first line at a substantial number of trusts [42/105 (40%) and 50/105 (48%), respectively]. Policies commonly recommended dual therapy with aminoglycosides and β-lactams for abdominal sepsis [40/93 trusts (43%)] and undifferentiated severe sepsis [54/94 trusts (57%)]. Most policies recommended treating for ≥ 7 days for most indications. Nearly all policies [100/105 trusts (95%)] recommended antimicrobial prescription reviews, but only 46/96 respondents (48%) reported monitoring compliance. Independent predictors of higher CDI rates were recommending a broad-spectrum regimen for community-acquired pneumonia (P=0.06) and, counterintuitively, a recommended treatment duration of Smart' by recommending broad-spectrum antibiotics for empirical therapy, but this may have the unintended potential to increase the use of broad-spectrum antibiotics and risk of CDI unless better mechanisms are in place

The association between trust in health care providers and medication adherence among Black women with hypertension

Directory of Open Access Journals (Sweden)

Willie M. Abel

2013-12-01

Full Text Available Background: Black women have the highest prevalence of hypertension in the world. Reasons for this disparity are poorly understood. The historical legacy of medical maltreatment of Blacks in the U.S. provides some insight into distrust in the medical profession, refusal of treatment, and poor adherence to treatment regimens.Methods: Black women (N=80 who were prescribed antihypertensive medications were recruited from urban communities in North Carolina. Study participants completed the Trust in Physician and Hill-Bone Compliance to High Blood Pressure Therapy questionnaires. An exact discrete-event model was used to examine the relationship between trust and medication adherence.Results: Mean age of study participants was 48 ± 9.2 years. The majority of participants (67% were actively employed and 30% had incomes at or below the federal poverty level. Increasing levels of trust in the health care provider was independently associated with greater medication adherence (PTrend=0.015.Conclusions: Black women with hypertension who trusted their health care providers were more likely to be adherent with their prescribed antihypertensive medications than those who did not trust their health care providers. Findings suggest that trusting relationships between Black women and health care providers are important to decreasing disparate rates of hypertension.

Public trust in health care: a comparison of Germany, the Netherlands, and England and Wales.

NARCIS (Netherlands)

Schee, E. van der; Braun, B.; Calnan, M.; Schnee, M.; Groenewegen, P.

2003-01-01

Aim: To describe and analyse public trust in health care in three European countries Background: Public trust in the social institutions of modern societies is important for the smooth functioning of society. Data on public trust are regularly collected in the EU for some institutional fields, such

The Effects of Advertising Strategies on Consumer Trust: A Case of Skin Care Products in Taiwan

OpenAIRE

Velly Anatasia; Sunitarya Sunitarya; Vinda Adriana

2016-01-01

The main aim of this study was to develop advertising strategies in order to increase consumer trust. Four advertising elements, celebrity endorsement, branding, product attribute, and third party certification, were investigated in this study. Data were collected to answer two research questions: (1) To investigate the advertising strategies of skin care products leading to consumer trust, (2) To know the effects of advertising strategies in skin care products on consumer trust. A 5-point Li...

Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system.

Science.gov (United States)

Grande, David; Shea, Judy A; Armstrong, Katrina

2012-03-01

Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system. To measure patient perceptions about the prevalence of industry gifts and their relationship to trust in doctors and the health care system. Cross sectional random digit dial telephone survey. African-American and White adults in 40 large metropolitan areas. Respondents' beliefs about whether their physician and physicians in general receive industry gifts, physician trust, and health care system distrust. Overall, 55% of respondents believe their physician receives gifts, and 34% believe almost all doctors receive gifts. Respondents of higher socioeconomic status (income, education) and younger age were more likely to believe their physician receives gifts. In multivariate analyses, those that believe their personal physician receives gifts were more likely to report low physician trust (OR 2.26, 95% CI 1.56-3.30) and high health care system distrust (OR 2.03, 95% CI 1.49-2.77). Similarly, those that believe almost all doctors accept gifts were more likely to report low physician trust (OR 1.69, 95% CI 1.25-2.29) and high health care system distrust (OR 2.57, 95% CI 1.82-3.62). Patients perceive physician-industry gift relationships as common. Patients that believe gift relationships exist report lower levels of physician trust and higher rates of health care system distrust. Greater efforts to limit industry-physician gifts could have positive effects beyond reducing influences on physician behavior.

The biometric imaginary: (Dis)trust in a policy vacuum.

Science.gov (United States)

Gunnarsdóttir, Kristrún; Rommetveit, Kjetil

2017-02-01

The decision in Europe to implement biometric passports, visas and residence permits was made at the highest levels without much consultation, checks and balances. Council regulation came into force relatively unnoticed in January 2005, as part of wider securitization policies urging systems interoperability and data sharing across borders. This article examines the biometric imaginary that characterizes this European Union decision, dictated by executive powers in the policy vacuum after 9/11 - a depiction of mobility governance, technological necessity and whom/what to trust or distrust, calling upon phantom publics to justify decisions rather than test their grounding. We consult an online blog we operated in 2010 to unravel this imaginary years on. Drawing on Dewey's problem of the public, we discuss this temporary opening of a public space in which the imaginary could be reframed and contested, and how such activities may shape, if at all, relations between politics, publics, policy intervention and societal development.

Public Trust in Health Information Sharing: Implications for Biobanking and Electronic Health Record Systems

Directory of Open Access Journals (Sweden)

Jodyn Platt

2015-02-01

Full Text Available Biobanks are made all the more valuable when the biological samples they hold can be linked to health information collected in research, electronic health records, or public health practice. Public trust in such systems that share health information for research and health care practice is understudied. Our research examines characteristics of the general public that predict trust in a health system that includes researchers, health care providers, insurance companies and public health departments. We created a 119-item survey of predictors and attributes of system trust and fielded it using Amazon’s MTurk system (n = 447. We found that seeing one’s primary care provider, having a favorable view of data sharing and believing that data sharing will improve the quality of health care, as well as psychosocial factors (altruism and generalized trust were positively and significantly associated with system trust. As expected, privacy concern, but counterintuitively, knowledge about health information sharing were negatively associated with system trust. We conclude that, in order to assure the public’s trust, policy makers charged with setting best practices for governance of biobanks and access to electronic health records should leverage critical access points to engage a diverse public in joint decision making.

Work-related change in residential elderly care: Trust, space and connectedness.

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van der Borg, Wieke E; Verdonk, Petra; Dauwerse, Linda; Abma, Tineke A

2017-07-01

Increasing care needs and a declining workforce put pressure on the quality and continuity of long-term elderly care. The need to attract and retain a solid workforce is increasingly acknowledged. This study reports about a change initiative that aimed to improve the quality of care and working life in residential elderly care. The research focus is on understanding the process of workforce change and development, by retrospectively exploring the experiences of care professionals. A responsive evaluation was conducted at a nursing home department in the Netherlands one year after participating in the change program. Data were gathered by participant observations, interviews and a focus and dialogue group. A thematic analysis was conducted. Care professionals reported changes in workplace climate and interpersonal interactions. We identified trust, space and connectedness as important concepts to understand perceived change. Findings suggest that the interplay between trust and space fostered interpersonal connectedness. Connectedness improved the quality of relationships, contributing to the well-being of the workforce. We consider the nature and contradictions within the process of change, and discuss how gained insights help to improve quality of working life in residential elderly care and how this may reflect in the quality of care provision.

The Effectiveness of Health Care Information Technologies: Evaluation of Trust, Security Beliefs, and Privacy as Determinants of Health Care Outcomes

Science.gov (United States)

2018-01-01

Background The diffusion of health information technologies (HITs) within the health care sector continues to grow. However, there is no theory explaining how success of HITs influences patient care outcomes. With the increase in data breaches, HITs’ success now hinges on the effectiveness of data protection solutions. Still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance. Objective The objective of this study was to study the effectiveness of HITs using the DeLone and McLean Information Systems Success Model (DMISSM). We examined the role of information assurance constructs (ie, the role of information security beliefs, privacy concerns, and trust in health information) as measures of HIT effectiveness. We also investigated the relationships between information assurance and three aspects of system success: attitude toward health information exchange (HIE), patient access to health records, and perceived patient care quality. Methods Using structural equation modeling, we analyzed the data from a sample of 3677 cancer patients from a public dataset. We used R software (R Project for Statistical Computing) and the Lavaan package to test the hypothesized relationships. Results Our extension of the DMISSM to health care was supported. We found that increased privacy concerns reduce the frequency of patient access to health records use, positive attitudes toward HIE, and perceptions of patient care quality. Also, belief in the effectiveness of information security increases the frequency of patient access to health records and positive attitude toward HIE. Trust in health information had a positive association with attitudes toward HIE and perceived patient care quality. Trust in health information had no direct effect on patient access to health records; however, it had an indirect relationship through privacy concerns. Conclusions Trust in health information and belief in the effectiveness of

The Effectiveness of Health Care Information Technologies: Evaluation of Trust, Security Beliefs, and Privacy as Determinants of Health Care Outcomes.

Science.gov (United States)

Kisekka, Victoria; Giboney, Justin Scott

2018-04-11

The diffusion of health information technologies (HITs) within the health care sector continues to grow. However, there is no theory explaining how success of HITs influences patient care outcomes. With the increase in data breaches, HITs' success now hinges on the effectiveness of data protection solutions. Still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance. The objective of this study was to study the effectiveness of HITs using the DeLone and McLean Information Systems Success Model (DMISSM). We examined the role of information assurance constructs (ie, the role of information security beliefs, privacy concerns, and trust in health information) as measures of HIT effectiveness. We also investigated the relationships between information assurance and three aspects of system success: attitude toward health information exchange (HIE), patient access to health records, and perceived patient care quality. Using structural equation modeling, we analyzed the data from a sample of 3677 cancer patients from a public dataset. We used R software (R Project for Statistical Computing) and the Lavaan package to test the hypothesized relationships. Our extension of the DMISSM to health care was supported. We found that increased privacy concerns reduce the frequency of patient access to health records use, positive attitudes toward HIE, and perceptions of patient care quality. Also, belief in the effectiveness of information security increases the frequency of patient access to health records and positive attitude toward HIE. Trust in health information had a positive association with attitudes toward HIE and perceived patient care quality. Trust in health information had no direct effect on patient access to health records; however, it had an indirect relationship through privacy concerns. Trust in health information and belief in the effectiveness of information security safeguards increases

Trust matters: Patients' and providers' accounts of the role of trust in ...

African Journals Online (AJOL)

Also, trust was considered as potentially contributing to trusted doctors' behaviour changes such as excessive self-pride, faking being busy and sluggishness in care provision as well as increasing their work load. Conclusion: The findings suggest that trust in patient-doctor relationship matters for hypertension care in rural ...

Does trust of patients in their physician predict loyalty to the health care insurer? The Israeli case study.

Science.gov (United States)

Gabay, Gillie

2016-01-01

This pioneer study tests the relationship between patients' trust in their physicians and patients' loyalty to their health care insurers. This is a cross-sectional study using a representative sample of patients from all health care insurers with identical health care plans. Regression analyses and Baron and Kenny's model were used to test the study model. Patient trust in the physician did not predict loyalty to the insurer. Loyalty to the physician did not mediate the relationship between trust in the physician and loyalty to the insurer. Satisfaction with the physician was the only predictor of loyalty to the insurer.

Trust in government and support for governmental regulation: the case of electronic health records.

Science.gov (United States)

Herian, Mitchel N; Shank, Nancy C; Abdel-Monem, Tarik L

2014-12-01

This paper presents results from a public engagement effort in Nebraska, USA, which measured public opinions about governmental involvement in encouraging the use of electronic health records (EHRs). We examine the role of trust in government in contributing to public support for government involvement in the development of EHR technologies. We hypothesize that trust in government will lead to support for federal and state governmental encouragement of the use of EHRs among doctors and insurance companies. Further, because individual experiences with health-care professionals will reduce perceptions of risk, we expect that support for governmental involvement will be tempered by greater personal experience with the health-care industry. Examining a small survey of individuals on the issue, we find general support for both of our hypotheses. The findings suggest that trust in government does have a positive relationship with support for government involvement in the policy domain, but that the frequency of personal experiences with health-care providers reduces the extent to which the public supports governmental involvement in the development of EHR technology. This inquiry contributes to our understanding of public attitudes towards government involvement in EHRs in the United States specifically and contributes to social science examining links between trust in government and support for governmental activity in the emerging policy domain regarding electronic health records systems. © 2012 John Wiley & Sons Ltd.

Building trust and confidence in laboratory ES and H policy and practices

Energy Technology Data Exchange (ETDEWEB)

Graf, J.

2000-08-01

This report describes a successful pilot event among LANL employees that can see as a model for employee involvement and community input. The conference was designed to begin building trust and confidence in Laboratory policy and practices in the area of Environment, Safety, and Health (ES and H). It represents a concrete step toward fostering better relationships among Lab employees and creating a new, innovative approach to communication that can also be used to build trust in the larger community. Based on the proven methods of the National Issues Forums and the Jefferson Center Citizen Jury Process, this conference enabled management to learn more about the thoughts and advice of LANL employees, During the course of the day, a random sample of Lab employees representing the LANL workforce learned about issues of health, safety and the environment, and some of the options available to increase trustworthiness in these areas. These Employee Advisors then discussed the options at some length and presented recommendations to senior Lab managers in the role of Decision Makers. At the end of the day, the participants offered their reflections and discussed what they learned during the conference, and Decision Makers responded to what they heard. The most common view expressed by the Employee Advisors was that a bottom-up approach was necessary to develop more relevant ES and H policies. They were unanimous in their desire for more employee inclusion into the decision making process. All Employee Advisors were in support of a Lab wide survey to determine employee concerns about ES and H issues. After listening to the deliberation, the Decision Makers responded with several commitments. The most significant was the pledge to meet with Employee Advisors by the end of February to discuss the status of their recommendations on ES and H policy and practices. The ensuing follow-up meeting explored employee concerns in greater depth resulting in forward-looking action steps

Predators and the public trust.

Science.gov (United States)

Treves, Adrian; Chapron, Guillaume; López-Bao, Jose V; Shoemaker, Chase; Goeckner, Apollonia R; Bruskotter, Jeremy T

2017-02-01

behavioural ecologies of humans and predators. The scientific community has not reached consensus on sustainable levels of human-caused mortality for many predator populations. This challenge includes both genuine conceptual uncertainty and exploitation of scientific debate for political gain. Second, human intolerance for predators exposes value conflicts about preferences for some wildlife over others and balancing majority rule with the protection of minorities in a democracy. We examine how differences between traditional assumptions and scientific studies of interactions between people and predators impede evidence-based policy. Even if the prior challenges can be overcome, well-reasoned policy on wild animals faces a greater challenge than other environmental assets because animals and humans change behaviour in response to each other in the short term. These coupled, dynamic responses exacerbate clashes between uses that deplete wildlife and uses that enhance or preserve wildlife. Viewed in this way, environmental assets demand sophisticated, careful accounting by disinterested trustees who can both understand the multidisciplinary scientific measurements of relative costs and benefits among competing uses, and justly balance the needs of all beneficiaries including future generations. Without public trust principles, future trustees will seldom prevail against narrow, powerful, and undemocratic interests. Without conservation informed by public trust thinking predator populations will face repeated cycles of eradication and recovery. Our conclusions have implications for the many subfields of the biological sciences that address environmental trust assets from the atmosphere to aquifers. © 2015 The Authors. Biological Reviews published by John Wiley & Sons Ltd on behalf of Cambridge Philosophical Society.

Policy analysis: palliative care in Ireland.

LENUS (Irish Health Repository)

Larkin, P

2014-03-01

Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the \\'policy analysis triangle\\' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation.

The Origin and Role of Trust in Local Policy Elites' Perceptions of High-Voltage Power Line Installations in the State of Arkansas.

Science.gov (United States)

Tumlison, Creed; Moyer, Rachael M; Song, Geoboo

2017-05-01

The debate over an installation of high-voltage power lines (HVPLs) has been intense, particularly in northwest Arkansas. Detractors claim that the installation will negatively affect both the natural environment and the local economy, which contains a large tourism component. By contrast, those in favor of installing HVPLs claim that the installation is necessary in order to reliably support the increasing demand for electric power. Using original data collected from a recent statewide Internet survey of 420 local policy elites in Arkansas, this article focuses on two key aspects. First, we examine how local policy elites' perceptions of risks versus benefits of HVPL installation in their communities are influenced by their levels of trust toward information provided by various sources (e.g., energy industry, environmental groups, and government). Second, we utilize cultural theory to explain how the cultural worldviews of policy elites--specifically, egalitarianism, individualism, hierarchism, and fatalism--shape these levels of trust and HVPL benefit-risk perceptions, while controlling for other factors claimed by previous literature, including levels of knowledge on energy-related issues and demographic characteristics. In general, our analysis indicates that policy elites' value-oriented formation of HVPL benefit-risk perceptions is partially due to the influence cultural values have on trust in information sources. We conclude this article by discussing broader implications for the origin and role of trust in policy elites' decisions throughout the policy-making process. © 2016 Society for Risk Analysis.

Autonomy, Trust, and Respect.

Science.gov (United States)

Nys, Thomas

2016-02-01

This article seeks to explore and analyze the relationship between autonomy and trust, and to show how these findings could be relevant to medical ethics. First, I will argue that the way in which so-called "relational autonomy theories" tie the notions of autonomy and trust together is not entirely satisfying Then, I will introduce the so-called Encapsulated Interest Account as developed by Russell Hardin. This will bring out the importance of the reasons for trust. What good reasons do we have for trusting someone? I will criticize Hardin's business model as insufficiently robust, especially in the context of health care, and then turn to another source of trust, namely, love. It may seem that trust-through-love is much better suited for the vulnerability that is often involved in health care, but I will also show that it has its own deficiencies. Good health care should therefore pay attention to both models of trust, and I will offer some tentative remarks on how to do this. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Blood donation and institutional trust: risk, policy rhetoric, and the men who have sex with men lifetime deferral policy in Canada.

Science.gov (United States)

Smith, André; Fiddler, Jay; Walby, Kevin; Hier, Sean

2011-11-01

This article examines the process of rebuilding institutional trust in the Canadian blood system in the aftermath of the tainted blood scandal. Our focus is the policy of lifetime deferral from donating blood for men who have sex with men. Drawing on findings from interviews with representatives of Health Canada's Expert Advisory Committee on Blood Regulation, the National Liaison Committee, Canadian Blood Services, and blood consumer groups, we demonstrate how claims making about rights, discrimination, science, and risk contribute to policy continuity. We also examine the link between policy continuity and the management of reputational risk.

Trust-based information system architecture for personal wellness.

Science.gov (United States)

Ruotsalainen, Pekka; Nykänen, Pirkko; Seppälä, Antto; Blobel, Bernd

2014-01-01

Modern eHealth, ubiquitous health and personal wellness systems take place in an unsecure and ubiquitous information space where no predefined trust occurs. This paper presents novel information model and an architecture for trust based privacy management of personal health and wellness information in ubiquitous environment. The architecture enables a person to calculate a dynamic and context-aware trust value for each service provider, and using it to design personal privacy policies for trustworthy use of health and wellness services. For trust calculation a novel set of measurable context-aware and health information-sensitive attributes is developed. The architecture enables a person to manage his or her privacy in ubiquitous environment by formulating context-aware and service provider specific policies. Focus groups and information modelling was used for developing a wellness information model. System analysis method based on sequential steps that enable to combine results of analysis of privacy and trust concerns and the selection of trust and privacy services was used for development of the information system architecture. Its services (e.g. trust calculation, decision support, policy management and policy binding services) and developed attributes enable a person to define situation-aware policies that regulate the way his or her wellness and health information is processed.

Figuring out whether they can be trusted: older widows' intentions relative to hired non-professional home-care helpers.

Science.gov (United States)

Porter, Eileen J; Lasiter, Sue; Poston, Emily

2005-01-01

The purpose of this phenomenological study was to describe the experience of older women relative to trusting hired non-professional home-care helpers. Open-ended interviews were done about the home-care experience with 25 women over three years, and 14 women (age 80-93) shared data about hiring and trusting helpers. The women perceived risks to personal safety that adversely influenced willingness to seek new helpers. After hiring a helper, the women were still trying to discern whether the helper could be trusted. Primary-care providers should enable older women to recognize and reduce the risk of having helpers and to monitor helpers' behavior, as well as assessing the psychosocial status of women who have such helpers.

Social capital and trust in providers.

Science.gov (United States)

Ahern, Melissa M; Hendryx, Michael S

2003-10-01

Trust in providers has been in decline in recent decades. This study attempts to identify sources of trust in characteristics of health care systems and the wider community. The design is cross-sectional. Data are from (1) the 1996 Household Survey of the Community Tracking Study, drawn from 24 Metropolitan Statistical Areas; (2) a 1996 multi-city broadcast media marketing database including key social capital indicators; (3) Interstudy; (4) the American Hospital Association; and (5) the American Medical Association. Independent variables include individual socio-demographic variables, HMO enrollment, community-level health sector variables, and social capital. The dependent variable is self-reported trust in physicians. Data are merged from the various sources and analyzed using SUDAAN. Subjects include adults in the Household Survey who responded to the items on trust in physicians (N=17,653). Trust in physicians is independently predicted by community social capital (pSocial capital plays a role in how health care is perceived by citizens, and how health care is delivered by providers. Efforts to build trust and collaboration in a community may improve trust in physicians, health care quality, access, and preserve local health care control.

Security policies and trust in ubiquitous computing.

Science.gov (United States)

Joshi, Anupam; Finin, Tim; Kagal, Lalana; Parker, Jim; Patwardhan, Anand

2008-10-28

Ubiquitous environments comprise resource-constrained mobile and wearable devices and computational elements embedded in everyday artefacts. These are connected to each other using both infrastructure-based as well as short-range ad hoc networks. Limited Internet connectivity limits the use of conventional security mechanisms such as public key infrastructures and other forms of server-centric authentication. Under these circumstances, peer-to-peer interactions are well suited for not just information interchange, but also managing security and privacy. However, practical solutions for protecting mobile devices, preserving privacy, evaluating trust and determining the reliability and accuracy of peer-provided data in such interactions are still in their infancy. Our research is directed towards providing stronger assurances of the reliability and trustworthiness of information and services, and the use of declarative policy-driven approaches to handle the open and dynamic nature of such systems. This paper provides an overview of some of the challenges and issues, and points out directions for progress.

Trust makers, breakers and brokers: building trust in the Australian food system.

Science.gov (United States)

Wilson, Annabelle; Coveney, John; Henderson, Julie; Meyer, Samantha; Calnan, Michael; Caraher, Martin; Webb, Trevor; Elliott, Anthony; Ward, Paul

2013-03-15

The importance of consumer trust in the food supply has previously been identified, and dimensions of consumer trust in food-who they trust and the type of trust that they exhibit-has been explored. However, there is a lack of research about the mechanisms through which consumer trust in the food supply is developed, maintained, broken and repaired. This study seeks to address this gap by exploring if, and how, consumer trust in the food supply is considered by the media, food industry and governments when responding to food scares. The aim of the research is to develop models of trust building that can be implemented following food scares. Semi-structured interviews will be undertaken with media, public relations officials and policy makers in Australia, New Zealand and the United Kingdom. Participants will be recruited through purposive sampling and will be asked to discuss a hypothetical case study outlining a food incident, and any experiences of specific food scares. Models of trust development, maintenance and repair will be developed from interview data. Comment on these models will be sought from experts in food-related organizations through a Delphi study, where participants will be asked to consider the usefulness of the models. Participants' comments will be used to revise the models until consensus is reached on the suitability and usability of the models. This study will contribute to the literature about systems-based trust, and explore trust as a social and regulatory process. The protocol and results will be of interest and use to the food industry, food regulators, consumer advocate groups, media seeking to report food-related issues and policy makers concerned with public health and consumer health and well-being. This research represents an important contribution to the translation of the theoretical conceptualizations of trust into practical use in the context of food.

Understanding the relationship between trust in health care and attitudes toward living donor transplant among African Americans with end-stage renal disease.

Science.gov (United States)

McDonald, Evangeline L; Powell, C Lamonte; Perryman, Jennie P; Thompson, Nancy J; Arriola, Kimberly R Jacob

2013-01-01

Transplantation is the favored therapy for patients with end-stage renal disease (ESRD). Unfortunately, demand for available organs far outpaces the supply. African Americans are disproportionately affected by the ever-widening gap between organ supply and demand. Additionally, structural, biological, and social factors contribute to feelings of unease some African Americans may feel regarding living donor transplant (LDT). The present research examines the relationship between trust in health care and attitudes toward LDT among African American ESRD patients. We hypothesized that lower trust in health care would be significantly associated with negative attitudes toward LDT, and that this relationship would be moderated by patient attitudes toward dialysis. Data were collected from August 2011 to April 2012 as part of a larger study. Measures included trust (of doctors, racial equity of treatment, and hospitals) and attitudes toward both LDT and dialysis. Bivariate analysis revealed that trust in one's doctor, hospital, and in racial equity in health care was significantly correlated with attitudes toward LDT (r = 0.265; r = 0.131; and r = 0.202, respectively). Additionally, attitudes toward dialysis moderated the relationships between Trust in Doctors/Attitudes toward LDT and Trust in Racial equity of treatment/Attitudes toward LDT. Findings suggest a strong relationship between trust in health care and attitudes toward LDT. These findings also shed light on how dialysis experiences are related to the relationship between trust in health care and attitudes toward LDT. © 2013 John Wiley & Sons A/S.

The Impact of Policy Incentives on Long-Term Care Insurance and Medicaid Costs: Does Underwriting Matter?

Science.gov (United States)

Cornell, Portia Y; Grabowski, David C

2018-05-16

To test whether underwriting modifies the effect of state-based incentives on individuals' purchase of long-term care insurance. Health and Retirement Study (HRS), 1996-2012. We estimated difference-in-difference regression models with an interaction of state policy indicators with individuals' probabilities of being approved for long-term care insurance. We imputed probabilities of underwriting approval for respondents in the HRS using a model developed with underwriting decisions from two U.S. insurance firms. We measured the elasticity response to long-term care insurance price using changes in simulated after-tax price as an instrumental variable for premium price. Tax incentives and Partnership programs increased insurance purchase by 3.62 percentage points and 1.8 percentage points, respectively, among those with the lowest risk (highest approval probability). Neither had any statistically significant effects among the highest risk individuals. We show that ignoring the effects of underwriting may lead to biased estimates of the potential state budget savings of long-term care insurance tax incentives. If the private market is to play a role in financing long-term care, policies need to address the underlying adverse selection problems. © Health Research and Educational Trust.

Improving Care And Research Electronic Data Trust Antwerp (iCAREdata): a research database of linked data on out-of-hours primary care.

Science.gov (United States)

Colliers, Annelies; Bartholomeeusen, Stefaan; Remmen, Roy; Coenen, Samuel; Michiels, Barbara; Bastiaens, Hilde; Van Royen, Paul; Verhoeven, Veronique; Holmgren, Philip; De Ruyck, Bernard; Philips, Hilde

2016-05-04

Primary out-of-hours care is developing throughout Europe. High-quality databases with linked data from primary health services can help to improve research and future health services. In 2014, a central clinical research database infrastructure was established (iCAREdata: Improving Care And Research Electronic Data Trust Antwerp, www.icaredata.eu ) for primary and interdisciplinary health care at the University of Antwerp, linking data from General Practice Cooperatives, Emergency Departments and Pharmacies during out-of-hours care. Medical data are pseudonymised using the services of a Trusted Third Party, which encodes private information about patients and physicians before data is sent to iCAREdata. iCAREdata provides many new research opportunities in the fields of clinical epidemiology, health care management and quality of care. A key aspect will be to ensure the quality of data registration by all health care providers. This article describes the establishment of a research database and the possibilities of linking data from different primary out-of-hours care providers, with the potential to help to improve research and the quality of health care services.

A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient.

Science.gov (United States)

Cooke, Mary; Hurley, Ciarán

2008-05-01

We aimed to identify policy, process and ethical issues related to allocation of National Health Service resources when patients with end-of-life illness are referred to acute care services. Sharing healthcare decisions denotes a different partnership between professionals and patients when patients are empowered to define their needs. Implementation of a transition from professional to patient decision-making appears to be dependent upon its interpretation by personnel delivering care using the local trust policy. The outcome of this is a reformation of responsibility for budget allocation, choice of acute care provider and selecting services, currently in the realm of primary care; be it the general practitioner, community practitioners, or the patient. We used a 'lens' approach to case study analysis in which the lens is constructed of a model of policy analysis and four principles of biomedical ethics. A patient's decision to decline care proposed by an Accident and Emergency department nurse and the nurse's response to that decision expose a policy that restricts the use of ambulance transport and with that, flexibility in responses to patients' decisions. End-of-life care partnership decisions require sensitivity and flexibility from all healthcare practitioners. We found that policy-based systems currently used to deliver care across the primary care - hospital care border are far from seamless and can lead to foreseeable problems. Health professionals responsible for the care of a patient at the end of life should consider the holistic outcomes of resource allocation decisions for patients. Government and health professional agenda suggest that patients should be given a greater element of control over their healthcare than has historically been the case. When patients take responsibility for their decisions, healthcare personnel should recognize that this signals a shift in the nature of the professional-patient relationship to one of partnership.

Four Essential Practices for Building Trust

Science.gov (United States)

Combs, Julie Peterson; Harris, Sandra; Edmonson, Stacey

2015-01-01

The presence of trust can enhance an organization's efforts to fulfill its mission, and the lack of trust can constrict those efforts. The authors offer four essential guidelines to help school leaders communicate in a way that builds trust. Build trust by understanding trust. Trusted leaders demonstrate care, character, and competence in their…

"You have to cover up the words of the doctor": the mediation of trust in interpreted consultations in primary care.

Science.gov (United States)

Robb, Nadia; Greenhalgh, Trisha

2006-01-01

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 U.K. 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

Towards a stakeholders' consensus on patient payment policy: the views of health-care consumers, providers, insurers and policy makers in six Central and Eastern European countries.

Science.gov (United States)

Tambor, Marzena; Pavlova, Milena; Golinowska, Stanisława; Sowada, Christoph; Groot, Wim

2015-08-01

Although patient charges for health-care services may contribute to a more sustainable health-care financing, they often raise public opposition, which impedes their introduction. Thus, a consensus among the main stakeholders on the presence and role of patient charges should be worked out to assure their successful implementation. To analyse the acceptability of formal patient charges for health-care services in a basic package among different health-care system stakeholders in six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Qualitative data were collected in 2009 via focus group discussions and in-depth interviews with health-care consumers, providers, policy makers and insurers. The same participants were asked to fill in a self-administrative questionnaire. Qualitative and quantitative data are analysed separately to outline similarities and differences in the opinions between the stakeholder groups and across countries. There is a rather weak consensus on patient charges in the countries. Health policy makers and insurers strongly advocate patient charges. Health-care providers overall support charges but their financial profits from the system strongly affects their approval. Consumers are against paying for services, mostly due to poor quality and access to health-care services and inability to pay. To build consensus on patient charges, the payment policy should be responsive to consumers' needs with regard to quality and equity. Transparency and accountability in the health-care system should be improved to enhance public trust and acceptance of patient payments. © 2012 John Wiley & Sons Ltd.

"You don't want to lose that trust that you've built with this patient...": (dis)trust, medical tourism, and the Canadian family physician-patient relationship.

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Crooks, Valorie A; Li, Neville; Snyder, Jeremy; Dharamsi, Shafik; Benjaminy, Shelly; Jacob, Karen J; Illes, Judy

2015-02-25

Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Medical tourism introduces challenges to decision-making that impact and are impacted by the physician-patient trust relationship-a relationship on which the foundation of beneficent health care lies. The objective of the study is to examine the views of Canadian family physicians about the roles that trust plays in decision-making about medical tourism, and the impact of medical tourism on the therapeutic relationship. We conducted six focus groups with 22 family physicians in the Canadian province of British Columbia. Data were analyzed thematically using deductive and inductive codes that captured key concepts across the narratives of participants. Family physicians indicated that they trust their patients to act as the lead decision-makers about medical tourism, but are conflicted when the information they are managing contradicts the best interests of the patients. They reported that patients distrust local health care systems when they experience insufficiencies in access to care and that this can prompt patients to consider going abroad for care. Trust fractures in the physician-patient relationship can arise from shame, fear and secrecy about medical tourism. Family physicians face diverse tensions about medical tourism as they must balance their roles in: (1) providing information about medical tourism within a context of information deficits; (2) supporting decision-making while distancing themselves from patients' decisions to engage in medical tourism; and (3) acting both as agents of the patient and of the domestic health care system. These tensions highlight the ongoing need for reliable third-party informational resources about medical tourism and the development of responsive policy.

Public trust and initiatives for new health care partnerships.

Science.gov (United States)

Mechanic, D

1998-01-01

Effective communication between doctor and patient is a critical component of high-quality care. The physician's credibility has a significant effect on treatment outcomes. Because changes in medicine and larger cultural trends challenge the ability of clinicians to engage their patients' trust, new kinds of partnerships must be created. To do this effectively, physicians have to sharpen their communication skills and devise strategies for assuring that their patients become informed allies in their own treatment. A number of innovations are helping to build these alliances: training in communication skills; creative uses of the Internet and videotape technologies; improved "customer service" programs; critical pathways for patients; and special educational aids. All these tools promise to be useful, but they require careful development and evaluation.

Trust and risk: a model for medical education.

Science.gov (United States)

Damodaran, Arvin; Shulruf, Boaz; Jones, Philip

2017-09-01

Health care delivery, and therefore medical education, is an inherently risky business. Although control mechanisms, such as external audit and accreditation, are designed to manage risk in clinical settings, another approach is 'trust'. The use of entrustable professional activities (EPAs) represents a deliberate way in which this is operationalised as a workplace-based assessment. Once engaged with the concept, clinical teachers and medical educators may have further questions about trust. This narrative overview of the trust literature explores how risk, trust and control intersect with current thinking in medical education, and makes suggestions for potential directions of enquiry. Beyond EPAs, the importance of trust in health care and medical education is reviewed, followed by a brief history of trust research in the wider literature. Interpersonal and organisational levels of trust and a model of trust from the management literature are used to provide the framework with which to decipher trust decisions in health care and medical education, in which risk and vulnerability are inherent. In workplace learning and assessment, the language of 'trust' may offer a more authentic and practical vocabulary than that of 'competency' because clinical and professional risks are explicitly considered. There are many other trust relationships in health care and medical education. At the most basic level, it is helpful to clearly delineate who is the trustor, the trustee, and for what task. Each relationship has interpersonal and organisational elements. Understanding and considered utilisation of trust and control mechanisms in health care and medical education may lead to systems that maturely manage risk while actively encouraging trust and empowerment. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Does trust in health care influence the use of complementary and alternative medicine by chronically ill people.

NARCIS (Netherlands)

Brink-Muinen, A. van den; Rijken, P.M.

2006-01-01

Background: People's trust in health care and health care professionals is essential for the effectiveness of health care, especially for chronically ill people, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that chronically ill people turn to

Health Care Organizations and Policy Leadership: Perspectives on Nonsmoker-Only Hiring Policies.

Science.gov (United States)

McDaniel, Patricia A; Malone, Ruth E

2018-02-01

To explore employers' decisions to base hiring policies on tobacco or nicotine use and community perspectives on such policies, and analyze the implications for organizational identity, community engagement, and health promotion. From 2013 to 2016, 11 executives from six health care organizations and one non-health-care organization with nonsmoker-only hiring policies were interviewed about why and how their policies were created and implemented, concerns about the policies, and perceptions of employee and public reactions. Focus groups were conducted with community members (n = 51) who lived in or near cities where participating employers were based, exploring participants' opinions about why an employer would stop hiring smokers and their support (or not) for such a policy. Most employers excluded from employment those using all forms of nicotine. Several explained their adoption of the policy as a natural extension of a smoke-free campus and as consistent with their identity as health care organizations. They regarded the policy as promoting health. No employer mentioned engaging in a community dialogue before adopting the policy or reported efforts to track the policy's impact on rejected applicants. Community members understood the cost-saving appeal of such policies, but most opposed them. They made few exceptions for health care organizations. Policy decisions undertaken by health care organizations have influence beyond their immediate setting and may establish precedents that others follow. Nonsmoker-only hiring policies may fit with a health care organization's institutional identity but may not be congruent with community values or promote public health.

Adequate trust avails, mistaken trust matters: on the moral responsibility of doctors as proxies for patients' trust in biobank research.

Science.gov (United States)

Johnsson, Linus; Helgesson, Gert; Hansson, Mats G; Eriksson, Stefan

2013-11-01

In Sweden, most patients are recruited into biobank research by non-researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good. © 2012 John Wiley & Sons Ltd.

Trust in telemedicine portals for rehabilitation care: an exploratory focus group study with patients and healthcare professionals.

Science.gov (United States)

Van Velsen, Lex; Wildevuur, Sabine; Flierman, Ina; Van Schooten, Boris; Tabak, Monique; Hermens, Hermie

2016-01-27

For many eServices, end-user trust is a crucial prerequisite for use. Within the context of Telemedicine, the role of trust has hardly ever been studied. In this study, we explored what determines trust in portals that facilitate rehabilitation therapy, both from the perspective of the patient and the healthcare professional. We held two focus groups with patients (total n = 15) and two with healthcare professionals (total n = 13) in which we discussed when trust matters, what makes up trust in a rehabilitation portal, what effect specific design cues have, and how much the participants trust the use of activity sensor data for informing treatment. Trust in a rehabilitation portal is the sum of trust in different factors. These factors and what makes up these factors differ for patients and healthcare professionals. For example, trust in technology is made up, for patients, mostly by a perceived level of control and privacy, while for healthcare professionals, a larger and different set of issues play a role, including technical reliability and a transparent data storage policy. Healthcare professionals distrust activity sensor data for informing patient treatment, as they think that sensors are unable to record the whole range of movements that patients make (e.g., walking and ironing clothes). The set of factors that affect trust in a rehabilitation portal are different from the sets that have been found for other contexts, like eCommerce. Trust in telemedicine technology should be studied as a separate subject to inform the design of reliable interventions.

Cultural identity and patient trust among older American Indians.

Science.gov (United States)

Simonds, Vanessa W; Goins, R Turner; Krantz, Elizabeth M; Garroutte, Eva Marie

2014-03-01

Patients' trust in healthcare providers and institutions has been identified as a likely contributor to racial-ethnic health disparities. The likely influence of patients' cultural characteristics on trust is widely acknowledged but inadequately explored. To compare levels of patients' trust in primary care provider (interpersonal trust) with trust in healthcare organizations (institutional trust) among older American Indians (AIs), and determine associations with cultural identity. Patient survey administered following primary care visits. Two-hundred and nineteen American Indian patients ≥ 50 years receiving care for a non-acute condition at two clinics operated by the Cherokee Nation in northeastern Oklahoma. Self-reported sociodemographic and cultural characteristics. Trust was measured using three questions about interpersonal trust and one measure of institutional trust; responses ranged from strongly agree to strongly disagree. Finding substantial variation only in institutional trust, we used logistic generalized estimating equations to examine relationships of patient cultural identity with institutional trust. Ninety-five percent of patients reported trusting their individual provider, while only 46 % reported trusting their healthcare institution. Patients who strongly self-identified with an AI cultural identity had significantly lower institutional trust compared to those self-identifying less strongly (OR: 0.6, 95 % CI: 0.4, 0.9). Interpersonal and institutional trust represent distinct dimensions of patients' experience of care that may show important relationships to patients' cultural characteristics. Strategies for addressing low institutional trust may have special relevance for patients who identify strongly with AI culture.

Does Ideological Education in China Suppress Trust in Religion and Foster Trust in Government?

Directory of Open Access Journals (Sweden)

Ying Xie

2017-05-01

Full Text Available A major goal of ideological education in China is to promote loyalty to the party-state and to instill atheism among the people. How effective is this ideological education? This article examines the relationship between education and trust in government and trust in religion using data from the 2010 Chinese General Social Survey. We find that education is negatively associated with trust in government, while positively related to trust in religion. Our findings suggest that policies aimed at displacing religion in favor of the Communist ideology have largely failed to shape the public mindset; rather, the more educated, the more people tend to trust religion instead of the government.

EU POLICIES REGARDING THE DEVELOPMENT OF TRUST-LIKE DEVICES - RECENT CHALLENGES, ACHIEVEMENTS, PROSPECTS AND TERMINOLOGICAL INSIGHTS

Directory of Open Access Journals (Sweden)

Irina GVELESIANI

2016-03-01

Full Text Available “Trust” is a versatile instrument which is suitable for a great variety of purposes. Many scholars believe, that the original form of this institution appeared in common law, while in the 20th century the process of globalization stipulated the “internationalization” of the trust mechanism. The starting point of this process was the conclusion of the Hague Convention on the Law Applicable to Trusts and on their Recognition. Initially, the civil law jurisdictions were unable to adopt “trust” structure in which common-law power and equity power belonged to separate entities. Despite this fact, in the recent years, trust-like devices have been introduced in certain economic-juridical systems of Europe. Their rapid implementation raised the question of the establishment of innovative policies. This paper will discuss the latest achievements and existing challenges based on the example of the German juridical-economic system. The aim is to make useful proposals for the successful planning of the European entrusting processes.

In Public Education Expenditures We Trust: Does Trust Increase Support for Public Education Expenditures?

Science.gov (United States)

Gur, Nurullah; Boyaci, Israfil; Ozcan, Yunus

2015-01-01

Trust is one crucial prerequisite for the welfare state. However, very few empirical studies exist that help us understand the mechanisms through which trust affects the welfare state. Influencing public support for developing friendly public policies might be one of these mechanisms. In this study, we use unique micro data from 34 countries to…

Does trust in health care influence the use of complementary and alternative medicine by chronically ill patients?

NARCIS (Netherlands)

Brink-Muinen, A. van den; Rijken, M.

2006-01-01

Background: Patients’ trust in health care (professionals) is essential for the effectiveness of health care, especially for chronically ill patients, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that the chronically ill turn to complementary and

"That is why I have trust": unpacking what 'trust' means to participants in international genetic research in Pakistan and Denmark.

Science.gov (United States)

Sheikh, Zainab; Hoeyer, Klaus

2018-06-01

Trust features prominently in a number of policy documents that have been issued in recent years to facilitate data sharing and international collaboration in medical research. However, it often remains unclear what is meant by 'trust'. By exploring a concrete international collaboration between Denmark and Pakistan, we develop a way of unpacking trust that shifts focus from what trust 'is' to what people invest in relationships and what references to trust do for them in these relationships. Based on interviews in both Pakistan and Denmark with people who provide blood samples and health data for the same laboratory, we find that when participants discuss trust they are trying to shape their relationship to researchers while simultaneously communicating important hopes, fears and expectations. The types of trust people talk about are never unconditional, but involve awareness of uncertainties and risks. There are different things at stake for people in different contexts, and therefore it is not the same to trust researchers in Pakistan as it is in Denmark, even when participants donate to the same laboratory. We conclude that casual references to 'trust' in policy documents risk glossing over important local differences and contribute to a de-politicization of basic inequalities in access to healthcare.

A Formal Model of Trust Chain based on Multi-level Security Policy

OpenAIRE

Kong Xiangying

2013-01-01

Trust chain is the core technology of trusted computing. A formal model of trust chain based on finite state automata theory is proposed. We use communicating sequential processes to describe the system state transition in trust chain and by combining with multi-level security strategy give the definition of trust system and trust decision theorem of trust chain transfer which is proved meantime. Finally, a prototype system is given to show the efficiency of the model.

The organisational and human resource challenges facing primary care trusts: protocol of a multiple case study

Directory of Open Access Journals (Sweden)

Tim Scott J

2001-11-01

Full Text Available Abstract Background The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs. Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. Methods The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development.

Trust matters

DEFF Research Database (Denmark)

Østergaard, Lise Rosendal

2015-01-01

This article makes a contribution to the debate about health service utilisation and the role of trust in fostering demand for health services in sub-Saharan Africa. It is framed as a narrative literature review based on a thematic analysis of nine empirical, qualitative studies. For the purposes...... of this article trust is defined as a voluntary course of action, which involves the optimistic expectation that the trustee will do no harm to the trustor and is increasingly perceived as an important influence on health system functioning. The article looks at trust issues in interpersonal, intergroup...... and institutional situations. The findings of the review point to four elements that are important for trust to develop in health sector relationships: the sensitive use of discretionary power by health workers, perceived empathy by patients of the health workers, the quality of medical care and workplace...

'Trust my doctor, trust my pancreas': trust as an emergent quality of social practice.

Science.gov (United States)

Cohn, Simon

2015-06-11

Growing attention is being paid to the importance of trust, and its corollaries such as mistrust and distrust, in health service and the central place they have in assessments of quality of care. Although initially focussing on doctor-patient relationships, more recent literature has broadened its remit to include trust held in more abstract entities, such as organisations and institutions. There has consequently been growing interest to develop rigorous and universal measures of trust. Drawing on illustrative ethnographic material from observational research in a UK diabetes clinic, this paper supports an approach that foregrounds social practice and resists conceiving trust as solely a psychological state that can be divorced from its context. Beyond exploring the less-than-conscious nature of trust, the interpretations attend to the extent to which trust practices are distributed across a range of actors. Data from clinical encounters reveal the extent to which matters of trust can emerge from the relationships between people, and sometimes people and things, as a result of a wide range of pragmatic concerns, and hence can usefully be conceived of as an extended property of a situation rather than a person. Trust is rarely explicitly articulated, but remains a subtle feature of experience that is frequently ineffable. A practice approach highlights some of the problems with adopting a general psychological or intellectualist conception of trust. In particular, assuming it is a sufficiently stable internal state that can be stored or measured not only transforms a diffuse and often ephemeral quality into a durable thing, but ultimately presents it as a generic state that has meaning independent of the specific relationships and context that achieve it. Emphasising the context-specific nature of trust practices does not dismiss the potential of matters of trust, when they emerge, to be transposed to other contexts. But it does highlight how, on each occasion

Authentic leadership as a source of optimism, trust in the organisation and work engagement in the public health care sector

Directory of Open Access Journals (Sweden)

Frederick W. Stander

2015-06-01

Full Text Available Orientation: The orientation of this study is towards authentic leadership (AL and its influence on optimism, trust in the organisation and work engagement of employees in the public health care sector. Research purpose: The objectives of this study were to determine whether the leadership style of AL could predict optimism, trust in the organisation and work engagement amongst a large sample of employees from various functions in public hospitals and clinics in Gauteng and to establish whether optimism and trust in the organisation could mediate the relationship between AL and work engagement. Research approach, design and method: A convenience sample of 633 public health employees from various functions within 27 public hospitals and clinics in the province was used in this research. A cross-sectional research design was implemented. Structural equation modelling was utilised to investigate the Authentic Leadership Inventory (ALI, and the validity and fit of the measurement model, to position AL as a job resource within the nomological net and to test its mediating effects. Main findings: The statistical analysis revealed that AL was a significant predictor of optimism and trust in the organisation and that optimism and trust in the organisation mediated the relationship between AL and work engagement. Practical/managerial implications: The research results suggested that organisations in the public health care sector should encourage their managers to adopt a more authentic leadership style. This will lead to higher levels of optimism, trust in the organisation and eventually work engagement. This will greatly assist employees in the domain of public health care to manage their demanding working environment. Contribution: This study provides evidence that the ALI can be used reliably within the South African context and specifically within the public health care sector. It further substantiates for the implementation of AL as a leadership

Trust, trustworthiness and health.

Science.gov (United States)

Dawson, Angus

2015-01-01

Trust is an essential component of good healthcare. If patients trust their physicians, then the relationship between them can be a richer and more meaningful one. The patient is more likely to feel confident and able to disclose symptoms, helping diagnosis and future care. If public health and community workers are trusted, not only is it likely that their work will be easier, in that their actions will be respected and accepted, but their advice will also be sought spontaneously. Trust, can, therefore, be thought of as something that is of benefit to all: healthcare workers, individuals and communities. Trust is, generally, something to be prized and we need to do anything we can to strengthen it.

Building bridges: an interpretive phenomenological analysis of nurse educators' clinical experience using the T.R.U.S.T. Model for inclusive spiritual care.

Science.gov (United States)

Scott Barss, Karen

2012-04-30

Educating nurses to provide evidence-based, non-intrusive spiritual care in today's pluralistic context is both daunting and essential. Qualitative research is needed to investigate what helps nurse educators feel more prepared to meet this challenge. This paper presents findings from an interpretive phenomenological analysis of the experience of nurse educators who used the T.R.U.S.T. Model for Inclusive Spiritual Care in their clinical teaching. The T.R.U.S.T. Model is an evidence-based, non-linear resource developed by the author and piloted in the undergraduate nursing program in which she teaches. Three themes are presented: "The T.R.U.S.T. Model as a bridge to spiritual exploration"; "blockades to the bridge"; and "unblocking the bridge". T.R.U.S.T. was found to have a positive influence on nurse educators' comfort and confidence in the teaching of spiritual care. Recommendations for maximizing the model's positive impact are provided, along with "embodied" resources to support holistic teaching and learning about spiritual care.

Obtaining corporate information from NHS foundation trusts.

Science.gov (United States)

Woodward, Valerie; Endacott, Ruth; Sheaff, Rod; Jones, Ray

Foundation trusts have boards of directors that are responsible for the day-to-day running of the organisation, planning services and developing strategy. Unlike non-foundation trusts and primary care trusts (PCTs), foundation trusts are not obliged to hold directors' board meetings in public. This article describes the online availability and accessibility of the minutes of such meetings in a number of foundation trusts, non-foundation trusts and PCTs. The implications for transparency in the NHS are also discussed.

Terrorism, Trust and Tourism

DEFF Research Database (Denmark)

Jensen, Susanne; Svendsen, Gert Tinggaard

2017-01-01

How does terrorism affect social trust and tourism? The rising number of terrorist attacks in Western Europe has caused safety problems not only for local citizens but also for tourists. In fact, terrorists challenge the formal violence monopoly of the state thus creating a sense of anarchy...... and distrust. Social trust is about trusting strangers, so when less predictable behaviour occurs in, a given country, people become more careful as they tend to trust most other people less. An interesting case for future research is Scandinavia as the level of terrorism is still low and, at the same time......, Scandinavia can record most social trust in the world meaning a competitive advantage when attracting tourists. Arguably, a double dividend is created from fighting terrorism, namely more social trust accumulated and more tourists attracted. Future research should therefore try to further test our model...

Towards Sustainable Health Care Organizations

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Mauro ROMANELLI

2017-09-01

Full Text Available Health care organizations have to develop a sustainable path for creating public value by seeking legitimacy for building and maintaining public trust with patients as social and economic institutions creating value and sustaining both health and wealth for people and communities within society. Health care organizations having at disposal decreasing resources and meeting increasing demands of citizens are following an unsustainable path. Designing sustainable health care systems and organizations is emerging as a strategic goal for developing the wealth of people and communities over time. Building sustainable organizations relies on valuing human resources, designing efficient and effective processes, using technology for better managing the relationships within and outside organizations. Sustainable health care organizations tend to rediscover the importance of human resource management and policies for effectively improving communication with patients and building trust-based relationships. While processes of accreditation contribute to legitimizing effectiveness and quality of health care services and efficient processes, introducing and using new information and communication technologies (ICTs and informatics helps communication leading to restore trust-based relationships between health care institutions and patients for value creation within society.

The Determinants of Trust

DEFF Research Database (Denmark)

Bjørnskov, Christian

, in particular emphasizing the role of social trust. This is in turn defined as the confidence people have that strangers, i.e. fellow citizens on whom they have no specific information, will not take advantage of them (Uslaner, 2002; Bjørnskov, 2006). Using the answers to the World Values Survey question “In...... general, do you think that most people can be trusted?”, the by now quite substantial literature has found that social trust is associated with a set of different macroeconomic outcomes: economic growth, the rule of law and overall quality of governance, corruption, education, the extent of violent crime...... and subjective well-being are all influenced by the propensity of people within any nation to trust each other. The questions are therefore where trust comes from and whether or not it can be affected by public policy. The answers to these questions seem to divide researchers into two camps: the optimists...

Cross sectional study of performance indicators for English Primary Care Trusts: testing construct validity and identifying explanatory variables

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Lilford Richard

2006-06-01

Full Text Available Abstract Background The performance of Primary Care Trusts in England is assessed and published using a number of different performance indicators. Our study has two broad purposes. Firstly, to find out whether pairs of indicators that purport to measure similar aspects of quality are correlated (as would be expected if they are both valid measures of the same construct. Secondly, we wanted to find out whether broad (global indicators correlated with any particular features of Primary Care Trusts, such as expenditure per capita. Methods Cross sectional quantitative analysis using data from six 2004/05 PCT performance indicators for 303 English Primary Care Trusts from four sources in the public domain: Star Rating, aggregated Quality and Outcomes Framework scores, Dr Foster mortality index, Dr Foster equity index (heart by-pass and hip replacements, NHS Litigation Authority Risk Management standards and Patient Satisfaction scores from the Star Ratings. Forward stepwise multiple regression analysis to determine the effect of Primary Care Trust characteristics on performance. Results Star Rating and Quality and Outcomes Framework total, both summary measures of global quality, were not correlated with each other (F = 0.66, p = 0.57. There were however positive correlations between Quality and Outcomes Framework total and patient satisfaction (r = 0.61, p Conclusion Performance assessment in healthcare remains on the Government's agenda, with new core and developmental standards set to replace the Star Ratings in 2006. Yet the results of this analysis provide little evidence that the current indicators have sufficient construct validity to measure the underlying concept of quality, except when the specific area of screening is considered.

Long-term care policy for older Americans: building a continuum of care.

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Palley, Howard A

2003-01-01

This paper deals primarily with social policy considerations relevant to the development of long-term care policy for the frail elderly in the United States. However, it also includes some commentary on meeting the acute care needs of the frail elderly. It defines chronic care treatment as a mix of "short-term" and "long-term" modes of care. Furthermore, it explores the need for treatment of such long-term illnesses to recognize the importance of alternative modes of caring which include strategies, both medical and nonmedical, delivered within and outside of hospitals and nursing homes. The paper includes an analysis of public and private sector priorities based in data published by the U.S. Health Care Financing Administration. It also includes some discussion of the PACE program in the United States and some other efforts to stimulate more in-home and community-based alternatives to nursing home care. Furthermore, it includes a discussion of the policy goal of "appropriateness" in developing long-term care (as well as general health priorities) and provides a critical discussion of problems with utilizing "cost/benefit analysis." The study concludes that too exclusive a focus on nursing home care for the elderly in the United States is unfortunate-both in terms of the desires of the elderly, their families and friends and in terms of focusing on "appropriateness" as a legitimate policy goal in the development of long-term care policy for the elderly in the United States.

Trust Management for Public Key Infrastructures: Implementing the X.509 Trust Broker

Directory of Open Access Journals (Sweden)

Ahmad Samer Wazan

2017-01-01

Full Text Available A Public Key Infrastructure (PKI is considered one of the most important techniques used to propagate trust in authentication over the Internet. This technology is based on a trust model defined by the original X.509 (1988 standard and is composed of three entities: the certification authority (CA, the certificate holder (or subject, and the Relying Party (RP. The CA plays the role of a trusted third party between the certificate holder and the RP. In many use cases, this trust model has worked successfully. However, we argue that the application of this model on the Internet implies that web users need to depend on almost anyone in the world in order to use PKI technology. Thus, we believe that the current TLS system is not fit for purpose and must be revisited as a whole. In response, the latest draft edition of X.509 has proposed a new trust model by adding new entity called the Trust Broker (TB. In this paper, we present an implementation approach that a Trust Broker could follow in order to give RPs trust information about a CA by assessing the quality of its issued certificates. This is related to the quality of the CA’s policies and procedures and its commitment to them. Finally, we present our Trust Broker implementation that demonstrates how RPs can make informed decisions about certificate holders in the context of the global web, without requiring large processing resources themselves.

78 FR 21424 - Royce Value Trust, Inc., et al.;

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2013-04-10

... small- and micro-cap companies. Value Trust has a non-fundamental investment policy that limits its... deemed to be underwriting shares of Global Trust's common stock. Value Trust has a fundamental investment... SECURITIES AND EXCHANGE COMMISSION [Investment Company Act Release No. 30448; File No. 812-13880...

The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units.

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Vogus, Timothy J; Sutcliffe, Kathleen M

2011-01-01

Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on the joint benefits of safety organizing and other contextual factors that help foster safety. Although we know that organizational practices often have more powerful effects when combined with other mutually reinforcing practices, little research exists on the joint benefits of safety organizing and other contextual factors believed to foster safety. Specifically, we examined the benefits of bundling safety organizing with leadership (trust in manager) and design (use of care pathways) factors on reported medication errors. A total of 1033 RNs and 78 nurse managers in 78 emergency, internal medicine, intensive care, and surgery nursing units in 10 acute-care hospitals in Indiana, Iowa, Maryland, Michigan, and Ohio who completed questionnaires between December 2003 and June 2004. Cross-sectional analysis of medication errors reported to the hospital incident reporting system for the 6 months after the administration of the survey linked to survey data on safety organizing, trust in manager, use of care pathways, and RN characteristics and staffing. Multilevel Poisson regression analyses indicated that the benefits of safety organizing on reported medication errors were amplified when paired with high levels of trust in manager or the use of care pathways. Safety organizing plays a key role in improving patient safety on hospital nursing units especially when bundled with other organizational components of a safety supportive system.

Maintaining control while delegating trust: Integrity constraints in trust management

NARCIS (Netherlands)

Etalle, S.; Winsborough, W.H.

2009-01-01

We introduce the use, monitoring, and enforcement of integrity constraints in trust management-style authorization systems. We consider what portions of the policy state must be monitored to detect violations of integrity constraints. Then, we address the fact that not all participants in a

Building trust to work with children after a severe traumatic accident.

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Hall, Julianne; Nayar, Shoba

2014-01-01

Trust is integral to nursing; yet little is known about how nurses establish trust when working with patients. This grounded theory study explored nurses' perspectives of how to build trust with a child and family in the context of paediatric acute health care. Seven paediatric acute care nurses were asked what they did when they cared for a child admitted to an acute care ward from emergency department or intensive care unit following a severe traumatic accident. Building trust emerged as the basic social process for an effective working relationship between a nurse and family to promote the rehabilitation of the child. This paper argues that building trust is critical to nurses developing a working relationship with both child and family to promote optimal health, and enables nurses to effectively step out and handover the care of the child to the family.

A Calculus for Trust Management

DEFF Research Database (Denmark)

Carbone, Marco; Nielsen, Mogens; Sassone, Vladimiro

2004-01-01

principals to policies. We elect to formalise policies using a Datalog-like logic, and to express protocols in the process algebra style. This yields an expressive calculus very suitable for the global computing scenarios, and provides a formalisation of notions such as trust evolution. For ctm we define...

Stochastic models of the Social Security trust funds.

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Burdick, Clark; Manchester, Joyce

Each year in March, the Board of Trustees of the Social Security trust funds reports on the current and projected financial condition of the Social Security programs. Those programs, which pay monthly benefits to retired workers and their families, to the survivors of deceased workers, and to disabled workers and their families, are financed through the Old-Age, Survivors, and Disability Insurance (OASDI) Trust Funds. In their 2003 report, the Trustees present, for the first time, results from a stochastic model of the combined OASDI trust funds. Stochastic modeling is an important new tool for Social Security policy analysis and offers the promise of valuable new insights into the financial status of the OASDI trust funds and the effects of policy changes. The results presented in this article demonstrate that several stochastic models deliver broadly consistent results even though they use very different approaches and assumptions. However, they also show that the variation in trust fund outcomes differs as the approach and assumptions are varied. Which approach and assumptions are best suited for Social Security policy analysis remains an open question. Further research is needed before the promise of stochastic modeling is fully realized. For example, neither parameter uncertainty nor variability in ultimate assumption values is recognized explicitly in the analyses. Despite this caveat, stochastic modeling results are already shedding new light on the range and distribution of trust fund outcomes that might occur in the future.

EPA guidance on building trust in mental health services.

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Gaebel, W; Muijen, M; Baumann, A E; Bhugra, D; Wasserman, D; van der Gaag, R J; Heun, R; Zielasek, J

2014-02-01

To advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system. We performed a systematic literature search and the retrieved documents were evaluated by two independent reviewers. Evidence tables were generated and recommendations were developed in an expert and stakeholder consensus process. We developed five recommendations which may increase trust in mental health care services and advance mental health care service utilization. Trust is a mutual, complex, multidimensional and dynamic interrelationship of a multitude of factors. Its components may vary between individuals and over time. They may include, among others, age, place of residence, ethnicity, culture, experiences as a service user, and type of disorder. For mental health care services, issues of knowledge about mental health services, confidentiality, continuity of treatment, dignity, safety and avoidance of stigma and coercion are central elements to increase trust. Evidence-based recommendations to increase mutual trust of service users and psychiatrists have been developed and may help to increase mental health care service utilization. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Medical bribery and the ethics of trust: the Romanian case.

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Manea, Teodora

2015-02-01

Medical bribery seems to be a global problem from Eastern Europe and the Balkans to China, a diffuse phenomenon, starting with morally acceptable gratitude and ending with institutional bribery. I focus my attention on Romania and analyze similar cases in Eastern European and postcommunist countries. Medical bribery can be regarded as a particular form of human transaction, a kind of primitive contract that occurs when people do not trust institutions or other forms of social contract that are meant to guarantee their rights and protect their interests. Concluding with strategies to fight medical bribery, I will underline better public policies for financing health and social care, and an ethic of trust that may help to restore trustworthiness of institutions and to rebuild interpersonal trust. This should be complemented by an educational program dedicated to understanding the negative consequences and mechanisms of corruption and the importance of ethical behavior. © The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Commentary: one strategy for building public trust in changing times.

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Dauphinee, W Dale; Tamblyn, Robyn; Cruess, Sylvia R; Cruess, Richard L

2010-06-01

Major health care reforms are being debated in the United States. While these debates address issues of access and cost, the systems-based problems of patient safety, continuous quality improvement, and an integrated approach to continuing professional development (CPD) remain traditional opportunities for the profession to directly improve health care and maintain professional accountability. Such challenges can be addressed independently of proposed reforms and offer an opportunity for the profession to build greater public trust. Given recent evidence questioning many assumptions behind individually focused CPD, and as physicians' work shifts into group and team contexts, it is an opportune time to address better CPD strategies within emerging group and team settings.The first strategic change requires a focus on managing the development of the individual physician's educational growth into a systems-oriented approach based on better information and feedback within groups of practitioners and health care teams. Second, the renewal of the linked visions of professional collegiality and accountability with professional regulation needs to be seen as a collective responsibility across key organizations within the profession's normal accountability framework. Thus, the professional colleges, certifying boards, and regulatory authorities need to collaborate with the CDP community in refocusing their collective activities to promote the profession's traditional role of improving the quality of care and maintaining the public's trust in these times of intense policy debate.

Public trust in the Spanish health‐care system

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Jovell, Albert; Blendon, Robert J.; Navarro, Maria Dolors; Fleischfresser, Channtal; Benson, John M.; DesRoches, Catherine M.; Weldon, Kathleen J.

2007-01-01

Abstract Background  Fifteen years ago, public opinion surveys in Spain showed substantial dissatisfaction with the health‐care system. Since that time, health‐care in Spain has undergone significant changes, including a decentralization of the system, an increase in spending and a change in the way the system is financed. Objective  This study examines how Spanish citizens rate the performance of their health system today, both as compared with other sectors of society and as compared with earlier time periods. Methods  Data are drawn from nationally representative telephone surveys of the non‐institutionalized adult Spanish population (age 18 years and over). The study was carried out in two phases: October–November 2005 (n = 3010) and January 2006 (n = 2101). Results  The majority of the Spanish population thinks the health system needs to be changed. The problems cited relate mostly to long wait times to get health‐care. Nevertheless, over the last 15 years, the proportion of people who have very negative views about the health system has decreased by half. The majority believes that not enough money is spent on health‐care, but few people would support an increase in taxes to provide additional funding. The survey finds the National Health System’s institutions and health professionals to be more highly trusted than other institutions and professional groups in the country. Conclusions  Government policy‐makers in Spain face a dilemma: the public wants more health spending to decrease wait times, but there is substantial resistance to increasing taxes as a means to finance improvements in the system’s capacity. PMID:17986071

An intervention to increase patients' trust in their physicians. Stanford Trust Study Physician Group.

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Thom, D H; Bloch, D A; Segal, E S

1999-02-01

To investigate the effect of a one-day workshop in which physicians were taught trust-building behaviors on their patients' levels of trust and on outcomes of care. In 1994, the study recruited 20 community-based family physicians and enrolled 412 consecutive adult patients from those physicians' practices. Ten of the physicians (the intervention group) were randomly assigned to receive a one-day training course in building and maintaining patients' trust. Outcomes were patients' trust in their physicians, patients' and physicians' satisfaction with the office visit, continuity in the patient-physician relationship, patients' adherence to their treatment plans, and the numbers of diagnostic tests and referrals. Physicians and patients in the intervention and control groups were similar in demographic and other data. There was no significant difference in any outcome. Although their overall ratings were not statistically significantly different, the patients of physicians in the intervention group reported more positive physician behaviors than did the patients of physicians in the control group. The trust-building workshop had no measurable effect on patients' trust or on outcomes hypothesized to be related to trust.

The Effect of Hospital Service Quality on Patient's Trust.

Science.gov (United States)

Zarei, Ehsan; Daneshkohan, Abbas; Khabiri, Roghayeh; Arab, Mohammad

2015-01-01

The trust is meant the belief of the patient to the practitioner or the hospital based on the concept that the care provider seeks the best for the patient and will provide the suitable care and treatment for him/her. One of the main determinants of patient's trust is the service quality. This study aimed to examine the effect of quality of services provided in private hospitals on the patient's trust. In this descriptive cross-sectional study, 969 patients were selected using the consecutive method from eight private general hospitals of Tehran, Iran, in 2010. Data were collected through a questionnaire containing 20 items (14 items for quality, 6 items for trust) and its validity and reliability were confirmed. Data were analyzed using descriptive statistics and multivariate regression. The mean score of patients' perception of trust was 3.80 and 4.01 for service quality. Approximately 38% of the variance in patient trust was explained by service quality dimensions. Quality of interaction and process (P quality of the environment had no significant effect on the patients' degree of trust. The interaction quality and process quality were the key determinants of patient's trust in the private hospitals of Tehran. To enhance the patients' trust, quality improvement efforts should focus on service delivery aspects such as scheduling, timely and accurate doing of the service, and strengthening the interpersonal aspects of care and communication skills of doctors, nurses and staff.

Macroeconomic Dynamics of Assets, Leverage and Trust

Science.gov (United States)

Rozendaal, Jeroen C.; Malevergne, Yannick; Sornette, Didier

A macroeconomic model based on the economic variables (i) assets, (ii) leverage (defined as debt over asset) and (iii) trust (defined as the maximum sustainable leverage) is proposed to investigate the role of credit in the dynamics of economic growth, and how credit may be associated with both economic performance and confidence. Our first notable finding is the mechanism of reward/penalty associated with patience, as quantified by the return on assets. In regular economies where the EBITA/Assets ratio is larger than the cost of debt, starting with a trust higher than leverage results in the highest long-term return on assets (which can be seen as a proxy for economic growth). Therefore, patient economies that first build trust and then increase leverage are positively rewarded. Our second main finding concerns a recommendation for the reaction of a central bank to an external shock that affects negatively the economic growth. We find that late policy intervention in the model economy results in the highest long-term return on assets. However, this comes at the cost of suffering longer from the crisis until the intervention occurs. The phenomenon that late intervention is most effective to attain a high long-term return on assets can be ascribed to the fact that postponing intervention allows trust to increase first, and it is most effective to intervene when trust is high. These results are derived from two fundamental assumptions underlying our model: (a) trust tends to increase when it is above leverage; (b) economic agents learn optimally to adjust debt for a given level of trust and amount of assets. Using a Markov Switching Model for the EBITA/Assets ratio, we have successfully calibrated our model to the empirical data of the return on equity of the EURO STOXX 50 for the time period 2000-2013. We find that dynamics of leverage and trust can be highly nonmonotonous with curved trajectories, as a result of the nonlinear coupling between the variables. This

Changing policies, changing patterns of care

DEFF Research Database (Denmark)

Rostgaard, Tine; Szebehely, Marta

2012-01-01

Despite pursuing the policy of ageing in place, the two Nordic countries of Denmark and Sweden have taken diverse roads in regard to the provision of formal, public tax-financed home care for older people. Whilst Sweden has cut down home care and targeted services for the most needy, Denmark has...... continued the generous provision of home care. This article focuses on the implication of such diverse policies for the provision and combination of formal and informal care resources for older people. Using data from Level of Living surveys (based on interviews with a total of 1,158 individuals aged 67...... countries tax-funded home care is used across social groups but targeting of resources at the most needy in Sweden creates other inequalities: Older people with shorter education are left with no one to resort to but the family, whilst those with higher education purchase help from market providers...

Ethical challenges: Trust and leadership in dementia care.

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Jakobsen, Rita; Sørlie, Venke

2016-09-01

To meet and take care of people with dementia implicate professional and moral challenges for caregivers. Using force happens daily. However, staff also encounter challenges with the management in the units. Managing the caretaking function is also significant in how caretakers experience working in dementia care. The purpose of this study is to explore the caregiver's experiences with ethical challenges in dementia care settings and the significance of professional leadership in this context. The design is qualitative, and data appear through narrative interviews. A total of 23 caretakers participated in the study. The transcribed interviews were subjected to a phenomenological-hermeneutical interpretation. The respondents signed an informed consent for participation prior to the interviews. They were assured anonymity and confidentiality in the publication of the data. Ricoeur's method for interpretation ensures anonymity as the researcher relates to the data as one collective text. The study is part of a larger research project in ethics, in its entirety approved in line with the Helsinki Convention. The findings show that the caretakers experienced inadequacy. Some of them described a negative work atmosphere where they experienced that their leaders did not take them seriously. Because of this, informal negative sub-groups functioned as an exclusive debriefing arena. Some of the informants described the opposite experience where the leaders actively supported them. The analyses of the findings are discussed in light of the concepts of trust and mistrust in leadership. There is a correlation between the leadership and the caregivers' experience of being in difficult situations. © The Author(s) 2015.

Patient-physician trust: an exploratory study.

Science.gov (United States)

Thom, D H; Campbell, B

1997-02-01

Patients' trust in their physicians has recently become a focus of concern, largely owing to the rise of managed care, yet the subject remains largely unstudied. We undertook a qualitative research study of patients' self-reported experiences with trust in a physician to gain further understanding of the components of trust in the context of the patient-physician relationship. Twenty-nine patients participants, aged 26 to 72, were recruited from three diverse practice sites. Four focus groups, each lasting 1.5 to 2 hours, were conducted to explore patients' experiences with trust. Focus groups were audio-recorded, transcribed, and coded by four readers, using principles of grounded theory. The resulting consensus codes were grouped into seven categories of physician behavior, two of which related primarily to technical competence (thoroughness in evaluation and providing appropriate and effective treatment) and five of which were interpersonal (understanding patient's individual experience, expressing caring, communicating clearly and completely, building partnership/sharing power and honesty/respect for patient). Two additional categories were predisposing factors and structural/staffing factors. Each major category had multiple subcategories. Specific examples from each major category are provided. These nine categories of physician behavior encompassed the trust experiences related by the 29 patients. These categories and the specific examples provided by patients provide insights into the process of trust formation and suggest ways in which physicians could be more effective in building and maintaining trust.

Know what you trust

NARCIS (Netherlands)

Spiessens, F.; den Hartog, Jeremy; Etalle, Sandro; Degano, P.; Guttman, J. D.; Martinelli, F.

2009-01-01

In Decentralized Trust Management (DTM) authorization decisions are made by multiple principals who can also delegate decisions to each other. Therefore, a policy change of one principal will often affect who gets authorized by another principal. In such a system of influenceable authorization a

An analysis of National Health Service Trust websites on the occupational backgrounds of 'Non-Executive Directors' on England's Acute Trusts.

Science.gov (United States)

Pritchard, Colin; Harding, Andrew Je

2014-05-01

To explore the occupational backgrounds of English Non-Executive Directors (NED) on Acute National Health Service (NHS) Trusts. Data extrapolated from Trust websites of NED' occupational backgrounds by gender and occupations, and inter-rater reliability test undertaken. Data were available on all but 24 of the 166 Acute Trusts' from all regions. Trust Chairs and NED were categorised by their dominant occupation. Differentiating NED with and without health or social care leadership experience. The ratings of NED' occupations positively correlated (p business' (Francis, 2013) rather than developing a more patient-centred, clinically led and integrated NHS? It is suggested that Boards need more NED with health and social care leadership experience and methods to identify the 'patient's agenda' to create 'a common culture' that places 'patients at the centre of everything we do' (Hunt, 2012). A key context for Trust Boards operations is funding, which Francis' terms of reference excluded, an issue that is briefly discussed.

Requirements engineering for trust management: Model, methodology, and reasoning

NARCIS (Netherlands)

Giorgini, P.; Massacci, F.; Mylopoulos, J.; Zannone, N.

2006-01-01

A number of recent proposals aim to incorporate security engineering into mainstream software engineering. Yet, capturing trust and security requirements at an organizational level, as opposed to an IT system level, and mapping these into security and trust management policies is still an open

When trust is threatened: Qualitative study of parents' perspectives on problematic clinical relationships in child cancer care.

Science.gov (United States)

Davies, Sarah; Salmon, Peter; Young, Bridget

2017-09-01

We explored parents' accounts of the parent-clinician relationship in childhood cancer to understand how parents who perceive threats to the relationship can be supported. Multicentre longitudinal qualitative study, with 67 UK parents of children (aged 1-12 years) receiving treatment for acute lymphoblastic leukaemia. Analyses drew on the wider sample but focussed on 50 semistructured interviews with 20 parents and were informed by constant comparison. All 20 parents described problems with clinical care such as inadequate information or mistakes by staff but varied in how much the problems threatened their sense of relationship with clinicians. Some parents saw the problems as having no relevance to the parent-clinician relationship. Others saw the problems as threats to the clinical relationship but worked to "contain" the threat in ways that preserved a trusting relationship with at least one senior clinician. Parents' containment work protected the security they needed from the parent-clinician relationship, but containment was a tenuous process for some. A few parents were unable to contain the problems at all; lacking trust in clinicians, these parents suffered considerably. Given the complexity of childhood cancer care, problems with clinical care are inevitable. By engaging in containment work, parents met their needs to feel secure in the face of these problems, but the extent to which parents should have to do this work is debatable. Parents could benefit from support to seek help when problems arise which threaten their trust in clinicians. Attachment theory can guide clinicians in giving this support. © 2017 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.

Staff immunisation: policy and practice in child care.

Science.gov (United States)

Spokes, Paula J; Ferson, Mark J; Ressler, Kelly-Anne

2011-08-01

The aims of this study were to determine the level of knowledge among child-care centre directors regarding the National Health and Medical Research Council (NHMRC) recommendations for the immunisation of child-care workers, the extent to which this knowledge was translated into practice and any organisational barriers to the development and implementation of staff immunisation policy. A cross-sectional survey, conducted in August 2006, in which a postal questionnaire was sent to a random sample of 784 NSW child-care centres. Centre directors were asked to complete the questionnaire on immunisation knowledge, policy and practice for the centre. A multivariate logistic-regression model was used to identify factors independently associated with centres with an immunisation policy for staff and centres that offered to pay all or part of the cost of vaccination of staff. Directors from 437 centres participated in the study for a response rate of 56%. Of these, 49% were aware of the NHMRC recommendations, and 57% had a staff immunisation policy in place. In the logistic regression model, centres with a written immunisation policy for staff were more likely to be aware of the NHMRC guidelines and offer long day care services. Centres that offered to pay all or part of the cost of immunisation for staff were more likely to be aware of the NHMRC guidelines, offer other child-care services and not operate for profit. Barriers to staff immunisation were related to the implementation of policy and included cost, time and access to information. The level of awareness of specific staff immunisation recommendations was relatively low. The transition of knowledge to policy was encouraging, although implementation of policies requires further commitment. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Social trust and grassroots governance in rural China.

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Huhe, Narisong; Chen, Jie; Tang, Min

2015-09-01

The relationship between social trust and governance has been one of the focal points of the academic and policy-making communities. Empirical studies on this relationship, however, have focused mostly on democracies. The scarcity of such studies in authoritarian countries has left many important questions unanswered: Is social trust associated with effective governance only in democratic settings? Can social trust improve the quality of governance in non-democracies as well? Drawing on data from 2005 China General Social Survey-a representative survey conducted nationwide at both the individual- and village-level in rural China, this paper attempts to answer these questions empirically by examining the relationship between social trust and the quality of governance in rural China. The findings reveal that different types of social trust-particularized trust and generalized trust-correspond with different effects in rural governance: whereas villagers' trust in people whom they knew personally was positively and significantly associated with the provision of various public goods and services, their trust in strangers had virtually no impact on rural governance. Copyright © 2015 Elsevier Inc. All rights reserved.

Re-thinking accountability: trust versus confidence in medical practice.

Science.gov (United States)

Checkland, K; Marshall, M; Harrison, S

2004-04-01

In seeking to prevent a reoccurrence of scandals such as that involving cardiac surgery in Bristol, the UK government has adopted a model of regulation that uses rules and surveillance as a way of both improving the quality of care delivered and increasing confidence in healthcare institutions. However, this approach may actually act to reduce confidence and trust while also reducing the moral motivation of practitioners. Accountability in health care is discussed, and it is suggested that openness about the difficult dilemmas that arise when practitioners have a duty to be accountable to more than one audience may be an alternative means of restoring trust. A greater emphasis on the sharing of information between individual health professionals and their patients would increase trust and would allow patients to hold their doctors to account for the quality of care they receive. Concentrating more on developing trust by the sharing of information and less on the futile search for complete confidence in systems and rules may improve the quality of care delivered while also nurturing the moral motivation of professionals upon which the delivery of high quality health care depends.

Divorce and Childhood Chronic Illness: A Grounded Theory of Trust, Gender, and Third-Party Care Providers.

Science.gov (United States)

Russell, Luke T; Coleman, Marilyn; Ganong, Lawrence H; Gayer, Debra

2016-05-01

Divorced parents face distinct challenges in providing care for chronically ill children. Children's residence in two households necessitates the development of family-specific strategies to ensure coparents' supervision of regimen adherence and the management of children's health care. Utilizing a risk and resilience perspective, a grounded theory study was conducted with 14 divorced parents of children with chronic illnesses. The importance of trust, gender, and relationships with third-party care providers emerged as key themes related to the development of effective coparenting relationships for maintaining children's health. Divorced parents were best able to support the management of their children's chronic conditions when care providers operated as neutral third parties and intermediaries. Collaborative family care may require health care practitioners to avoid being drawn into contentious inter-parental conflicts. © The Author(s) 2016.

US and territory telemedicine policies: identifying gaps in perinatal care

Science.gov (United States)

Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.

2016-01-01

BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource

Should We Trust in Values? Explaining Public Support for Pro-Environmental Taxes

Directory of Open Access Journals (Sweden)

Sverker C. Jagers

2013-01-01

Full Text Available In this paper we are concerned with what explains public acceptance and support of environmental taxes. We examine findings in environmental psychology emphasizing that people’s (environmental value-orientation is the dominant driver determining individuals’ support for pro-environmental policy instruments. We introduce a complementary model, mainly drawing upon findings in political science, suggesting that people’s support for policy instruments is dependent on their level of political trust and their trust in other citizens. More specifically, we analyze whether political trust and inter-personal trust affect individuals’ support for an increased carbon dioxide tax in Sweden, while checking their value orientation, self-interest, and various socio-economic values. We make use of survey data obtained from a mail questionnaire sent out to a random sample of 3,000 individuals in 2009. We find that apart from people’s values, beliefs, and norms, both political trust and interpersonal trust have significant effects on people's attitudes toward an increased tax on carbon dioxide.

Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model.

Science.gov (United States)

van Rensburg, André Janse; Fourie, Pieter

2016-01-01

Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies. Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed. Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource

Similar and yet so different: cash-for-care in six European countries' long-term care policies.

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Da Roit, Barbara; Le Bihan, Blanche

2010-09-01

In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

The Neurobiology of Trust and Schooling

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Sankey, Derek

2018-01-01

Are there neurobiological reasons why we are willing to trust other people and why "trust" and moral values such as "care" play a quite pivotal role in our social lives and the judgements we make, including our social interactions and judgements made in the context of schooling? In pursuing this question, this paper largely…

Family care work: a policy-relevant research agenda.

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Moen, Phyllis; DePasquale, Nicole

2017-03-01

This article addresses the need for policy-relevant research agendas on family care in transaction with formal care and public as well as organisational norms and policies in light of the crisis in caregiving for older adults. We propose a combined institutional and life-course theoretical approach, suggesting seven ways of organising scholarly enquiry to promote understanding of the changing nature of family care in the 21st century, inform policymakers' efforts at supporting family caregivers and improve caregivers' and care recipients' quality of life. These include: (1) moving beyond snapshots of individuals; (2) conducting comparative cross-cultural and crosscohort analyses; (3) documenting social heterogeneity, vulnerability and inequality; (4) capturing individuals' and families' adaptive strategies and cycles of control during the caregiving process; (5) investigating policy innovations and natural experiments; (6) assessing third parties as mediating institutions between regulatory environments and caregiving families; and (7) attending to the subjective meanings of care.

Trust, power, and vulnerability: a discourse on helping in nursing.

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Carter, Michele A

2009-12-01

This article uses philosophical inquiry to present the relationship between the helping role in nursing and the concept of trust essential to it. It characterizes helping as the moral center of the nurse-patient relationship and discusses how patients' expectations of help and caring create obligations of trustworthiness on the part of the nurse. It uses literature from various disciplines to examine different theoretical accounts of trust, each presenting important features of trust relationships that apply to health care professionals, patients, and families. Exploring the concept of trust, and the key leverage points that elicit it, develops a thesis that nurses can improve their understanding of the principal attributes and the conditions that foster or impede trust. The article concludes that trust is the core moral ingredient of helping relationships. Trust as a moral value is even more basic than duties of beneficence, respect, veracity, and autonomy. Trust is the confident expectation that others can be relied upon to act with good will and to secure what is best for the person seeking help.

Young entrepreneurs’ trust during the recession: Evidence from Serbia

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Babić Vojislav

2015-01-01

Full Text Available This paper deals with the influence of positive trust on business activities, entrepreneurship development, and economic growth. During the global recession, institutions make numerous decisions to find answers to the crisis that influence the behaviour of entrepreneurs. In such situations, significant stocks of trust are of great importance for economy stability and the motivation of future entrepreneurs. In the first section the terms, functions, and types of trust are defined. The second section presents the results of measuring the interpersonal and institutional trust of young entrepreneurs, representatives of future entrepreneurship and business and bearers of networking ideas in Serbia. The results show that young entrepreneurs have a serious trust deficit, which is worrying in people who are potential future business leaders. Only one fifth of the respondents intends to start their own firm when they have finished studying. The reasons most often given are that government economic policy and monopolies hamper starting a business. Most of the respondents thought that the government should be more involved in providing a better environment for medium and small business. Most respondents believed that the Serbian recession was caused foremost by wrong governmental economic policy, followed by corruption.

'Trust and teamwork matter': community health workers' experiences in integrated service delivery in India.

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Mishra, Arima

2014-01-01

A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011-2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive 'teamwork' and 'building trust with the community' (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology - which the health workers espouse - is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration.

Trust as the Foundation of Resource Exchange in GENI

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Marshall Brinn

2015-08-01

Full Text Available Researchers and educators in computer science and other domains are increasingly turning to distributed test beds that offer access to a variety of resources, including networking, computation, storage, sensing, and actuation. The provisioning of resources from their owners to interested experimenters requires establishing sufficient mutual trust between these parties. Building such trust directly between researchers and resource owners will not scale as the number of experimenters and resource owners grows. The NSF GENI (Global Environment for Network Innovation project has focused on establishing scalable mechanisms for maintaining such trust based on common approaches for authentication, authorization and accountability. Such trust reflects the actual trust relationships and agreements among humans or real-world organizations. We describe here GENI’s approaches for federated trust based on mutually trusted authorities, and implemented via cryptographically signed credentials and shared policies.

Trust Trust Me (The Additivity)

OpenAIRE

Mano , Ken; Sakurada , Hideki; Tsukada , Yasuyuki

2017-01-01

Part 4: Trust Metrics; International audience; We present a mathematical formulation of a trust metric using a quality and quantity pair. Under a certain assumption, we regard trust as an additive value and define the soundness of a trust computation as not to exceed the total sum. Moreover, we point out the importance of not only soundness of each computed trust but also the stability of the trust computation procedure against changes in trust value assignment. In this setting, we define tru...

Monetary and Fiscal Policies for a Finite Planet

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Adam Scanlan

2013-06-01

Full Text Available Current macroeconomic policy promotes continuous economic growth. Unemployment, poverty and debt are associated with insufficient growth. Economic activity depends upon the transformation of natural materials, ultimately returning to the environment as waste. Current levels of economic throughput exceed the planet’s carrying capacity. As a result of poorly constructed economic institutions, society faces the unacceptable choice between ecological catastrophe and human misery. A transition to a steady-state economy is required, characterized by a rate of throughput compatible with planetary boundaries. This paper contributes to the development of a steady-state economy by addressing US monetary and fiscal policies. A steady-state monetary policy would support counter-cyclical, debt-free vertical money creation through the public sector, in ways that contribute to sustainable well-being. The implication for a steady-state fiscal policy is that any lending or spending requires a careful balance of recovery of money, not as a means of revenue, but as an economic imperative to meet monetary policy goals. A steady-state fiscal policy would prioritize targeted public goods investments, taxation of ecological “bads” and economic rent and implementation of progressive tax structures. Institutional innovations are considered, including common asset trusts, to regulate throughput, and a public monetary trust, to strictly regulate money supply.

Moderating Effects of Trust on Environmentally Significant Behavior in Korea

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Seong-Gin Moon

2017-03-01

Full Text Available To treat environmental problems and to seek sustainable development, voluntary and cooperative efforts, which is really against the traditional mentality with the emphasis on the individual competitive optimization, became the key to maintain the sustainability of complex social and ecological systems. To understand the cooperative and voluntary individual’s environmentally significant behavior (ESB, this paper focuses on the role of trust, and assesses the effect of trust on the relationship between existing factors and ESB. A structural equation model (SEM is constructed to estimate the moderating effects of trust on ESB in Korea. We found that people with a negative view on strict environmental regulations do not exhibit ESB and thus nudge policies could be much more effective than the forceful measure. It is noteworthy that public private partnership, as a kind of optimal trust, should be more promoted in the environmental protection policies.

Access control, security, and trust a logical approach

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Chin, Shiu-Kai

2010-01-01

Access Control, Security, Trust, and Logic Deconstructing Access Control Decisions A Logical Approach to Access Control PRELIMINARIES A Language for Access ControlSets and Relations Syntax SemanticsReasoning about Access Control Logical RulesFormal Proofs and Theorems Soundness of Logical RulesBasic Concepts Reference Monitors Access Control Mechanisms: Tickets and Lists Authentication Security PoliciesConfidentiality, Integrity, and Availability Discretionary Security Policies Mandatory Security Policies Military Security Policies Commercial PoliciesDISTRIBUTED ACCESS CONTROL Digital Authenti

Care ‘going market’: Finnish elderly-care policies in transition

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Anneli Anttonen

2011-06-01

-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} The article evaluates marketization and its effects on elderly-care policies in Finland, where the welfare state has been the most important mechanism in mitigating failures caused by the functioning of market. In addition, since the 1960s the public sector has been regarded as the guarantee for citizens' social rights and the common good. Therefore, marketization, denoting to market logics intervened with social-care practices that construct care as a commodity and the individual in need of care as a consumer, is a critical juncture for an evaluation of the underlying pattern change. To evaluate the change this article employs a framework of institutional policy analysis. By focusing on institutional framing of care policies, institutionalized responsibilities, policy discourses, and policy outcomes and by using textual and statistical data, this article aims to reach a detailed but comprehensive picture on marketization and its influence in the Finnish social-care regime. All institutional aspects analysed in the study show a clear transition from universal social policies based on public responsibility to market-friendly policies and the marketization of social care. However, they also imply that marketization is regulated by public authorities. On the basis of these results, we argue that Finnish elderly-care policies is going through a profound change, in magnitude similar to what occurred 30-40 years ago when the politics of universalism was breaking through. The new direction points to the market and a deep-going reform of social-care service provision is taking place, and the earlier state-centred welfare production mode is at least partly withering away. In this respect the pattern of social-care service

How Academic Health Systems Can Achieve Population Health in Vulnerable Populations Through Value-Based Care: The Critical Importance of Establishing Trusted Agency.

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Wesson, Donald E; Kitzman, Heather E

2018-01-16

Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.

Trust Account Fraud And Effective Information Security Management

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Sameera Mubarak

2010-09-01

Full Text Available The integrity of lawyers trust accounts has come under scrutiny in the last few years. There are strong possibilities of information technology security breaches happening within the firms, either accidental or deliberate. The damage caused by these security breaches could be extreme. For example, a trust account fund in an Australian law firm was misused in a security breach in which Telstra charged. A$50,000 for phone usage, mainly for ISD calls to Hong Kong.Our study involved interviewing principles of ten law companies to find out solicitors attitudes to computer security and the possibility of breaches of their trust accounts. We simultaneously carried out a survey to see if the trends identified in our case-studies could be backed up with broader quantitative data. We have also conducted in-depth interviews of 5 trust account regulators from the Law society of South Australia to know their view points on security threats on trust accounts. An overall finding highlights that law firms were not current with technology to combat computer crime, and inadequate access control was a major concern in safeguarding account data. Our conclusions revealed the urgent need for law firms to adopt security controls, implement information security policies and procedures and obtain cooperation from management to communicate these policies to staff.

Effects of Perceived Discrimination and Trust on Breast Cancer Screening among Korean American Women.

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Hong, Hye Chong; Ferrans, Carol Estwing; Park, Chang; Lee, Hyeonkyeong; Quinn, Lauretta; Collins, Eileen G

Korean American (KA) women continue to have lower breast cancer screening rates than other racial groups. Perceived discrimination and trust have been associated with breast cancer screening adherence, but little is known about the associations in KA women. Surveys were completed by 196 KA women in the Chicago metropolitan area. Multiple and Firth logistic regression analyses were performed to identify factors (perceived discrimination, trust, acculturation, cultural beliefs, health care access) influencing breast cancer screening adherence (mammogram). In addition, SPSS macro PROCESS was used to examine the mediating role of trust between perceived discrimination and breast cancer screening adherence. Ninety-three percent of the women surveyed had health insurance and 54% reported having a mammogram in the past 2 years. Predictors of having a mammogram were knowing where to go for a mammogram, having a regular doctor or usual place for health care, greater trust in health care providers, and lower distrust in the health care system. Perceived discrimination had an indirect effect on breast cancer screening through trust. The breast cancer screening rate among KA women is low. Perceived discrimination in health care, trust in health care providers, and distrust in the health care system directly or indirectly influenced breast cancer screening adherence in KA women. Trust is a factor that can be strengthened with educational interventions. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

INNOVATION - THE ROLE OF TRUST

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Kornélia Lazányi

2017-11-01

Full Text Available Innovations and constant change are inevitable parts of our everyday lives. It is not only because advanced technologies are more effective, but mostly because in the 21st century more and more realise that scarce resources – among them the safe and clean environment as such - necessitate a paradigm change and intense innovation. This revolution is easily trackable in the organisational and (supranational policies. However, innovation, and its necessary prerequisites are seldom investigated from the individuals’ point of view. It is easy to understand that inter-organisational trust is inevitable on both the consumers’ and the providers’ (innovators’ side, however, it has to be made clear that an innovative organisation has to create a trusting environment within the company, in order to foster collaboration, the generation of new ideas, creativity and finally innovation. The present paper endeavours to call attention to the notion of trust and its antecedents and consequences in relation to innovations. The aim is to provide assistance in understanding how to develop trust in each other and hence foster further innovations and development.

Problems of judiciary trust

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Vuković Slobodan

2007-01-01

Full Text Available Topic of the article is problem of trust in judiciary as a most important part of legal system. For all empirical researches so far have shown very law degree of this trust many authors were searching for the causes of this phenomenon. Among multifold causes some are special worth while to be mentioned here: historical inheritance, political pressures, delaying of judiciary decisions, respect of the laws, transferring of responsibility from political power to the judiciary, public comments of judiciary decisions, media pressures, efficiency of judiciary and police. Among inner factors author pays attention to competency of judges, modes of penal policy, modes of judges’ entitlement, problems of communication, involvement into criminal and corruptional affairs, etc.

Palliative care policy analysis in Iran: A conceptual model

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Mojgan Ansari

2018-01-01

Full Text Available Background: Palliative care programs are rapidly evolving for patients with life-threatening illnesses. Increased and earlier access for facilities is a subject of growing importance in health services, policy, and research. Aim: This study was conducted to explain stakeholders' perceptions of the factors affecting the design of such a palliative care system and its policy analysis. Methodology: Semi-structured in-depth interviews conducted following purposive sampling of the participants. Twenty-two participants were included in the study. The interviews were analyzed using qualitative-directed content analysis based on "policy analysis triangle" framework. Results: The findings showed the impact of four categories, namely context (political, social, and structural feasibility, content (target setting, process (attracting stakeholder participation, the standardization of care, and education management, and actors (the Ministry of Health and Medical Education, health-care providers, and volunteers in the analysis of the palliative care policies of Iran. Conclusion: In the past 6 years, attention to palliative care has increased significantly as a result of the National Cancer Research Network with the support of the Ministry of Health. The success of health system plan requires great attention to its aspects of social, political, and executive feasibility. Careful management by policymakers of different stakeholders is vital to ensure support for any national plan, but this is challenging to achieve.

Policy choices in dementia care-An exploratory analysis of the Alberta continuing care system (ACCS) using system dynamics.

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Cepoiu-Martin, Monica; Bischak, Diane P

2018-02-01

The increase in the incidence of dementia in the aging population and the decrease in the availability of informal caregivers put pressure on continuing care systems to care for a growing number of people with disabilities. Policy changes in the continuing care system need to address this shift in the population structure. One of the most effective tools for assessing policies in complex systems is system dynamics. Nevertheless, this method is underused in continuing care capacity planning. A system dynamics model of the Alberta Continuing Care System was developed using stylized data. Sensitivity analyses and policy evaluations were conducted to demonstrate the use of system dynamics modelling in this area of public health planning. We focused our policy exploration on introducing staff/resident benchmarks in both supportive living and long-term care (LTC). The sensitivity analyses presented in this paper help identify leverage points in the system that need to be acknowledged when policy decisions are made. Our policy explorations showed that the deficits of staff increase dramatically when benchmarks are introduced, as expected, but at the end of the simulation period, the difference in deficits of both nurses and health care aids are similar between the 2 scenarios tested. Modifying the benchmarks in LTC only versus in both supportive living and LTC has similar effects on staff deficits in long term, under the assumptions of this particular model. The continuing care system dynamics model can be used to test various policy scenarios, allowing decision makers to visualize the effect of a certain policy choice on different system variables and to compare different policy options. Our exploration illustrates the use of system dynamics models for policy making in complex health care systems. © 2017 John Wiley & Sons, Ltd.

The grounded theory of "trust building".

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Ramezani, Monir; Ahmadi, Fazlollah; Mohammadi, Eesa; Kazemnejad, Anoshirvan

2017-01-01

Despite the growing importance of spiritual care, the delivery of spiritual care is still an area of disagreement among healthcare providers. To develop a grounded theory about spiritual care delivery based on Iranian nurses' perceptions and experiences. A grounded theory approach: A qualitative study using the grounded theory approach. Participants and research context: Data were collected through holding 27 interviews with 25 participants (17 staff nurses, 3 physicians, 3 patients, 1 family member, and 1 nurse assistant). The study setting was the Imam Khomeini Hospital Complex. Sampling was started purposively and continued theoretically. Data analysis was performed by the method proposed by Strauss and Corbin. Ethical consideration: The study was approved by the Ethics Committee of Tarbiat Modares University and the agreement of the administrators of the study setting was got before starting the study. The core category of the study was "Trust building" which reflected the nature of spiritual care delivery by nurses. Trust building was the result of eight main categories or strategies including creating a positive mentality at hospital admission, understanding patients in care circumstances, having a caring presence, adhering to care ethics, developing meaningful relationships, promoting positive thinking and energy, establishing effective communication with patients, and attempting to create a safe therapeutic environment. Poor interprofessional coordination negatively affected this process while living toward developing greater cognizance of divinity and adhering to the principles of professional ethics facilitated it. The outcome of the process was to gain a sense of partial psychological security. The "Trust building" theory can be used as a guide for describing and expanding nurses' roles in spiritual care delivery, developing care documentation systems and clinical guidelines, and planning educational programs for nursing students and staff nurses.

Trust - Essential Requirement and Basis for pHealth Services.

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Ruotsalainen, Pekka; Blobel, Bernd

2017-01-01

Trust is a social code and glue between persons and organizations in any business domain including health. pHealth is a complex concept that is built around health service providers, individuals and artefacts such as sensors, mobile devices, networks, computers, and software applications. It has many stakeholders such as organizations, persons, patients, customers, and tele-operators. pHealth services are increasingly offered in insecure information space, and used over organizational, geographical and jurisdictional borders. This all means that trust is an essential requirement for successful pHealth services. To make pHealth a successful business, organizations offering pHealth services should establish inter-organizational trust and trusted relationship between their customers. Before starting to use services, the pHealth user should have a possibility to define how much it trusts on the service provider and on the surrounding information infrastructure. The authors' analysis show that trust models used in today's health care and e-commerce are insufficient for networked pHealth. Calculated trust as proposed by the authors is stronger than the predefined dispositional trust model currently used in health care, other's recommendations used in e-commerce and risk assessment. Until now, caused by the lack of business incentive, lack of regulatory and political pressure, pHealth providers have not demonstrated meaningful interest in moving from the current unsatisfactory situation to trust calculation by making information necessary for this methodology available. To make pHealth successful, a combination of legal, political, organizational, technological and educational efforts is needed to initiate the paradigm change and start the era of trust-based pHealth services.

Enacting Trust

OpenAIRE

Campbell, Brian

2012-01-01

Small and removed from the Spanish mainland, the Enclave of Ceuta has always depended\\ud on flows of goods and labour out of the Moroccan hinterland, with individuals from\\ud different ethnic and religious groups forming informal, flexible and personal economic\\ud bonds based on mutual ‘confianza’ (trust). Since its entry into the European Union in 1986,\\ud the Spanish government has erected a border-wall around the enclave, and introduced new\\ud migration policies branding many informal work...

"Who Cares for the Children?" Lessons from a Global Perspective of Child Care Policy

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Lokteff, Maegan; Piercy, Kathleen W.

2012-01-01

We present the argument that the meaning of child care and the policies that address it are explicitly linked with national ideologies, work force participation, economic success, and child outcomes. The relationship between family and child care policies is cyclical in nature, with a nation's ideology and vision of family often driving child care…

Perceptions of work-time and leisure-time among managers and field staff in a UK primary health care trust.

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Brown, Reva Berman; Adebayo, Shirley A

2004-09-01

The aims of the research were to explore the issues around the perception of District Nurses in an inner London Primary Health Care Trust of their use of work-time and leisure-time, and to reveal how the boundaries between these two aspects can become blurred and impinge on each other. Time use is helpful in considerations of wider issues such as satisfaction at work and work-life balance. The data were collected by a questionnaire to seek the views of managers and field staff on issues such as the impact on the quality of patient care of the nurses' perception of work-time and leisure-time. The research identified the different perception of "work-time" that employees have in relation to their place within the hierarchical structure. The findings answered the question of whether time is perceived differently, dependent on one's occupation within the Trust.

Trust in the institutions of the European Union: A cross-country examination

OpenAIRE

Eliyahu V. Sapir and Galina Zapryanova Christine Arnold

2012-01-01

Trust in political institutions is one of the key elements which make representative democracies work. Trust creates a connection between citizens and representative political institutions. Democratic governments which enjoy a large degree of trust also tend to have higher degrees of legitimacy and policy efficacy. In Europe’s multi-level governance structure, it is imperative to understand the determinants of trust in the institutions of the European Union. With the increasing salience of ...

Does Variation in the Extent of Generalized Trust, Individual Education and Extensiveness of Social Security Policies Matter for Maximization of Subjective Well-Being?

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Valeeva, Rania F.

2016-01-01

In this paper, I examine whether generalized trust and education, as well as social security policies of welfare state institutions matter for cross-national differences in subjective well-being (SWB), because knowledge on this issue is still lacking. For this purpose I integrated the insights of two sociological theories: Social Function…

Trusting the state, trusting each other?

DEFF Research Database (Denmark)

Sønderskov, Kim Mannemar; Dinesen, Peter Thisted

2016-01-01

Trust in state institutions is a prominent explanation of social trust. However, previous—mainly cross-sectional—analyses provide limited causal evidence regarding the relationship between institutional trust and social trust and it is thus essentially unknown whether an observed relationship...... reflects reverse causality (social trust forming institutional trust), or both forms of trust reflecting deep-seated dispositions (common confounding). Against the backdrop of the shortcomings of previous cross-sectional analyses, this paper utilizes two Danish panel surveys containing measures of both...... types of trust for the same individuals surveyed at multiple points in time over a long time-span (up to 18 years) to address the potentially reverse and/or spurious relationship. Using individual fixed effects and cross-lagged panel models, the results provide strong evidence of trust in state...

Advance care planning for nursing home residents with dementia: policy vs. practice.

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Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2016-03-01

The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

Investigation of the trust status of the nurse-patient relationship.

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Ozaras, Gözde; Abaan, Süheyla

2016-09-07

Professional nurses provide holistic healthcare to people and deal with patients closely. Furthermore, patients need nurses to do self-care and patients trust them for their treatments. Therefore, trust is extremely important in a professional care relationship and in satisfactory patient outcomes. The aim of this study was to examine the patients' views on the trust status toward nurses and the factors important for the development of trust in a nurse-patient relationship. This research was planned as a descriptive cross-sectional study. The study was carried out between April and July 2014 at the oncology hospital of a university in Ankara, Turkey. The sample size was calculated by power analysis and was composed of 356 inpatients diagnosed with cancer. For data collection, a questionnaire and the "Trust in Nurses Scale" were used. FROM THE HOSPITAL AND WRITTEN INFORMED CONSENT OBTAINED FROM PARTICIPATING PATIENTS: Approval from the University Clinical Research Ethics Committee was obtained. Written approval was obtained from the hospital and consent letter from the patients. The average score on the scale was 24.5 ± 3.9, meaning that patients had a high level of trust toward nurses in this hospital. The patients who were in the 50-59 age group and men had statistically higher scores compared with other groups. Patients' answers revealed that themes of "Personal and Professional Characteristics" were important when developing trust, however "Mistreatment, Professional Incapability, and Communication Problem" were important causing mistrust toward the nurses. In this study, the nurses' professional competencies and interpersonal caring attributes emerged as most important in developing trust. This study paid attention to the values and attitudes that develop patients' trust toward nurses. Moreover, the findings raise ethical questions about how the patients' basic rights are to be protected and how their trust level can be heightened. Nurse managers need to

Framework model and principles for trusted information sharing in pervasive health.

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Ruotsalainen, Pekka; Blobel, Bernd; Nykänen, Pirkko; Seppälä, Antto; Sorvari, Hannu

2011-01-01

Trustfulness (i.e. health and wellness information is processed ethically, and privacy is guaranteed) is one of the cornerstones for future Personal Health Systems, ubiquitous healthcare and pervasive health. Trust in today's healthcare is organizational, static and predefined. Pervasive health takes place in an open and untrusted information space where person's lifelong health and wellness information together with contextual data are dynamically collected and used by many stakeholders. This generates new threats that do not exist in today's eHealth systems. Our analysis shows that the way security and trust are implemented in today's healthcare cannot guarantee information autonomy and trustfulness in pervasive health. Based on a framework model of pervasive health and risks analysis of ubiquitous information space, we have formulated principles which enable trusted information sharing in pervasive health. Principles imply that the data subject should have the right to dynamically verify trust and to control the use of her health information, as well as the right to set situation based context-aware personal policies. Data collectors and processors have responsibilities including transparency of information processing, and openness of interests, policies and environmental features. Our principles create a base for successful management of privacy and information autonomy in pervasive health. They also imply that it is necessary to create new data models for personal health information and new architectures which support situation depending trust and privacy management.

Acceptance of selective contracting: the role of trust in the health insurer.

Science.gov (United States)

Bes, Romy E; Wendel, Sonja; Curfs, Emile C; Groenewegen, Peter P; de Jong, Judith D

2013-10-02

In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees' trust in the health insurer on their acceptance of selective contracting. An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. This study provides insight into factors that influence people's acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop.

Acceptance of selective contracting: the role of trust in the health insurer

Science.gov (United States)

2013-01-01

Background In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees’ trust in the health insurer on their acceptance of selective contracting. Methods An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Results Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. Conclusion This study provides insight into factors that influence people’s acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop. PMID:24083663

Trust and the transformation of energy systems

Energy Technology Data Exchange (ETDEWEB)

Rayner, Steve [James Martin Institute for Science and Civilization, Said Business School, Park End Street, Oxford, OX1 1HP (United Kingdom)

2010-06-15

The author looks at diverse concepts and roles of trust in the challenge of decarbonising energy systems, drawing on 25 years of personal experience in the fields of energy and environmental policy research. The paper focuses on three issues-public trust in science, institutional trust in making technology choices, and the idea that high-trust societies are more sustainable than those exhibiting low-trust. While trust is a key concept in understanding the public acceptability of technology choices, it is only one of a suite of interrelated concepts that must be addressed, which also includes liability, consent, and fairness. Furthermore, rational distrust among competing institutional world views may be critical in understanding the role of social capital in socioeconomic and technological development. Thus the concept of trust has become a portmanteau, carrying a diverse range of ideas and conditions for sustainable energy systems. The paper concludes with three emphases for decision makers. First, the issue is the energy system, not particular generating technologies. Second, the energy system must be recognized to be as much a social system as it is a technical one. Third, the system requires incorporation of the minimum level of diversity of engineering technologies and social actors to be sustainable. (author)

Trust and the transformation of energy systems

International Nuclear Information System (INIS)

Rayner, Steve

2010-01-01

The author looks at diverse concepts and roles of trust in the challenge of decarbonising energy systems, drawing on 25 years of personal experience in the fields of energy and environmental policy research. The paper focuses on three issues-public trust in science, institutional trust in making technology choices, and the idea that high-trust societies are more sustainable than those exhibiting low-trust. While trust is a key concept in understanding the public acceptability of technology choices, it is only one of a suite of interrelated concepts that must be addressed, which also includes liability, consent, and fairness. Furthermore, rational distrust among competing institutional world views may be critical in understanding the role of social capital in socioeconomic and technological development. Thus the concept of trust has become a portmanteau, carrying a diverse range of ideas and conditions for sustainable energy systems. The paper concludes with three emphases for decision makers. First, the issue is the energy system, not particular generating technologies. Second, the energy system must be recognized to be as much a social system as it is a technical one. Third, the system requires incorporation of the minimum level of diversity of engineering technologies and social actors to be sustainable.

Protecting care home residents from mistreatment and abuse: on the need for policy

Directory of Open Access Journals (Sweden)

Phelan A

2015-11-01

Full Text Available Amanda Phelan School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland Abstract: With a rising older person population with increasing life expectancies, the demand for care homes will increase in the future. Older people in care homes are particularly vulnerable due to their dependencies related to cognitive and/or functional self-care challenges. Although many care homes provide good care, maltreatment and abuse of older people can and does occur. One major step in preventing and addressing maltreatment in care homes is having comprehensive and responsive policy, which delineates national expectations that are locally implemented. This paper examines the literature related to maltreatment in care homes and argues for policy based on a multisystems approach. Policy needs to firstly acknowledge and address general societal issues which tacitly impact on older person care delivery, underpin how care homes and related systems should be operationalized, and finally delineate expected standards and outcomes for individual experience of care. Such a policy demands attention at every level of the health care and societal system. Furthermore, contemporary issues central to policy evolution in care homes are discussed, such as safeguarding education and training and fostering organization whistle-blowing protection. Keywords: care homes, maltreatment, policy, older people

Does a Consumer-Targeted Deprescribing Intervention Compromise Patient-Healthcare Provider Trust?

Science.gov (United States)

Zhang, Yi Zhi; Turner, Justin P; Martin, Philippe; Tannenbaum, Cara

2018-04-16

One in four community-dwelling older adults is prescribed an inappropriate medication. Educational interventions aimed at patients to reduce inappropriate medications may cause patients to question their prescriber’s judgment. The objective of this study was to determine whether a patient-focused deprescribing intervention compromised trust between older adults and their healthcare providers. An educational brochure was distributed to community-dwelling older adults by community pharmacists in order to trigger deprescribing conversations. At baseline and 6-months post-intervention, participants completed the Primary Care Assessment Survey, which measures patient trust in doctors and pharmacists. Changes in trust were ascertained post-intervention. Proportions with 95% confidence intervals (CI), and logistic regression were used to determine a shift in trust and associated predictors. 352 participants responded to the questionnaire at both time points. The majority of participants had no change or gained trust in their doctors for items related to the choice of medical care (78.5%, 95% CI = 74.2–82.8), communication transparency (75.4%, 95% CI = 70.7–79.8), and overall trust (81.9%, 95% CI = 77.9–86.0). Similar results were obtained for participants’ perceptions of their pharmacists, with trust remaining intact for items related to the choice of medical care (79.4%, 95% CI = 75.3–83.9), transparency in communicating (82.0%, 95% CI = 78.0–86.1), and overall trust (81.6%, 95% CI = 77.5–85.7). Neither age, sex nor the medication class targeted for deprescribing was associated with a loss of trust. Overall, the results indicate that patient-focused deprescribing interventions do not shift patients’ trust in their healthcare providers in a negative direction.

Does a Consumer-Targeted Deprescribing Intervention Compromise Patient-Healthcare Provider Trust?

Directory of Open Access Journals (Sweden)

Yi Zhi Zhang

2018-04-01

Full Text Available One in four community-dwelling older adults is prescribed an inappropriate medication. Educational interventions aimed at patients to reduce inappropriate medications may cause patients to question their prescriber’s judgment. The objective of this study was to determine whether a patient-focused deprescribing intervention compromised trust between older adults and their healthcare providers. An educational brochure was distributed to community-dwelling older adults by community pharmacists in order to trigger deprescribing conversations. At baseline and 6-months post-intervention, participants completed the Primary Care Assessment Survey, which measures patient trust in doctors and pharmacists. Changes in trust were ascertained post-intervention. Proportions with 95% confidence intervals (CI, and logistic regression were used to determine a shift in trust and associated predictors. 352 participants responded to the questionnaire at both time points. The majority of participants had no change or gained trust in their doctors for items related to the choice of medical care (78.5%, 95% CI = 74.2–82.8, communication transparency (75.4%, 95% CI = 70.7–79.8, and overall trust (81.9%, 95% CI = 77.9–86.0. Similar results were obtained for participants’ perceptions of their pharmacists, with trust remaining intact for items related to the choice of medical care (79.4%, 95% CI = 75.3–83.9, transparency in communicating (82.0%, 95% CI = 78.0–86.1, and overall trust (81.6%, 95% CI = 77.5–85.7. Neither age, sex nor the medication class targeted for deprescribing was associated with a loss of trust. Overall, the results indicate that patient-focused deprescribing interventions do not shift patients’ trust in their healthcare providers in a negative direction.

Examining trust in health professionals among family caregivers of nursing home residents with advanced dementia.

Science.gov (United States)

Boogaard, Jannie A; Werner, Perla; Zisberg, Anna; van der Steen, Jenny T

2017-12-01

In a context of increasing emphasis on shared decision-making and palliative care in dementia, research on family caregivers' trust in health professionals in advanced dementia is surprisingly scant. The aim of the present study was to assess trust in nursing home health professionals of family caregivers of nursing home residents with advanced dementia, and possible correlates, such as family caregivers' satisfaction, involvement in care, care burden and patients' symptom burden. A cross-sectional study was carried out using structured questionnaires administered through the telephone. Generalized estimating equation analyses with adjustment for nursing home clustering were applied to assess the most important associations with family caregivers' trust. A total of 214 family caregivers of persons with dementia residing in 25 nursing homes participated in the study. The majority of the participants (67%) were women and adult children (75%). The majority of the family caregivers trusted physicians, nurses and nurses' aides at a moderate-to-high level. Approximately half to one-third reported moderate-to-low levels of trust. Higher levels of trust were associated with more positive care outcomes, such as higher family satisfaction with care and more positive evaluations of physician-family communication. The present study showed the importance of family caregivers trusting nursing home health professionals for their experiences as caregivers. Although causation cannot be established, increased family caregivers' trust in nursing home health professionals by improving communication and exchange of information might provide a good basis for providing optimal palliative care in advanced dementia. Geriatr Gerontol Int 2017; 17: 2466-2471. © 2017 Japan Geriatrics Society.

Designing and implementing a trust-wide quality assurance programme.

Science.gov (United States)

Coope, Sally-Ann

2018-04-02

Derbyshire Community Health Services (DCHS) NHS Foundation Trust provides a wide range of community-based health services. After the Care Quality Commission (CQC) found gaps in the trust's assurance process, its board decided to develop a method of continuous quality improvements that could be used as a basis for the trust's quality assurance system. The trust adapted and built on an acute model so it was suitable for community services. The final assurance system, Quality Always, has four elements: the clinical assessment and accreditation scheme; leadership development; 'champions' within clinical teams to support and promote the scheme; and dashboards to record and monitor progress. A system to recognise and reward achievement was essential for success. Quality Always has resulted in better care quality, an improved CQC rating, a sense of achievement among staff, the development of support networks, learning (especially among support staff) and good practice being shared.

"Then They Trust You …": Managing Ergonomics in Home Care.

Science.gov (United States)

Love, Marsha; Tendick-Matesanz, Felipe; Thomason, Jane; Carter, Davine; Glassman, Myra; Zanoni, Joseph

2017-08-01

The home care workforce, already at 2.7 million caregivers, will become the nation's fastest growing occupation by 2024 as the senior boom generation accelerates the demand for in home services to meet its long-term care needs. The physically challenging work of assisting clients with intimate, essential acts of daily living places home care workers (HCWs) at risk for musculoskeletal disorders (MSDs); yet, HCWs typically receive little formal job training and may lack appropriate assistive devices. In this qualitative pilot study, HCW focus groups described workplace MSD risk factors and identified problem-solving strategies to improve ergonomic conditions. The results revealed that HCWs rely on their behavioral insights, self-styled communications skills and caring demeanor to navigate MSD risks to themselves and increase clients' physical independence of movement. We suggest changes in employer and government policies to acknowledge HCWs as valued team members in long-term care and to enhance their effectiveness as caregivers.

Social Trust, Safety and the Choice of Tourist Destination

DEFF Research Database (Denmark)

Jensen, Susanne; Svendsen, Gert Tinggaard

2016-01-01

Does social trust influence safety and tourists’ destination choice? Our claim is that the roots of safety may take two forms: either formal institutions or informal institutions. Formal institutions concern how society can build up control mechanisms through the legal system, police authority...... and military. The problem is that high visibility of police and military in public spaces may give the tourist the impression of an unsafe and insecure destination. Instead, social trust through self-enforcements of social norms for behaviour may be important because the informal institutions guarantee...... the safety of tourists (and locals) without signalling a problem with safety. Building social trust may further enhance the feeling of safety and thereby attract even more tourists. Thus, our trust-safety theory may guide the active use of social trust by tourist officials and policy makers....

Ethical dilemmas in community mental health care.

Science.gov (United States)

Liégeois, A; Van Audenhove, C

2005-08-01

Ethical dilemmas in community mental health care is the focus of this article. The dilemmas are derived from a discussion of the results of a qualitative research project that took place in five countries of the European Union. The different stakeholders are confronted with the following dilemmas: community care versus hospital care (clients); a life with care versus a life without care (informal carers); stimulation of the client toward greater responsibility versus protection against such responsibility (professionals); budgetary control versus financial incentives (policy makers), and respect for the client versus particular private needs (neighbourhood residents). These dilemmas are interpreted against the background of a value based ethical model. This model offers an integral approach to the dilemmas and can be used to determine policy. The dilemmas are discussed here as the result of conflicting values-namely autonomy and privacy, support and safety, justice and participation, and trust and solidarity.

Social trust and ionizing radiation

Energy Technology Data Exchange (ETDEWEB)

Meadd, E. [Faculty of Environmental Studies, York University, Toronto, Ontario (Canada)

2002-07-01

The linkages that exist between the environmental risks associated with nuclear energy production (both perceived and real) and the myriad of social and political issues and processes that influence social trust are a current issue in literature, but are not well explored, particularly for the Canadian context. This paper will examine one particular issue and its relationship with social trust: ionizing radiation and public health. Social trust is defined for this paper as including interpersonal trust, but having a much broader focus, extending to public trust in governments, institutions, corporations, and the power elite, and across whole societies. Of particular interest for the nuclear energy issue is how waning social trust may impact the functioning of democratic decision-making processes, particularly those associated with the siting of waste facilities. Social trust is a central issue in the management of environmental risks, particularly those related to high technology; its absence is seen as a major cause of intractable conflict in decisions related to nuclear power generation and waste disposal. Understanding the dynamics of social trust is important if a resolution is to be found to the nuclear waste management debate in Canada, that is, one that involves broad public, or social, support. For instance, what factors cause distrust to emerge, and when distrust emerges, what authorities do members of affected communities seek out for information and support? This paper begins to examine social trust in relation to human health and ionizing radiation, particularly low dose radiation from radioactive wastes resulting from uranium and radium processing activities in Port Hope, Ontario. These activities date back to the 1930s and are of great concern to community members. This paper looks at some of the roots of public concern, for example, scientific uncertainty around whether or not human health is compromised by exposure to low dose ionizing radiation

Social trust and ionizing radiation

International Nuclear Information System (INIS)

Meadd, E.

2002-01-01

The linkages that exist between the environmental risks associated with nuclear energy production (both perceived and real) and the myriad of social and political issues and processes that influence social trust are a current issue in literature, but are not well explored, particularly for the Canadian context. This paper will examine one particular issue and its relationship with social trust: ionizing radiation and public health. Social trust is defined for this paper as including interpersonal trust, but having a much broader focus, extending to public trust in governments, institutions, corporations, and the power elite, and across whole societies. Of particular interest for the nuclear energy issue is how waning social trust may impact the functioning of democratic decision-making processes, particularly those associated with the siting of waste facilities. Social trust is a central issue in the management of environmental risks, particularly those related to high technology; its absence is seen as a major cause of intractable conflict in decisions related to nuclear power generation and waste disposal. Understanding the dynamics of social trust is important if a resolution is to be found to the nuclear waste management debate in Canada, that is, one that involves broad public, or social, support. For instance, what factors cause distrust to emerge, and when distrust emerges, what authorities do members of affected communities seek out for information and support? This paper begins to examine social trust in relation to human health and ionizing radiation, particularly low dose radiation from radioactive wastes resulting from uranium and radium processing activities in Port Hope, Ontario. These activities date back to the 1930s and are of great concern to community members. This paper looks at some of the roots of public concern, for example, scientific uncertainty around whether or not human health is compromised by exposure to low dose ionizing radiation

Financing and funding health care: Optimal policy and political implementability.

Science.gov (United States)

Nuscheler, Robert; Roeder, Kerstin

2015-07-01

Health care financing and funding are usually analyzed in isolation. This paper combines the corresponding strands of the literature and thereby advances our understanding of the important interaction between them. We investigate the impact of three modes of health care financing, namely, optimal income taxation, proportional income taxation, and insurance premiums, on optimal provider payment and on the political implementability of optimal policies under majority voting. Considering a standard multi-task agency framework we show that optimal health care policies will generally differ across financing regimes when the health authority has redistributive concerns. We show that health care financing also has a bearing on the political implementability of optimal health care policies. Our results demonstrate that an isolated analysis of (optimal) provider payment rests on very strong assumptions regarding both the financing of health care and the redistributive preferences of the health authority. Copyright © 2015 Elsevier B.V. All rights reserved.

Trust and memory: organizational strategies, institutional conditions and trust negotiations in specialty clinics for Alzheimer's disease.

Science.gov (United States)

Beard, Renée L

2008-03-01

Clinicians aim to establish trust during medical encounters because, without it, health consumers may not seek medical care, consider their diagnoses legitimate, or adhere to treatment regimens. This paper examines the identification and treatment of memory loss within two specialty clinics to understand how cultural dynamics, such as organizational ethos and work practices, influence the social fabric of cognitive evaluations. Ethnographic data suggest important historical and cultural differences in the approaches to Alzheimer's disease (AD). Organizational routines, however, support a common goal, that of moving individuals from "potential patients" to patients, and ultimately research subjects, through establishing trust. Although the processes through which trust is potentially achieved, or the social conditions of trust, were similar at the sites, the object of trust was different. Whereas one clinic encouraged trust in collective medical expertise, the other focused on trust in specific clinicians. These conditions affect the clinical consequences of trust, particularly how and when the diagnosis is delivered, use of the AD label and other terminology, and the level of standardization. The individual consequences include perceptions of patients and depictions of the prognosis. Whether cognitive impairment is viewed as a scientific puzzle to be solved or is seen as a chronic illness significantly shapes the organizational processes of clinical evaluation. Alzheimer's disease, as a cultural object, is a particularly salient exemplar of the clinical negotiation of ambiguous diagnostic categorizations and the unpredictable patient in daily biomedical practice.

Do you trust? Whom do you trust? When do you trust?

NARCIS (Netherlands)

Snijders, C.C.P.; Keren, G.; Thye, S.R.; Lawler, E.J.; Macy, M.W.; Walker, H.A.

2001-01-01

We try to provide a broader view on the factors that infiuence the decision to trust and honor trust. Using the "Trust Game" as our experimental paradigm, we consider three classes offactors that may he related to trust issues. The first one considers individual differences with regard to the

Dispositional pathways to trust: Self-esteem and agreeableness interact to predict trust and negative emotional disclosure.

Science.gov (United States)

McCarthy, Megan H; Wood, Joanne V; Holmes, John G

2017-07-01

Expressing our innermost thoughts and feelings is critical to the development of intimacy (Reis & Shaver, 1988), but also risks negative evaluation and rejection. Past research suggests that people with high self-esteem are more expressive and self-disclosing because they trust that others care for them and will not reject them (Gaucher et al., 2012). However, feeling good about oneself may not always be enough; disclosure may also depend on how we feel about other people. Drawing on the principles of risk regulation theory (Murray et al., 2006), we propose that agreeableness-a trait that refers to the positivity of interpersonal motivations and behaviors-is a key determinant of trust in a partner's caring and responsiveness, and may work in conjunction with self-esteem to predict disclosure. We examined this possibility by exploring how both self-esteem and agreeableness predict a particularly risky and intimate form of self-disclosure, the disclosure of emotional distress. In 6 studies using correlational, partner-report, and experimental methods, we demonstrate that self-esteem and agreeableness interact to predict disclosure: People who are high in both self-esteem and agreeableness show higher emotional disclosure. We also found evidence that trust mediates this effect. People high in self-esteem and agreeableness are most self-revealing, it seems, because they are especially trusting of their partners' caring. Self-esteem and agreeableness were particularly important for the disclosure of vulnerable emotions (i.e., sadness; Study 5) and disclosures that were especially risky (Study 6). These findings illustrate how dispositional variables can work together to explain behavior in close relationships. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Can we trust what parents tell us? A systematic review.

Science.gov (United States)

Brand, Paul L P; van Dulmen, Sandra

2017-09-01

Taking a history is a key diagnostic instrument in paediatric consultations. Numerous issues potentially reduce the history's reliability. Therefore, paediatricians have always expressed ambivalence regarding history taking from parents, both valuing and distrusting it. In this review, we describe how parents build and present a description of their child's health issues in the conceptual framework of self-regulation theory. We performed a systematic review on the literature on the reliability of history taking. No studies examined the reliability of history taking from parents, but there is a considerable body of evidence on the issue of mutual trust in relationships between health care professionals and patients. Because trust is a dynamic relational phenomenon, taking a patient centred approach in consultations is likely to increase the patients' and parents' trust in the health care professional, and their willingness to follow the health care professional's treatment proposals. We provide evidence based recommendations on how to build and maintain trust in paediatric consultations by taking a patient centred approach in such consultations. Copyright © 2017. Published by Elsevier Ltd.

‘Trust and teamwork matter’: Community health workers' experiences in integrated service delivery in India

Science.gov (United States)

Mishra, Arima

2014-01-01

A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011–2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive ‘teamwork’ and ‘building trust with the community’ (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology – which the health workers espouse – is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration. PMID:25025872

The labor impacts of policy change in health care: how federal policy transformed home health organizations and their labor practices.

Science.gov (United States)

Szasz, A

1990-01-01

Health care organizations are highly labor-intensive; policies designed to stimulate organizational change are likely to have labor impacts. This paper examines the labor effects of policy change in home health care. Major federal home care policy trends since 1980 have spurred the evolution of the typical home care provider toward greater organizational and market rationality. Greater managerial sophistication has introduced changes in management/labor relations. Survey data from the 1986 DRG Impact Study are used to show how the pressure of cost-containment policies has pushed agencies to cut labor costs by increasing workloads, managerial supervision, and control of the work process. Research on the effects of recent policy change in health care has to date focused primarily on potential client effects. Labor impacts are rarely examined and are poorly understood at the time that policy is made. Findings in this article suggest that these issues deserve greater, more systematic attention, because unanticipated labor impacts may prove to be significant impediments to the realization of intended policy goals.

Trust and Control in Public Sector Reform

DEFF Research Database (Denmark)

Vallentin, Steen; Thygesen, Niels Thyge

2017-01-01

to a substitution view when it comes to accounting for public sector reform as structure and process. Also, we propose a widening of the theoretical lens in the form of an emergent view of how trust and control, instead of being beforehand determinable and more or less stable identities, emerge in multiple......This paper provides an analysis of trust-based management reform in the Danish public sector from the point of view of the trust–control nexus. Based on a qualitative case study of home care in the municipality of Copenhagen we argue that a complementary view of trust and control is superior...... and singular ways from multiple events in the organisation. Noticing a dearth of research that explicitly addresses trust issues with regard to public sector management and organisation, the paper is a response to the call for more studies of trust as an institutionally embedded phenomenon....

49 CFR 387.307 - Property broker surety bond or trust fund.

Science.gov (United States)

2010-10-01

.... Evidence of a trust fund with a financial institution must be filed using the FMCSA's prescribed Form BMC... 49 Transportation 5 2010-10-01 2010-10-01 false Property broker surety bond or trust fund. 387.307... MINIMUM LEVELS OF FINANCIAL RESPONSIBILITY FOR MOTOR CARRIERS Surety Bonds and Policies of Insurance for...

The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care.

Science.gov (United States)

Goodwin, N

2001-01-01

This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care

Directory of Open Access Journals (Sweden)

Nick Goodwin

2001-03-01

Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

Day Care: A Program in Search of a Policy.

Science.gov (United States)

Bikales, Gerda

This report examines current issues relating to day care and challenges many of the policy assumptions that underlie a major public program of subsidized day care for children. A historical perspective of day care is presented and various types of day care are described. The costs and benefits of day care are examined and the relation of day care…

Concepts of trust among patients with serious illness.

Science.gov (United States)

Mechanic, D; Meyer, S

2000-09-01

This paper examines conceptions of trust among three groups of respondents diagnosed with either breast cancer, Lyme disease or mental illness. Interviews were carried out using an open-ended interview guide to explore how patients made assessments of trust in their doctors and health care plans. The guide followed a conceptual approach that asked questions about competence, agency/fiduciary responsibility, control, disclosure and confidentiality. Respondents were given ample opportunity to raise other areas of concern. The data were organized using the NUDIST software package for the analysis of non-numerical and unstructured qualitative data. Patients viewed trust as an iterative process and commonly tested their physicians against their knowledge and expectations. Interpersonal competence, involving caring, concern and compassion, was the most common aspect of trust reported, with listening as a central focus. Most patient comments referred to learnable skills and not simply to personality characteristics. Technical competence also received high priority but was often assessed by reputation or interpersonal cues. Patients were much concerned that doctors be their agents and fight for their interests with health care plans. Disclosure and confidentiality were less common concerns; most patients anticipated that doctors would be honest with them and respect their confidences. Patients' responses also appeared to vary by their disease, their socio-demographic characteristics, their involvement with self-help groups, and how their illness conditions unfolded.

Program Partitioning using Dynamic Trust Models

DEFF Research Database (Denmark)

Søndergaard, Dan; Probst, Christian W.; Jensen, Christian D.

2006-01-01

Developing distributed applications is a difficult task. It is further complicated if system-wide security policies shall be specified and enforced, or if both data and hosts are owned by principals that do not fully trust each other, as is typically the case in service-oriented or grid...

Employer Child Care Resources: A Guide to Developing Effective Child Care Programs and Policies.

Science.gov (United States)

Women's Bureau (DOL), Washington, DC.

Increasing numbers of employers are responding to employee child care needs by revising their benefit packages, work schedules, and recruitment plans to include child care options. This guide details ways to develop effective child care programs and policies. Section 1 of the guide describes employees' growing child care needs and employers'…

76 FR 29195 - National Strategy for Trusted Identities in Cyberspace (NSTIC) Governance Workshop

Science.gov (United States)

2011-05-20

... Trusted Identities in Cyberspace (NSTIC) Governance Workshop AGENCY: National Institute of Standards... for Trusted Identities in Cyberspace (NSTIC) Governance Workshop to be held on Thursday, June 9, 2011... discuss various governance models to administer the process for policy and standards adoption for the...

Aging, care and social policy. Continuities and changes in Argentina and Mexico

Directory of Open Access Journals (Sweden)

María Concepción ARROYO RUEDA

2015-12-01

Full Text Available This paper intends to show from a comparative perspective of social policy, the provision of care in old age in Argentina and Mexico. It will also show the experience of the national policy of care in Argentina. In this country we carried out interviews with coordinators, operational personnel and users of the national program of care. The participants identify in the policy a vision of rights and social inclusion of the elderly and effective support for family caregivers. Meanwhile, in the case of Mexico, we observe scarce and ambiguous legislation on the subject, which is predominated by the practice of informal care to older people, given mainly by the women in the families. Basic care is outside the aging policy and confined within the «familist model» according to an exalted social assessment of the moral obligation of family care.

A Nordic Perspective on Early Childhood Education and Care Policy

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Karila, Kirsti

2012-01-01

The national policies and historical roots of early childhood education (ECE) vary from society to society. In the Nordic countries, early childhood education and care (ECEC) policies have been built in the context of the welfare state. As such, they are closely connected to other welfare policy areas such as social policy, family policy and…

Trust in the early chain of healthcare: lifeworld hermeneutics from the patient's perspective.

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Norberg Boysen, Gabriella; Nyström, Maria; Christensson, Lennart; Herlitz, Johan; Wireklint Sundström, Birgitta

2017-12-01

Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre. A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden. The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient's lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the "voice of the lifeworld" enables the patient to feel trust. Trust in the early chain of healthcare entails caregivers' ability to pay attention to both medical and existential issues in compliance with the patient's information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language.

Trust Management Considerations For the Cooperative Infrastructure Defense Framework: Trust Relationships, Evidence, and Decisions

Energy Technology Data Exchange (ETDEWEB)

Maiden, Wendy M.

2009-12-01

Cooperative Infrastructure Defense (CID) is a hierarchical, agent-based, adaptive, cyber-security framework designed to collaboratively protect multiple enclaves or organizations participating in a complex infrastructure. CID employs a swarm of lightweight, mobile agents called Sensors designed to roam hosts throughout a security enclave to find indications of anomalies and report them to host-based Sentinels. The Sensors’ findings become pieces of a larger puzzle, which the Sentinel puts together to determine the problem and respond per policy as given by the enclave-level Sergeant agent. Horizontally across multiple enclaves and vertically within each enclave, authentication and access control technologies are necessary but insufficient authorization mechanisms to ensure that CID agents continue to fulfill their roles in a trustworthy manner. Trust management fills the gap, providing mechanisms to detect malicious agents and offering more robust mechanisms for authorization. This paper identifies the trust relationships throughout the CID hierarchy, the types of trust evidence that could be gathered, and the actions that the CID system could take if an entity is determined to be untrustworthy.

Why the Japanese Nuclear Power Plants are not trusted? Verification of current nuclear energy policy

International Nuclear Information System (INIS)

Yoshioka, Hitoshi

2007-01-01

Since the liberalization of electric power following the trend of structural reform and government's economic and financial rebuild had impacted the management of electric utilities in 1990, current nuclear power comes to be subject to government's leadership and support to promote nuclear energy. The Framework for Nuclear Energy Policy Japan of atomic energy commission in 2005 aims to (1) maintain the 30 to 40% or more share of nuclear energy in electricity generation up to 2030 and afterwards, (2) promote the nuclear fuel cycle and (3) commercialize the fast-breeder reactors. Nuclear Energy National Plan of ministry of economy, trade and industry in 2006 makes reference to construction of FBR demonstration reactor by 2025, development of Japanese next-generation LWR and also construction of second reprocessing plant. Major stakeholders related with nuclear power generation such as politicians, government (the authorities concerned), electric utilities and local governments play respective important role in nuclear policy as 'a tetrahedral structure'. The Niigataken Chuets-oki earthquake reminded risk problems of nuclear power management and shook the nuclear tetrahedron structure, which might collapse with loss of public trust. (T. Tanaka)

Empowering leadership, perceived organizational support, trust, and job burnout for nurses: a study in an Italian general hospital.

Science.gov (United States)

Bobbio, Andrea; Bellan, Maria; Manganelli, Anna Maria

2012-01-01

A strong nursing leadership that instills trust in the leader and in the organization is an important component for an effective leadership, particularly for health care organizations, because trust defines the heart of health care workplaces by promoting patient safety, excellence in care, recruitment, and retention of the nursing staff. This study aimed to test the impact of perceived empowerment leadership style expressed by the nurse supervisor, nurses' perceived organizational support, trust in the leader, and trust in the organization on nurses' job burnout. A group of 273 nurses from an Italian public general hospital took part in a cross-sectional study on a voluntary basis by filling out an anonymous questionnaire. Empowering leadership was an important predictor of trust in the leader. Trust in the organization was influenced by perceived organizational support and by the Informing dimension of the empowering leadership style. Trust in the leader and trust in the organization showed a negative impact on job burnout and also mediated the effects of some empowering leadership dimensions and perceived organizational support on job burnout. The central role of trust in health care organizations was corroborated, as well as the beneficial effects of adopting specific features of empowerment leadership behaviors toward the nursing staff. Empowering leadership could be successfully proposed in training programs directed to nurses' supervisors and health care managers.

Health care policy and community pharmacy: implications for the New Zealand primary health care sector.

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Scahill, Shane; Harrison, Jeff; Carswell, Peter; Shaw, John

2010-06-25

The aim of our paper is to expose the challenges primary health care reform is exerting on community pharmacy and other groups. Our paper is underpinned by the notion that a broad understanding of the issues facing pharmacy will help facilitate engagement by pharmacy and stakeholders in primary care. New models of remuneration are required to deliver policy expectations. Equally important is redefining the place of community pharmacy, outlining the roles that are mooted and contributions that can be made by community pharmacy. Consistent with international policy shifts, New Zealand primary health care policy outlines broad directives which community pharmacy must respond to. Policymakers are calling for greater integration and collaboration, a shift from product to patient-centred care; a greater population health focus and the provision of enhanced cognitive services. To successfully implement policy, community pharmacists must change the way they think and act. Community pharmacy must improve relationships with other primary care providers, District Health Boards (DHBs) and Primary Health Organisations (PHOs). There is a requirement for DHBs to realign funding models which increase integration and remove the requirement to sell products in pharmacy in order to deliver services. There needs to be a willingness for pharmacy to adopt a user pays policy. General practitioners (GPs) and practice nurses (PNs) need to be aware of the training and skills that pharmacists have, and to understand what pharmacists can offer that benefits their patients and ultimately general practice. There is also a need for GPs and PNs to realise the fiscal and professional challenges community pharmacy is facing in its attempt to improve pharmacy services and in working more collaboratively within primary care. Meanwhile, community pharmacists need to embrace new approaches to practice and drive a clearly defined agenda of renewal in order to meet the needs of health funders, patients

Health care models guiding mental health policy in Kenya 1965 - 1997

Directory of Open Access Journals (Sweden)

Jenkins Rachel

2010-04-01

Full Text Available Abstract Background Mental health policy is needed to set the strategy and direction for the provision of mental health services in a country. Policy formulation does not occur in a vacuum, however, but is influenced by local and international factors in the health sector and other sectors. Methods This study was carried out in 1997 to examine the evolution of mental health policy in Kenya between 1965 and 1997 in the context of changing international concepts of health and development. Qualitative content analysis of policy documents was combined with interviews of key policy makers. Results The study showed that during the period 1965-1997 the generic health policy in Kenya changed from one based on the Medical Model in the 1960s and 1970s to one based on the Primary Health Care Model in the late 1970s and the 1980s and finally to one based on the Market Model of health care in the 1990s. The mental health policy, on the other hand, evolved from one based on the Medical Model in the 1960s to one based on the Primary Health Care Model in the 1990s, but did not embrace the Market Model of health care. This resulted in a situation in the 1990s where the mental health policy was rooted in a different conceptual model from that of the generic health policy under which it was supposed to be implemented. This "Model Muddlement" may have impeded the implementation of the mental health policy in Kenya. Conclusions Integration of the national mental health policy with the general health policy and other sector policies would be appropriate and is now underway.

Psychometric properties of the Trust in Physician Scale in Tamil Nadu, India.

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Kalsingh, Maria Jusler; Veliah, Geetha; Gopichandran, Vijayaprasad

2017-01-01

Trust in health care is of high intrinsic value. It also leads to positive outcomes such as better treatment adherence and disclosure of sensitive information. Therefore, there is a need to measure trust in health care objectively. To assess the psychometric properties of the Trust in Physician Scale in Tamil Nadu, India. The study was conducted in a private tertiary hospital setting in Tamil Nadu by a cross-sectional survey design. The Trust in Physician Scale and General Trust Scale were administered to 288 participants in the waiting area of a tertiary care hospital in Tamil Nadu. Descriptive statistics, exploratory factor analysis, and Cronbach's alpha statistics were used to assess the validity and reliability of the scale. The respondents were predominantly men from rural areas, older than 35 years of age, and with lesser than 8 years of schooling. The questionnaire had acceptable internal consistency with Cronbach's alpha of 0.707 (95% confidence interval 0.654-0.755). Exploratory factor analysis divided the questionnaire into four domains. Seven items loaded into factor 1 which explained dependability and competence of the physician, two items loaded on factor 2, and one each in factors 3 and 4. The latter four items had very low item to total correlations and hence did not contribute much to the questionnaire. The Trust in Physician questionnaire needs to be modified to accurately measure the domains of trust in the context of the study area. More qualitative studies are required to understand the domains of trust in this cultural and social context.

Opportunity seized or missed? A case study of leadership and organizational change in the creation of a Care Trust.

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Dickinson, Helen; Peck, Edward; Davidson, Deborah

2007-10-01

This paper describes an action research study which focused on an exploration of the aspirations for and initial achievements of Stratham Mental Health NHS and Social Care Trust. Local leaders perceived that Stratham had a good history of health and social care partnership working and as such, adopted an integrationist view of culture to help shape the context of the new structural form. In doing so, consistency remained a key message to staff throughout this organizational transition and the change did not appear to cause the distraction to core business which the literature suggests it would do so. However, this continuity may have come at a cost, at least initially. In the process of formalizing the previous partnership into a Care Trust, Stratham may not have produced all the beneficial effects of synergy which are usually (albeit eventually) associated with mergers in the private sector. Certainly, local actors could see opportunities that had been missed. By focusing on the structural manifestation of the relationship, the opportunities to broaden informal horizontal linkages may have been underexploited. The study of Stratham serves to confirm that the integrationist conception of culture is limited and that the differentiation of professional groupings and the ambiguity of individual experience will always make contested the meanings that are attributed to organizational change.

Mass casualty incidents: are NHS staff prepared? An audit of one NHS foundation trust.

Science.gov (United States)

Milkhu, C S; Howell, D C J; Glynne, P A; Raptis, D; Booth, H L; Langmead, L; Datta, V K

2008-09-01

Lack of knowledge of an NHS trust's major incident policies by clinical staff may result in poorly coordinated responses during a mass casualty incident (MCI). To audit knowledge of the major incident policy by clinical staff working in a central London major acute NHS trust designated to receive casualties on a 24-h basis during a MCI. A 12-question proforma was distributed to 307 nursing and medical staff in the hospital, designed to assess their knowledge of the major incident policy. Completed proformas were collected over a 2-month period between December 2006 and February 2007. A reply rate of 34% was obtained, with a reasonable representation from all disciplines ranging from nurses to consultants. Despite only 41% having read the policy in full, 70% knew the correct immediate action to take if informed of major incident activation. 76% knew the correct stand-down procedure. 56% knew the correct reporting point but less than 25% knew that an action card system was utilised. Nurses had significantly (p<0.01) more awareness of the policy than doctors. In view of the heightened terrorist threat in London, knowledge of major incident policy is essential. The high percentage of positive responses relating to immediate and stand-down actions reflects the rolling trust-wide MCI education programme and the organisational memory of the trust following several previous MCI in the capital. There is still scope for an improvement in awareness, however, particularly concerning knowledge of action cards, which are now displayed routinely throughout clinical areas and will be incorporated into induction packs.

Nursing shaping and influencing health and social care policy.

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Fyffe, Theresa

2009-09-01

This paper seeks to consider how nursing as a profession in the United Kingdom is developing its role in shaping and influencing policy using lessons learnt from a policy study tour undertaken in the United States of America and extensive experience as a senior nurse within the government, the health service and more recently within a Professional Organization. The nursing profession faces major changes in health and health care and nurses need to be visible in the public debate about future models of health and health care. This paper critically reviews recent UK and USA literature and policy with relevance to nursing. Strategies that support nurses and nursing to influence policy are in place but more needs to be done to address all levels of nursing in order to find creative solutions that promote and increase the participation of nurses in the political process and health policy. There are lessons to be learnt in the UK from the US nursing experience. These need to be considered in the context of the UK and devolution. Although much has been achieved in positioning nurses and nursing as an influencer in the arena of policy and political decision-making, there is a need for greater co-ordination of action to ensure that nursing is actively supported in influencing and shaping health and health care policy. All leaders and other stakeholders require to play their part in considering how the actions set out in this article can be taken forward and how gaps such as education, fellowship experience and media engagement can be addressed in the future.

Health care policy at a crossroads?

DEFF Research Database (Denmark)

Lassen, Inger Marie; Strunck, Jeanne; Ottesen, Aase Marie

2018-01-01

analyse and discuss how political discourse moments (Rancière 1999; Gamson 1992; Carvalho 2008) influence the contents of the national health quality strategies and how variation in the construal of patient roles and agency indicate discursive struggle in Danish national health care policy. Underlying...

Trust increases euthanasia acceptance: a multilevel analysis using the European Values Study.

Science.gov (United States)

Köneke, Vanessa

2014-12-20

This study tests how various kinds of trust impact attitudes toward euthanasia among the general public. The indication that trust might have an impact on euthanasia attitudes is based on the slippery slope argument, which asserts that allowing euthanasia might lead to abuses and involuntary deaths. Adopting this argument usually leads to less positive attitudes towards euthanasia. Tying in with this, it is assumed here that greater trust diminishes such slippery slope fears, and thereby increases euthanasia acceptance. The effects of various trust indicators on euthanasia acceptance were tested using multilevel analysis, and data from the European Values Study 2008 (N = 49,114, 44 countries). More precisely, the influence of people's general levels of trust in other people, and their confidence in the health care system, were measured--both at the individual and at the country level. Confidence in the state and the press were accounted for as well, since both institutions might monitor and safeguard euthanasia practices. It was shown that the level of trust in a country was strongly positively linked to euthanasia attitudes, both for general trust and for confidence in health care. In addition, within countries, people who perceived their fellow citizens as trustworthy, and who had confidence in the press, were more supportive of euthanasia than their less trusting counterparts. The pattern was, however, not true for confidence in the state and for confidence in the health care system at the individual level. Notably, all confirmative effects held, even when other variables such as religiosity, education, and values regarding autonomy were controlled for. Trust seems to be a noteworthy construct to explain differences in attitudes towards euthanasia, especially when drawing cross-country comparisons. Therefore, it should be added to the existing literature on correlates of euthanasia attitudes.

Financial institutions as an example of institutions of public trust

OpenAIRE

Agata Jakubowska

2013-01-01

Financial institutions are commonly known as institutions of public trust and they are fundamental for activities of other economic entities. The level of trust determines the competitive position of financial institutions. That is why care about the best standards is the most important task for these institutions. Financial institutions are called institutions of public trust and thus high professionalism and more responsibility is demanded from them. This article presents basic problems con...

Trust Development With the Spanish-Speaking Mexican American Patient: A Grounded Theory Study.

Science.gov (United States)

Jones, Sharon M

2018-06-01

Interpersonal trust between patient and nurse is important in patient-centered care. Trust development may be more difficult if the patient and nurse do not speak the same language. In this grounded theory study, Spanish-speaking Mexican American adults ( n = 20) hospitalized on a medical-surgical or obstetric unit in the Midwestern United States were interviewed. Through data analysis, a model of how trust develops between nurse and patient revealed eight categories and the core category Caring for Me Well Even When Not Understanding Me. The beginning phase had four categories: Asking for Help, Bothering, Communicating, and Understanding. The middle phase had two categories: Platicando (chatting) and Being Available. The end point category was Having Trust, and outcomes were Feeling Comfortable and Feeling Supported. The language barrier was a hindrance to trust development but the nurse's way of being (personality) was more important. Therefore, the patient did develop trust with nurses who did not speak Spanish.

Aging, care and social policy. Continuities and changes in Argentina and Mexico

OpenAIRE

Arroyo Rueda, María Concepción

2016-01-01

This paper intends to show from a comparative perspective of social policy, the provision of care in old age in Argentina and Mexico. It will also show the experience of the national policy of care in Argentina. In this country we carried out interviews with coordinators, operational personnel and users of the national program of care. The participants identify in the policy a vision of rights and social inclusion of the elderly and effective support for family caregivers. Meanwhile, in the c...

Evidence-based health care: development and audit of a clinical standard for research and its impact on an NHS trust.

Science.gov (United States)

Parkin, Claire; Bullock, Ian

2005-04-01

Working within a modern National Health Service in the United Kingdom, the place for research and its dissemination is increasingly important. The organization of this within each National Health Service (NHS) Trust is challenging but nevertheless essential. If health care professionals are to be empowered to adopt an evidence-based approach in both the planning and delivery of care, research aware employees are crucial. This paper highlights the importance of NHS hospital trusts implementing initiatives that will facilitate this process. One such initiative has been the development and survey of a clinical standard for research. The primary development aim was to provide a benchmark standard for all nursing research. The standard was developed to fit within the current dynamic quality improvement (DQI) programme and has directly contributed to an evolving culture of research by shaping nurses' awareness, and offering a support and consultancy network within the Trust. The standard is one aspect of a research awareness programme, with the primary objective of providing guidance and education whilst developing nurses throughout the research process. The planned strategic outcome is to see a positive outcome on the quality of research in the Trust. A baseline survey was conducted to provide a definitive snap shot of research understanding and practice within the Trust following the introduction of the research standard. The standard was developed by a team of clinicians led by a member of the quality team, to ensure that it fitted the DQI structure, and a member of the Nursing Research Unit (NRU). The standard was distributed to every clinical area and 192 nurses were surveyed to evaluate its impact on their awareness of educational opportunities, their use of the consultancy and support service, their use of other support services, their research utilization and research quality. The survey demonstrated that the implementation of the standard had increased awareness

A multi-domain trust management model for supporting RFID applications of IoT.

Directory of Open Access Journals (Sweden)

Xu Wu

Full Text Available The use of RFID technology in complex and distributed environments often leads to a multi-domain RFID system, in which trust establishment among entities from heterogeneous domains without past interaction or prior agreed policy, is a challenge. The current trust management mechanisms in the literature do not meet the specific requirements in multi-domain RFID systems. Therefore, this paper analyzes the special challenges on trust management in multi-domain RFID systems, and identifies the implications and the requirements of the challenges on the solutions to the trust management of multi-domain RFID systems. A multi-domain trust management model is proposed, which provides a hierarchical trust management framework include a diversity of trust evaluation and establishment approaches. The simulation results and analysis show that the proposed method has excellent ability to deal with the trust relationships, better security, and higher accuracy rate.

[The development of public policies for elderly care in Brazil].

Science.gov (United States)

Fernandes, Maria Teresinha de Oliveira; Soares, Sônia Maria

2012-12-01

The objective of this documental analysis is to discuss the legal aspects involved in the development of elderly care policies in Brazil, considering the socio-historical-political context, and in view of the aspects that outline the wellbeing of an aged individual. Data collection was performed between June and September of 2010 via governmental websites. Documents were included if they complied with the proposed objective; were connected with elderly care policies, and lay within the legal accomplishments regarding elderly care policies in 2006 and the Elói Chaves Law of 1923. This analysis indicated that elderly wellbeing depends significantly on resource allocation in sectors other than the healthcare area, with emphasis on the elderly in the labor market and the feminization of old age. It is expected that the community and administrators will discuss the needs of the elderly population and the integration of care networks that remain necessary for the heterogeneity of this population.

How do high cost-sharing policies for physician care affect total care costs among people with chronic disease?

Science.gov (United States)

Xin, Haichang; Harman, Jeffrey S; Yang, Zhou

2014-01-01

This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

Communicating Trust Between Parents and Their Children

DEFF Research Database (Denmark)

Demant, Jakob Johan; Ravn, Signe

2013-01-01

This article discusses how Danish parents and their children communicate trust. Based on Niklas Luhmann’s sociological theory, the article explores new aspects of communication about alcohol-related rules. The analysis shows how the parents emphasize the importance of communicating trust, while...... the adolescents, on the other hand, observe the parents’ communication on the basis of their own, more instrumental, logic. Trust becomes a functional solution to the parents’ paradoxical situation, because it enables them to balance between a democratic family ideal, emphasizing the adolescents’ independence......, while taking care of risk behavior. The article draws on Danish qualitative data comprising 37 focus group interviews with adolescents (14-16 years of age) and six focus group interviews with parents....

Primary health care and public policy.

Science.gov (United States)

Mangelsdorf, K L; Luna, J; Smith, H L

1988-01-01

The health problems of Ecuador are similar to those in other developing countries where the standard of living is low, and housing and sanitation are inadequate. Women, children, and those living in rural areas are those most severely affected. National policy has been to attempt to increase access to health care in rural areas through the construction of new facilities and the appointment of highly paid medical staff. However, little attention was paid to sociocultural factors, which caused the peasantry to reject the medical care system, or to problems of internal efficiency which inhibited utilization. Since the 1970s various national and international organizations have attempted to implement primary health care (PHC) through the use of trained community health workers (CHWs). The primary problems faced by the CHWs were shortages of medicines and supplies, an almost total lack of supervision, and lack of transportation available to take staff to isolated villages. The poor supervision is blamed for the 17% drop out rate among CHWs since 1980. Independent PHC programs have also been established in Ecuador by voluntary organizations. These work best when coordinated with governmental programs, in order to allow monitoring and to avoid the duplication of services. Problems with the establishment of PHC programs in Ecuador will continue, as the government has no clear cut policy, and difficulties financing on a broad national scale. Other problems include the absence of effective supervision and logistical support for even small pilot programs, and inconsistencies in the training and role definition for CHWs. These problems need to be met in the implementation of a national PHC policy.

Understanding Parents' Child Care Decision-Making: A Foundation for Child Care Policy Making. Research-to-Policy, Research-to-Practice Brief. OPRE 2011-12

Science.gov (United States)

Weber, Roberta

2011-01-01

Policies such as those related to child care subsidies and quality rating and improvement systems are designed to increase the likelihood that child care and education arrangements meet developmental needs of children and employment needs of parents. Ultimately, parents select child care arrangements, and the quality and stability of these…

Early experiences with the multidose drug dispensing system – A matter of trust?

Science.gov (United States)

Wekre, Liv Johanne; Melby, Line; Grimsmo, Anders

2011-01-01

Objective To study early experiences with multidose drug dispensing (MDD) among different groups of health personnel. Design Qualitative study based on focus-group interviews. Setting Primary health care, Trondheim, Norway. Main outcome The importance of trust in the technology and in collaborating partners is actualized in the early implementation of MDD. Results GPs, home-care nurses, pharmacists, and medical secretaries trusted the new MDD technology. The quality of the GPs’ medication records improved. However, health personnel, including the GPs themselves, would not always trust the medication records of the GPs. Checking the multidose bags arriving from the pharmacy was considered unnecessary in the written routines dealing with MDD. However, home-care nurses experienced errors and continued to manually check the bags. Nurses in the home-care service felt a loss of knowledge with regard to the patients’ medications and in turn experienced reduced ability to give medical information to patients and to observe the effects of the drugs. The home-care services’ routines for drug handling were not always trusted by the other groups of health personnel involved. Conclusion Health personnel faced some challenges during the implementation of the MDD system, but most of them remained confident in the new system. Building trust has to be a process that runs in parallel with the introduction of new technology and the establishment of new routines for improving the quality in handling of medicines and to facilitate better cooperation and communication. PMID:21323496

Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor?

Science.gov (United States)

Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Padmadas, Sabu S

2016-02-01

To investigate, the impact of maternity-related fee payment policies on the uptake of skilled birth care amongst the poor in Ghana. Population data representing 12 288 births between November 1990 and October 2008 from four consecutive rounds of the Ghana demographic and health surveys were used to examine the impact of four major maternity-related payment policies: the full-cost recovery 'cash and carry' scheme; 'antenatal care fee exemption'; 'delivery care fee exemption' and the 'National Health Insurance Scheme (NHIS)'. Concentration curves were used to analyse the rich-poor gap in the use of skilled birth care by the four policy interventions. Multilevel logistic regression was used to examine the effect of the policies on the uptake of skilled birth care, adjusting for relevant predictors and clustering within communities and districts. The uptake of skilled birth care over the policy periods for the poorest women was trivial when compared with their non-poor counterparts. The rich-poor gap in skilled birth care use was highly pronounced during the 'cash and carry' and 'free antenatal care' policies period. The benefits during the 'free delivery care' and ' NHIS' policy periods accrued more for the rich than the poor. There exist significant differences in skilled birth care use between and within communities and districts, even after adjusting for policy effects and other relevant predictors. The maternal care fee exemption policies specifically targeted towards the poorest women had limited impact on the uptake of skilled birth care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Do professional boundaries limit trust?

Science.gov (United States)

Smythe, Elizabeth; Hennessy, Julia; Abbott, Max; Hughes, Frances

2018-02-01

The present study uses stories of mental health support workers talking about their relationship with clients to wonder about how trust might be limited by the professional boundaries of nursing. The writing arose out of an appreciative inquiry study looking at the role of mental health support workers. Participants talked about how they worked with their clients. As researchers, we were struck by the depth of trust that was built between worker and client. We have brought a phenomenological lens to wonder about the nature of trust, as shown in the data. The original research sought to identify what was working well for mental health support workers. The present study brings a phenomenological interpretive approach to four stories from the discovery phase of the study, with our thinking informed by Heidegger and van Manen. Interviews were conducted with 26 mental health support workers and six stakeholders in 2012-2103. For this paper, we drew from those transcripts stories of three mental health support workers and one stakeholder. Through a process of talking together, writing, and rewriting, we wondered about the meaning within these stories, with a strong focus on how trust was enacted. We saw that mental health support workers in this study, by not carrying the boundaries of being 'professional', seemed free to grow a stronger relationship of trust which was therapeutic. We ask: Is it time to rethink how professional boundaries limit the level of trust achieved with clients to the detriment of impactful care? © 2017 Australian College of Mental Health Nurses Inc.

EPA guidance on building trust in mental health services

NARCIS (Netherlands)

Gaebel, W.; Muijen, M.; Baumann, A.E.; Bhugra, D.; Wasserman, D.; Gaag, R.J. van der; Heun, R.; Zielasek, J.

2014-01-01

PURPOSE: To advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system. METHODS: We

BNFL and environmental care. An introduction to our policy

Energy Technology Data Exchange (ETDEWEB)

1992-12-31

British Nuclear Fuel plc (BNFL) acknowledge a duty of care for the environment and aims to reduce the effects of its activities on the environment to as low as reasonably practicable. Its environmental policy statement is presented and its approach, investment policies and activities to implement this policy are outlined. The activities include energy efficiency, recycling, surveillance and research, conservation and open information. (UK).

Enhancing the contribution of research to health care policy-making: a case study of the Dutch Health Care Performance Report.

Science.gov (United States)

Hegger, Ingrid; Marks, Lisanne K; Janssen, Susan W J; Schuit, Albertine J; van Oers, Hans A M

2016-01-01

The Dutch Health Care Performance Report, issued by the National Institute of Public Health and the Environment, aims to monitor health care performance in The Netherlands. Both the National Institute and the Ministry of Health wish to increase the contribution of the Report to health care policy-making. Our aim was to identify ways to achieve that. We used contribution mapping as a theoretical framework that recognizes alignment of research as crucial to managing contributions to policy-making. To investigate which areas need alignment efforts by researchers and/or policy-makers, we interviewed National Institute researchers and policy-makers from the Ministry of Health and assessed the process for developing the 2010 Report. We identified six areas where alignment is specifically relevant for enhancing the contributions of future versions of the Dutch Health Care Performance Report: well-balanced information for different ministerial directorates; backstage work; double role actors; reports of other knowledge institutes; data collection/generation and presentation forms. The contribution of health care performance reporting to policy-making is complex and requires continuous alignment efforts between researchers and policy-makers. These efforts should form an inseparable part of health care performance reporting and although this demands considerable resources, it is worth considering since it may pay back in better contributions to policy-making. © The Author(s) 2015.

Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia.

Science.gov (United States)

Blair, Robert A; Morse, Benjamin S; Tsai, Lily L

2017-01-01

Trust in government has long been viewed as an important determinant of citizens' compliance with public health policies, especially in times of crisis. Yet evidence on this relationship remains scarce, particularly in the developing world. We use results from a representative survey conducted during the 2014-15 Ebola Virus Disease (EVD) epidemic in Monrovia, Liberia to assess the relationship between trust in government and compliance with EVD control interventions. We find that respondents who expressed low trust in government were much less likely to take precautions against EVD in their homes, or to abide by government-mandated social distancing mechanisms designed to contain the spread of the virus. They were also much less likely to support potentially contentious control policies, such as "safe burial" of EVD-infected bodies. Contrary to stereotypes, we find no evidence that respondents who distrusted government were any more or less likely to understand EVD's symptoms and transmission pathways. While only correlational, these results suggest that respondents who refused to comply may have done so not because they failed to understand how EVD is transmitted, but rather because they did not trust the capacity or integrity of government institutions to recommend precautions and implement policies to slow EVD's spread. We also find that respondents who experienced hardships during the epidemic expressed less trust in government than those who did not, suggesting the possibility of a vicious cycle between distrust, non-compliance, hardships and further distrust. Finally, we find that respondents who trusted international non-governmental organizations (INGOs) were no more or less likely to support or comply with EVD control policies, suggesting that while INGOs can contribute in indispensable ways to crisis response, they cannot substitute for government institutions in the eyes of citizens. We conclude by discussing the implications of our findings for future

Measuring Trust

OpenAIRE

Glaeser, Edward Ludwig; Laibson, David I.; Scheinkman, Jose A.; Soutter, Christine L.

2000-01-01

We combine two experiments and a survey to measure trust and trustworthiness—two key components of social capital. Standard attitudinal survey questions about trust predict trustworthy behavior in our experiments much better than they predict trusting behavior. Trusting behavior in the experiments is predicted by past trusting behavior outside of the experiments. When individuals are closer socially, both trust and trustworthiness rise. Trustworthiness declines when partners are of differen...

Making Me Feel Comfortable: Developing Trust in the Nurse for Mexican Americans.

Science.gov (United States)

Jones, Sharon M

2015-11-01

Trust (confianza) is an important component of patient-centered care and culturally competent care and a major element in the Hispanic culture. The aim of this study was to conceptualize the process of the development of interpersonal trust by hospitalized patients in their nurses. Using the grounded theory method, English-speaking Mexican American patients (N = 22) were interviewed. The core category was Making Me Feel Comfortable. The cyclical process included a beginning stage (Having Needs, Relying on the Nurse), middle stage (Coming Across to Me, Taking Care of Me, Connecting), and end point (Feeling Confianza) with two outcomes (Confiding in the Nurse, Taking Away the Negative). Anytime there was a negative element during the middle stage, this element halted any further development of trust with the nurse. Unique findings were related to Hispanic cultural values of familism and personalismo. The findings have implications which impact patient safety and quality care. © The Author(s) 2014.

The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus.

Science.gov (United States)

McDonald, Julie; Jayasuriya, Rohan; Harris, Mark Fort

2012-03-13

Ongoing care for chronic conditions such as diabetes is best provided by a range of health professionals working together. There are challenges in achieving this where collaboration crosses organisational and sector boundaries. The aim of this article is to explore the influence of power dynamics and trust on collaboration between health professionals involved in the management of diabetes and their impact on patient experiences. A qualitative case study conducted in a rural city in Australia. Forty five health service providers from nineteen organisations (including fee-for-service practices and block funded public sector services) and eight patients from two services were purposively recruited. Data was collected through semi-structured interviews that were audio-taped and transcribed. A thematic analysis approach was used using a two-level coding scheme and cross-case comparisons. Three themes emerged in relation to power dynamics between health professionals: their use of power to protect their autonomy, power dynamics between private and public sector providers, and reducing their dependency on other health professionals to maintain their power. Despite the intention of government policies to support more shared decision-making, there is little evidence that this is happening. The major trust themes related to role perceptions, demonstrated competence, and the importance of good communication for the development of trust over time. The interaction between trust and role perceptions went beyond understanding each other's roles and professional identity. The level of trust related to the acceptance of each other's roles. The delivery of primary and community-based health services that crosses organisational boundaries adds a layer of complexity to interprofessional relationships. The roles of and role boundaries between and within professional groups and services are changing. The uncertainty and vulnerability associated with these changes has affected the level

Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts.

Science.gov (United States)

Thompson, Charles Dr; Mahay, Arun; Stuckler, David; Steele, Sarah

2017-09-01

We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Freedom of Information requests were sent to the 105 England's NHS Trusts delivering acute care in England. NHS Trusts providing secondary care in England. English NHS Trusts. We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation.

Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts

Science.gov (United States)

Mahay, Arun; Stuckler, David; Steele, Sarah

2017-01-01

Objective We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Design Freedom of Information requests were sent to the 105 England’s NHS Trusts delivering acute care in England. Setting NHS Trusts providing secondary care in England. Participants English NHS Trusts. Main outcome measures We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. Results A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Conclusions Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation. PMID:28904806

Trust

OpenAIRE

Fojtů, Dominik

2015-01-01

This rigorous thesis is focused on a status of trust in an application practise in a Czech legislation with a context of historical aspects of institutes similar to trusts as well as actual legislation. The thesis includes also analyses of more difficult provisions concerning the trust, including economic impacts representing accounting and tax consequences. Also comparison with established modifications trusts in Europe and their possible utilization of the Czech point of view of the settlor...

Developing New Mexico Health Care Policy: An application of the Vital Issues Process

Energy Technology Data Exchange (ETDEWEB)

Engi, D. [Sandia National Labs., Albuquerque, NM (United States); Icerman, L. [Icerman & Associates, Santa Fe, NM (United States)

1995-06-01

The Vital Issues Process, developed by the Sandia National Laboratories Strategic Technologies Department, was utilized by the Health Care Task Force Advisory Group to apply structure to their policy deliberations. By convening three expert panels, an overarching goal for the New Mexico health care system, seven desired outcomes, nine policy options, and 17 action items were developed for the New Mexico health care system. Three broadly stated evaluation criteria were articulated and used to produce relative rankings of the desired outcomes and policy options for preventive care and information systems. Reports summarizing the policy deliberations were submitted for consideration by the Health Care Task Force, a Joint Interim Committee of the New Mexico Legislature, charged with facilitating the development and implementation of a comprehensive health care delivery system for New Mexico. The Task Force reported its findings and recommendations to the Second Session of the 41st New Mexico State Legislature in January 1994.

Trust in the early chain of healthcare: lifeworld hermeneutics from the patient’s perspective

Science.gov (United States)

Norberg Boysen, Gabriella; Nyström, Maria; Christensson, Lennart; Herlitz, Johan; Wireklint Sundström, Birgitta

2017-01-01

ABSTRACT Purpose: Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre. Method: A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden. Results: The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient’s lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the “voice of the lifeworld” enables the patient to feel trust. Conclusion: Trust in the early chain of healthcare entails caregivers’ ability to pay attention to both medical and existential issues in compliance with the patient’s information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language. PMID:28793852

Trust

OpenAIRE

Söllner, Matthias; Benbasat, Izak; Gefen, David; Leimeister, Jan Marco; Pavlou, Paul A.

2016-01-01

Trust is the enabler of social interaction. Although the origins of research on trust traditionally lie outside the Information Systems (IS) domain, the importance of trust for IS research rapidly grew in the late 1990s, and it is still growing with the increasing ubiquity and advancement of technology in organizations, virtual teams, online markets, and user-technology interactions. Theoretically, the central role of trust is tied to the growing social change that Information and Communicati...

The cloud understanding the security, privacy and trust challenges

CERN Document Server

Robinson, Neil; Cave, Jonathan; Starkey, Tony; Graux, Hans

2011-01-01

This report discusses how policy-makers might address the challenges and risks in respect of the security, privacy and trust aspects of cloud computing that could undermine the attainment of broader economic and societal objectives across Europe.

Achieving Prudent Dementia Care (Palliare: An International Policy and Practice Imperative

Directory of Open Access Journals (Sweden)

Debbie Tolson

2016-12-01

Full Text Available This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care ('Palliare', that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities

The impact of managed care and current governmental policies on an urban academic health care center.

Science.gov (United States)

Rodriguez, J L; Peterson, D J; Muehlstedt, S G; Zera, R T; West, M A; Bubrick, M P

2001-10-01

Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.

Disintegrated care: the Achilles heel of international health policies in low and middle-income countries

Directory of Open Access Journals (Sweden)

Jean-Pierre Unger

2006-09-01

Full Text Available Purpose: To review the evidence basis of international aid and health policy. Context of case: Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. Data sources: National policies, international programmes and pilot experiments are examined in both scientific and grey literature. Conclusions and discussion: We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care.

Institutional trust in the national social security and municipal healthcare systems for the elderly in Japan.

Science.gov (United States)

Murayama, Hiroshi; Taguchi, Atsuko; Ryu, Shuhei; Nagata, Satoko; Murashima, Sachiyo

2012-09-01

Japanese social security systems and institutions for the elderly, as well as the general attitude toward elderly care services among the Japanese population, have been undergoing a dramatic change. By examining the association between institutional trust, which is a representative element of social capital, and anxiety regarding receiving elderly care, we can uncover clues toward building a more robust social security system for the elderly. This study examines the relationship between institutional trust, in the national social security and municipal healthcare systems for the elderly, and anxiety with respect to receiving elderly care among the general Japanese population. A cross-sectional survey was conducted using a self-administered questionnaire that was returned by mail in January and February 2005. The target population was 4735 community residents aged 20-75 years, who lived in the city of Koka, Shiga, Japan. A total of 2264 questionnaires were included in the analysis. A binominal logistic regression analysis showed that responses of 'trust' [odds ratio (OR): 2.09, 95% confidence interval (95% CI): 1.01-4.30] and 'strongly trust' (OR: 3.80, 95% CI: 1.55-9.31) for the national system were associated with not having anxiety regarding elderly care, compared with the reference category of feeling strongly distrust. However, trust in the municipal system showed no association with this anxiety. These results indicate the importance of developing strategies to increase a common trust in the national care services for the elderly to reduce the anxiety people feel regarding whether they will be able to receive elderly care when required.

Vaccine hesitancy and trust. Ethical aspects of risk communication.

Science.gov (United States)

Nihlén Fahlquist, Jessica

2018-03-01

This paper analyses vaccination policy from an ethical perspective, against the background of the growing hesitancy towards e.g. the measles vaccine. The paper is normative and analyses ethical aspects of risk communication in the context of vaccination. It is argued that ethical analysis of risk communication should be done at the level of the message, the procedure and the effects. The paper takes examples from the Swedish context, linking the current lack of trust in experts to the 2009 vaccination policy and communication promoting the H1N1 vaccine Pandemrix. During the Swedish H1N1 vaccination policy in 2009, the message was that the vaccine is safe. However, a group of adolescents developed narcolepsy as a side effect of the vaccine. Taking this into account, it becomes clear that the government should communicate risks and benefits responsibly and take responsibility for individuals affected negatively by populational health interventions. To communicate respectfully entails not treating vaccine sceptics as ill-informed or less educated, but instead taking the concerns of the vaccine hesitant, who potentially could change their minds, as a starting-point of a respectful discussion. There will inevitably be individuals who suffer from side effects of justifiable population-based health promotion activities. However, the public should be able to trust the message and count on the government to take responsibility for individuals affected by side effects. This is important for normative reasons, but is additionally likely to contribute to restored and maintained trust.

Medical revalidation as professional regulatory reform: Challenging the power of enforceable trust in the United Kingdom.

Science.gov (United States)

Spendlove, Zoey

2018-05-01

For more than two decades, international healthcare crises and ensuing political debates have led to increasing professional governance and regulatory policy reform. Governance and policy reforms, commonly representing a shift from embodied trust in professionals to state enforceable trust, have challenged professional power and self-regulatory privileges. However, controversy remains as to whether such policies do actually shift the balance of power and what the resulting effects of policy introduction would be. This paper explores the roll-out and operationalisation of revalidation as medical regulatory reform within a United Kingdom National Health Service hospital from 2012 to 2013, and its impact upon professional power. Revalidation policy was subject to the existing governance and management structures of the organisation, resulting in the formal policy process being shaped at the local level. This paper explores how the disorganised nature of the organisation hindered rather than facilitated robust processes of professional governance and regulation, fostering formalistic rather than genuine professional engagement with the policy process. Formalistic engagement seemingly assisted the medical profession in retaining self-regulatory privileges whilst maintaining professional power over the policy process. The paper concludes by challenging the concept of state enforceable trust and the theorisation that professional groups are effectively regulated and controlled by means of national and organisational objectives, such as revalidation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Toward a New Era of Policy: Health Care Service Delivery to First Nations

Directory of Open Access Journals (Sweden)

Miranda D. Kelly

2011-05-01

Full Text Available The disproportionate burdens of ill health experienced by First Nations have been attributed to an uncoordinated, fragmented health care system. This system is rooted in public policies that have created jurisdictional gaps and a long-standing debate between federal, provincial and First Nations governments as to who is responsible for First Nations health care. This article examines: (1 the policies that shape First Nations health care in Canada and in the province of British Columbia (BC specifically; (2 the interests of the actors involved in First Nations health policy; and (3 recent developments in BC that present an opportunity for change to First Nations health policy development and have broader implications for Indigenous health policy across Canada and worldwide.

XML Based Adaptive IPSEC Policy Management in a Trust Management Context

National Research Council Canada - National Science Library

Mohan, R

2002-01-01

... the level of security service "on-the-fly" to respond to changing network and operational conditions, The IPsec implementation in OpenESD works in conjunction with the Trust Management System, KeyNote...

Perceived risk, trust in government, and response to repository siting in the United States

International Nuclear Information System (INIS)

Kraft, M.E.

1991-01-01

Conflicts over the siting of high-level radioactive waste repositories have been intense and unrelenting. Public and state opposition to implementation of the US Nuclear Waste Policy Act is tied closely to the perception of unacceptably high repository risks and to lack of trust and confidence in governmental agencies, particularly the DOE. This paper explores the relationship of perceived risk, trust in government, and opposition to repository siting in the US in an attempt to clarify the conditions of successful implementation of nuclear waste policy in the decades ahead

Ensuring due process in the IACUC and animal welfare setting: considerations in developing noncompliance policies and procedures for institutional animal care and use committees and institutional officials.

Science.gov (United States)

Hansen, Barbara C; Gografe, Sylvia; Pritt, Stacy; Jen, Kai-Lin Catherine; McWhirter, Camille A; Barman, Susan M; Comuzzie, Anthony; Greene, Molly; McNulty, Justin A; Michele, Daniel Eugene; Moaddab, Naz; Nelson, Randall J; Norris, Karen; Uray, Karen D; Banks, Ron; Westlund, Karin N; Yates, Bill J; Silverman, Jerald; Hansen, Kenneth D; Redman, Barbara

2017-10-01

Every institution that is involved in research with animals is expected to have in place policies and procedures for the management of allegations of noncompliance with the Animal Welfare Act and the U.S. Public Health Service Policy on the Humane Care and Use of Laboratory Animals. We present here a model set of recommendations for institutional animal care and use committees and institutional officials to ensure appropriate consideration of allegations of noncompliance with federal Animal Welfare Act regulations that carry a significant risk or specific threat to animal welfare. This guidance has 3 overarching aims: 1 ) protecting the welfare of research animals; 2 ) according fair treatment and due process to an individual accused of noncompliance; and 3 ) ensuring compliance with federal regulations. Through this guidance, the present work seeks to advance the cause of scientific integrity, animal welfare, and the public trust while recognizing and supporting the critical importance of animal research for the betterment of the health of both humans and animals.-Hansen, B. C., Gografe, S., Pritt, S., Jen, K.-L. C., McWhirter, C. A., Barman, S. M., Comuzzie, A., Greene, M., McNulty, J. A., Michele, D. E., Moaddab, N., Nelson, R. J., Norris, K., Uray, K. D., Banks, R., Westlund, K. N., Yates, B. J., Silverman, J., Hansen, K. D., Redman, B. Ensuring due process in the IACUC and animal welfare setting: considerations in developing noncompliance policies and procedures for institutional animal care and use committees and institutional officials. © FASEB.

A Mysterious European Threesome: Work-care Regimes, Policies and Gender

Directory of Open Access Journals (Sweden)

Anália Torres

2012-07-01

Full Text Available Arguing that European family lives are affected by many societal factors, this article discusses the interplay between three sets of phenomena: the management of work and care responsibilities, workcarepolicies and regimes, and gender order within the family context. Based on discussions about orientations to work and care, we compare European countries and analyze regularities and singularities among them. Identifying and assessing the interplay between structural, institutional and cultural determinants of orientations we try to explain country diversity mobilizing data from the European Social Survey (rounds 2002, 2004 and 2006 and data from Eurobarometer 2003.The paper is organized around three analytical axes. First, we nalyze how work and family orientations are perceived by the Europeans. Secondly, we assess different European political policies regarding work and care arrangements, the outcome being a proposal for a workcare political typology. And finally we discuss the connectionsbetween those policies and the production or reproduction of gender order within the family. We conclude that in countries with more egalitarian gender values and policies targeted at workcarearrangements, individuals experience less workfamily conflict. Conversely, in countries with more traditional gender values and restricted or disadvantaged policies we found more familyworkconflict. But institutional constraints don’t act alone: orientations to work and care differ according to age, education, family forms and employment status.

The quality of interaction between managers and clinicians: a question of trust

NARCIS (Netherlands)

Brown, P.; Alaszewski, A.; Pilgrim, D.; Calnan, M.

2011-01-01

A lack of trust between clinicians and junior/middle managers is well documented in health care systems but under-theorized. Face-to-face interactions between clinicians and managers, through which trust is constructed, are vitally shaped by assumptions drawn from local organizational

Genomic sequencing: assessing the health care system, policy, and big-data implications.

Science.gov (United States)

Phillips, Kathryn A; Trosman, Julia R; Kelley, Robin K; Pletcher, Mark J; Douglas, Michael P; Weldon, Christine B

2014-07-01

New genomic sequencing technologies enable the high-speed analysis of multiple genes simultaneously, including all of those in a person's genome. Sequencing is a prominent example of a "big data" technology because of the massive amount of information it produces and its complexity, diversity, and timeliness. Our objective in this article is to provide a policy primer on sequencing and illustrate how it can affect health care system and policy issues. Toward this end, we developed an easily applied classification of sequencing based on inputs, methods, and outputs. We used it to examine the implications of sequencing for three health care system and policy issues: making care more patient-centered, developing coverage and reimbursement policies, and assessing economic value. We conclude that sequencing has great promise but that policy challenges include how to optimize patient engagement as well as privacy, develop coverage policies that distinguish research from clinical uses and account for bioinformatics costs, and determine the economic value of sequencing through complex economic models that take into account multiple findings and downstream costs. Project HOPE—The People-to-People Health Foundation, Inc.

Understanding Factors That Influence Stakeholder Trust of Natural Resource Science and Institutions

Science.gov (United States)

Gray, Steven; Shwom, Rachael; Jordan, Rebecca

2012-03-01

Building trust between resource users and natural resource institutions is essential when creating conservation policies that rely on stakeholders to be effective. Trust can enable the public and agencies to engage in cooperative behaviors toward shared goals and address shared problems. Despite the increasing attention that trust has received recently in the environmental management literature, the influence that individual cognitive and behavioral factors may play in influencing levels of trust in resource management institutions, and their associated scientific assessments, remains unclear. This paper uses the case of fisheries management in the northeast to explore the relationships between an individual's knowledge of the resource, perceptions of resource health, and participatory experience on levels of trust. Using survey data collected from 244 avid recreational anglers in the Northeast U.S., we test these relationships using structural equation modeling. Results indicate that participation in fisheries management is associated with increased trust across all aspects of fisheries management. In addition, higher ratings of resource health by anglers are associated with higher levels of trust of state and regional institutions, but not federal institutions or scientific methods.

International policies toward parental leave and child care.

Science.gov (United States)

Waldfogel, J

2001-01-01

The pleasures and pressures of parenting a newborn are universal, but the supports surrounding parents vary widely from country to country. In many nations, decades of attention to benefits and services for new parents offer lessons worthy of attention in this country. This article describes policies regarding parental leave, child care, and early childhood benefits here and in 10 industrial nations in North America and Europe. The sharpest contrast separates the United States from the other countries, although differences among the others also are instructive: The right to parental leave is new to American workers; it covers one-half of the private-sector workforce and is relatively short and unpaid. By contrast, other nations offer universal, paid leaves of 10 months or more. Child care assistance in Europe is usually provided through publicly funded programs, whereas the United States relies more on subsidies and tax credits to reimburse parents for part of their child care expenses. Nations vary in the emphasis they place on parental leave versus child care supports for families with children under age three. Each approach creates incentives that influence parents' decisions about employment and child care. Several European nations, seeking flexible solutions for parents, are testing "early childhood benefits" that can be used to supplement income or pay for private child care. Based on this review, the author urges that the United States adopt universal, paid parental leave of at least 10 months; help parents cover more child care costs; and improve the quality of child care. She finds policy packages that support different parental choices promising, because the right mix of leave and care will vary from family to family, and child to child.

Relationship between Trust, Distributed Leadership and Job Performance in Health Care Context

DEFF Research Database (Denmark)

Jain, Ajay K.; Günzel-Jensen, Franziska

2014-01-01

satisfaction mediates the relationship between vertical trust and distributed leadership, and further distributed leadership had a positive impact on job performance. Furthermore, the results also showed that job satisfaction had a positively significant impact on distributed leadership and employees......´ performance. Moreover, distributed leadership has affected employees´ performance positively and it carries the impact of job satisfaction on performance. Implications: The study showed that trust and job satisfaction are important triggers of DL. Furthermore, results are also interesting because literature......Purpose: This study aims at investigating the effect of vertical trust on distributed leadership and performance as mediated by job satisfaction, and further to see the role of DL in carrying out the effect of satisfaction on employees´ performance. Design: Grounded in literature on organizational...

A New Health Care Prevention Agenda: Sustainable Food Procurement and Agricultural Policy.

Science.gov (United States)

Harvie, Jamie; Mikkelsen, Leslie; Shak, Linda

2009-07-01

Health care leaders are broadening their awareness to include the need to address the food system as a means to individual, public, and global health, above and beyond basic nutritional factors. Key voices from the health care sector have begun to engage in market transformation and are aggregating to articulate the urgency for engagement in food and agricultural policy. Systemic transformation requires a range of policies that complement one another and address various aspects of the food system. Health care involvement in policy and advocacy is vital to solve the expanding ecological health crises facing our nation and globe and will require an urgency that may be unprecedented.

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers

Directory of Open Access Journals (Sweden)

Ilaria Mosca

2017-04-01

Full Text Available Background The sustainability of long-term care (LTC is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester. Methods This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1 public- and private funding; (2 informal care and externalities; and (3 the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. Results The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. Conclusion The analysis shows why it is difficult for EU Member State

The company you keep: spreading effects of financial fraud on investor trust.

Science.gov (United States)

Bernet, Patrick Michael; Getzen, Thomas E

2007-01-01

Investor trust is valuable to health care organizations. Without it, they may face higher capital costs. This study explores recent cases of fraud and the appearance of impropriety by health care organizations, focusing on the manners in which trust was violated, the systems that allowed those violations, and the effects on financial markets. Increases in the incidence and scale of such transgressions may be harbingers of worse times ahead. This article examines how recent events have affected the cost of capital, and what health care organizations can do to avoid being judged by the company they keep.

Protection of Children in Malaysia through Foster Care Legislation and Policy

Directory of Open Access Journals (Sweden)

Azizah Mohd

2012-01-01

Full Text Available Children are immature, naive and unable to care for themselves. Due to this verynature of children, they are in need of among others, care, attention andsupervision from adults. Care, attention and supervision are among the means ofcare and protection of children, which can only be acquired in a familyenvironment. One of the ways to achieve family environment is through FosterCare where a child who is in need of care and protection will be placed with afamily permanently or temporarily or until they are able to care for themselves.Foster care will at least provide for a family life experience especially for childrenwithout family or who have problems in their family life. This paper is to examinethe Concept of Foster care in Malaysia and the law relating to it as to provideprotection to children in need of care and protection. Examination will focus onrelevant legislations and policy relating to Foster Care. Discussion will extend toanalysis on whether the available laws and policies are adequate to sustainchildren protection in Malaysia through Foster Care.

Global Acceptance of Biosimilars: Importance of Regulatory Consistency, Education, and Trust.

Science.gov (United States)

Cazap, Eduardo; Jacobs, Ira; McBride, Ali; Popovian, Robert; Sikora, Karol

2018-05-16

Globally, biosimilars are expected to have a key role in improving patient access to biological therapies and addressing concerns regarding the escalating cost of health care. Indeed, in Europe, increased use of biologics and reduced drug prices have been observed after the introduction of biosimilars. Recently, several monoclonal antibody biosimilars of anticancer therapies have been approved, and numerous others are in various stages of clinical development. Biosimilars are authorized via a regulatory pathway separate from that used for generic drugs; they are also regulated separately from novel biologics. Biosimilar approval pathways in many major regulatory regions worldwide are, to a broad degree, scientifically aligned. However, owing to regional differences in health care priorities, policies, and resources, some important regulatory inconsistencies are evident. Acceptance of biosimilars by health care systems, health care professionals, and patients will be a key factor in the uptake of these therapies, and such regulatory variations could contribute to confusion and diminished confidence regarding the quality, efficacy, and reliability of these agents. Furthermore, the need for manufacturers to account for regulatory inconsistencies introduces inefficiencies and delays into biosimilar development programs. These issues should be addressed if biosimilars are to attain their maximal global potential. This review summarizes the evolution of the global biosimilar landscape and provides examples of inconsistencies between regulatory requirements in different regions. In addition, we review ongoing efforts to improve regulatory alignment and highlight the importance of education as a crucial factor in generating trust in, and acceptance of, biosimilars on a worldwide scale. Biosimilars of monoclonal antibody anticancer therapies are beginning to emerge, and more are likely to become available for clinical use in the near future. The extent to which biosimilars

Does Trust Matter for Entrepreneurship: Evidence from a Cross-Section of Countries

Directory of Open Access Journals (Sweden)

Oasis Kodila-Tedika

2016-03-01

Full Text Available Differences in trust levels between countries explain the observed discrepancies in entrepreneurial spirit amongst them. We test this hypothesis with a cross-section of 60 countries in 2010. Our findings suggest that about half of the variation in entrepreneurial spirit across countries in the world is driven by trust considerations. This result is robust to regional clustering, outliers and alternative conditioning variables. The findings of the study indicate that while formal incentives to nurture entrepreneurship must be maintained, policy makers should also seek to pay attention to the role of trust cultivated through informal networks.

Implementing care policy in developing countries

International Nuclear Information System (INIS)

Tattum, L.; Phishner, E.S.

1992-01-01

How do chief executives of Western companies, from their plush offices, keep tabs on what happens at chemical plants in developing countries? Many point out that it is difficult to operate a Responsible Care policy in countries where industry associations have not yet started a coordinated initiative. 'Responsible Care is a program that has primarily a geographic dimension and is organized country by country by the industry associations,' note Kaspar Eigenmann, head of corporate unit safety and environment at Ciba (Basel). Where there is a campaign, the local Ciba company participates, he says. 'It's obvious that the industrialized countries are taking the lead,' adds Eigenmann

Consumer trust to a Web site: moderating effect of attitudes toward online shopping.

Science.gov (United States)

San Martín, Sonia; Camarero, Carmen

2008-10-01

In this paper, authors suggest a model that reflects the role played by the Web site characteristics and the previous level of satisfaction as determinant factors of trust in the Web site. Also, authors consider the moderating effects of consumers' motives and inhibitors to purchase online. Results show that satisfaction with previous purchases, the Web site security and privacy policies, and service quality are the main determinants of trust. Also, the motives and inhibitors the individuals perceive when buying online determine the type of signals they consider to trust.

Trust us Trust Thorp Campaign

International Nuclear Information System (INIS)

Kane, John

1995-01-01

The history of the nuclear industry in the UK has been dominated by Sellafield reprocessing site in west Cumbria. The site, formerly owned by the United Kingdom Atomic Energy Authority was transferred to the newly-formed British Nuclear Fuels plc in 1971. Although trade union representation existed at Sellafield before the emergence of BNFL, it is only after this date that collective trade union activity began to emerge. In 1977, after a long running dispute with management about the issue of radiation dose uptake, the workforce went on strike, forcing the management to question their previous 'need to know' attitude and to improve industrial relations. In 1984, it was recognised that the lobbying influence of trade unions within politics, and especially the Labour party could be used to greater effect to challenge potentially -damaging influence of anti-nuclear campaigners. The National Campaign for the Nuclear Industry (NCNI) was born, combining nine industrial and non-industrial trade unions within the nuclear industry. Its task during the last ten years has been to put forward the interests of its members collectively and to secure the, role of nuclear power. within a balanced energy policy in the political arena. In dome so, it has gained a credible voice within both the trade union movement and the Labour party. The new Thermal Oxide Reprocessing Plant (THORP) received strong support from the NCNI during its construction and commissioning phases. When it became clear that the anti-nuclear lobby had gained the upper hand and were beginning to seriously delay the necessary legal instruments required to start the plant, the power of collective action was once again recognised, and the TRUST US campaign was born. The campaign was run and organised by a clerks committee and fronted by the Trade Unions at Sellafield., and turned out to be one of the most successful] trade union campaigns in recent history. The first task involved getting, the entire workforce on

TrustBuilder2: A Reconfigurable Framework for Trust Negotiation

Science.gov (United States)

Lee, Adam J.; Winslett, Marianne; Perano, Kenneth J.

To date, research in trust negotiation has focused mainly on the theoretical aspects of the trust negotiation process, and the development of proof of concept implementations. These theoretical works and proofs of concept have been quite successful from a research perspective, and thus researchers must now begin to address the systems constraints that act as barriers to the deployment of these systems. To this end, we present TrustBuilder2, a fully-configurable and extensible framework for prototyping and evaluating trust negotiation systems. TrustBuilder2 leverages a plug-in based architecture, extensible data type hierarchy, and flexible communication protocol to provide a framework within which numerous trust negotiation protocols and system configurations can be quantitatively analyzed. In this paper, we discuss the design and implementation of TrustBuilder2, study its performance, examine the costs associated with flexible authorization systems, and leverage this knowledge to identify potential topics for future research, as well as a novel method for attacking trust negotiation systems.

Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study.

Science.gov (United States)

Aldridge, Cassie; Bion, Julian; Boyal, Amunpreet; Chen, Yen-Fu; Clancy, Mike; Evans, Tim; Girling, Alan; Lord, Joanne; Mannion, Russell; Rees, Peter; Roseveare, Chris; Rudge, Gavin; Sun, Jianxia; Tarrant, Carolyn; Temple, Mark; Watson, Sam; Lilford, Richard

2016-07-09

Increased mortality rates associated with weekend hospital admission (the so-called weekend effect) have been attributed to suboptimum staffing levels of specialist consultants. However, evidence for a causal association is elusive, and the magnitude of the weekend specialist deficit remains unquantified. This uncertainty could hamper efforts by national health systems to introduce 7 day health services. We aimed to examine preliminary associations between specialist intensity and weekend admission mortality across the English National Health Service. Eligible hospital trusts were those in England receiving unselected emergency admissions. On Sunday June 15 and Wednesday June 18, 2014, we undertook a point prevalence survey of hospital specialists (consultants) to obtain data relating to the care of patients admitted as emergencies. We defined specialist intensity at each trust as the self-reported estimated number of specialist hours per ten emergency admissions between 0800 h and 2000 h on Sunday and Wednesday. With use of data for all adult emergency admissions for financial year 2013-14, we compared weekend to weekday admission risk of mortality with the Sunday to Wednesday specialist intensity ratio within each trust. We stratified trusts by size quintile. 127 of 141 eligible acute hospital trusts agreed to participate; 115 (91%) trusts contributed data to the point prevalence survey. Of 34,350 clinicians surveyed, 15,537 (45%) responded. Substantially fewer specialists were present providing care to emergency admissions on Sunday (1667 [11%]) than on Wednesday (6105 [42%]). Specialists present on Sunday spent 40% more time caring for emergency patients than did those present on Wednesday (mean 5·74 h [SD 3·39] vs 3·97 h [3·31]); however, the median specialist intensity on Sunday was only 48% (IQR 40-58) of that on Wednesday. The Sunday to Wednesday intensity ratio was less than 0·7 in 104 (90%) of the contributing trusts. Mortality risk among patients

Social trust aspects of rural electrification

Energy Technology Data Exchange (ETDEWEB)

NONE

2000-10-01

This report is a contribution to a growing body of work which acknowledges the importance of social considerations in the electricity industry, and provides an electricity industry perspective on the role of social trust, which is closely related to concepts such as social responsibility, corporate governance and corporate stewardship. The report provides a full explanation of the concept of social trust, defines its components (competence, commitment, consistency, fairness, respect, caring and empathy) and makes suggestions as to how each of these components could be implemented in a variety of settings and situations such as facility planning, construction and operation, risk management and customer relations.

Quantifying and Qualifying Trust: Spectral Decomposition of Trust Networks

NARCIS (Netherlands)

Pavlovic, Dusko; Degano, Pierpaolo; Etalle, Sandro; Guttman, Joshua

In a previous FAST paper, I presented a quantitative model of the process of trust building, and showed that trust is accumulated like wealth: the rich get richer. This explained the pervasive phenomenon of adverse selection of trust certificates, as well as the fragility of trust networks in

Rethinking trust.

Science.gov (United States)

Kramer, Roderick M

2009-06-01

Will we ever learn? We'd barely recovered from Enron and WorldCom before we faced the subprime mortgage meltdown and more scandals that shook our trust in businesspeople. Which raises the question: Do we trust too much? In this article, Stanford professor and social psychologist Kramer explores the reasons we trust so easily--and, often, so unwisely. He explains that genetics and childhood learning make us predisposed to trust and that it's been a good survival mechanism. That said, our willingness to trust makes us vulnerable. Our sense of trust kicks in on remarkably simple cues, such as when people look like us or are part of our social group. We also rely on third parties to verify the character of others, sometimes to our detriment (as the victims of Bernard Madoff learned). Add in our illusions of invulnerability and our tendencies to see what we want to see and to overestimate our own judgment, and the bottom line is that we're often easily fooled. We need to develop tempered trust. For those who trust too much, that means reading cues better; for the distrustful, it means developing more receptive behaviors. Everyone should start with small acts of trust that encourage reciprocity and build up. Having a hedge against potential abuses also helps. Hollywood scriptwriters, for instance, register their treatments with the Writers Guild of America to prevent their ideas from being stolen by the executives they pitch. To attract the right relationships, people must strongly signal their own honesty, proactively allay concerns, and, if their trust is abused, retaliate. Trusting individuals in certain roles, which essentially means trusting the system that selects and trains them, also works but isn't foolproof. And don't count on due diligence alone for protection; constant vigilance is needed to make sure the landscape hasn't changed.

26 CFR 26.2654-1 - Certain trusts treated as separate trusts.

Science.gov (United States)

2010-04-01

... trusts under local law, treatment of a single trust as separate trusts under this paragraph (a)(1) does... applicable state law, then each resulting trust is treated as a separate trust for purposes of Chapter 13... Internal Revenue Code, if those portions are not treated as separate trusts under local law. Also...

The Importance of Consumer Trust for the Emergence of a Market for Green products

DEFF Research Database (Denmark)

Nuttavuthisit, Krittinee; Thøgersen, John

2017-01-01

Consumer trust is a key prerequisite for establishing a market for credence goods, such as “green” products, especially when they are premium priced. This article reports research on exactly how, and how much, trust influences consumer decisions to buy new green products. It identifies consumer t...... behavior. Implications for policy and future research are discussed....

Retrospective: Ivy Lee and the German Dye Trust.

Science.gov (United States)

Hainsworth, Brad E.

1987-01-01

Examines the relationship between public relations trailblazer Ivy Lee and the German Dye Trust, which became an agent for the policies of Adolf Hitler. Discusses how Lee's efforts to use this relationship to persuade his contacts to influence the Nazi leadership failed because of his formal connection with this group. (JD)

Implementation of the European Working Time Directive in an NHS trust: impact on patient care and junior doctor welfare.

Science.gov (United States)

McIntyre, Hugh F; Winfield, Sarah; Te, Hui Sen; Crook, David

2010-04-01

To comply with the European Working Time Directive (EWTD), from 1 August 2009, junior doctors are required to work no more than 48 hours per week. In accordance with this, East Sussex Hospitals Trust introduced changes to working practice in August 2007. To assess the impact upon patient care and junior doctor welfare a retrospective observational survey comparing data from the year prior to and the year following August 2007 was conducted. No impact on the standard of patient care, as measured by length of stay, death during admission or readmission was found. However, there was a notable increase in episodes of sick leave among junior doctors. Implementation of the EWTD may maintain standards of patient care but may be detrimental to the welfare of doctors in training.

The Need to Trust and to Trust More Wisely in Academe

Science.gov (United States)

Bowman, Richard F.

2012-01-01

Where trust is an issue, there is no trust. Trust in diverse organizations has never been lower. A shadow of doubt stalks one's every decision to trust collegially and institutionally. Still, colleagues sense intuitively that institutions cannot function optimally without a bedrock level of trust. In academic life, trust is a form of social…

Effect of delivery care user fee exemption policy on institutional ...

African Journals Online (AJOL)

Background: To improve access to skilled attendance at delivery and thereby reduce maternal mortality, the Government of Ghana introduced a policy exempting all women attending health facilities from paying delivery care fees. Objective: To examine the effect of the exemption policy on delivery-related maternal mortality.

Public policy and medical tourism: ethical implications for the Egyptian health care system.

Science.gov (United States)

Haley, Bob

2011-01-01

Egypt's medical tourism industry has been experiencing tremendous growth. However, Egypt continues to lack the necessary investment in its public health system to effectively care for its population. Current policy and the emergence of medical tourism have led to unequal health care access, resulting in high a prevalence of infectious diseases and lack of resources for its most vulnerable populations. As a new Egyptian government emerges, it is important for policymakers to understand the critical issues and ethical concerns of existing health policy. This understanding may be used to propose new policy that more effectively allocates to care for Egypt's population.

Trust in automation: integrating empirical evidence on factors that influence trust.

Science.gov (United States)

Hoff, Kevin Anthony; Bashir, Masooda

2015-05-01

We systematically review recent empirical research on factors that influence trust in automation to present a three-layered trust model that synthesizes existing knowledge. Much of the existing research on factors that guide human-automation interaction is centered around trust, a variable that often determines the willingness of human operators to rely on automation. Studies have utilized a variety of different automated systems in diverse experimental paradigms to identify factors that impact operators' trust. We performed a systematic review of empirical research on trust in automation from January 2002 to June 2013. Papers were deemed eligible only if they reported the results of a human-subjects experiment in which humans interacted with an automated system in order to achieve a goal. Additionally, a relationship between trust (or a trust-related behavior) and another variable had to be measured. All together, 101 total papers, containing 127 eligible studies, were included in the review. Our analysis revealed three layers of variability in human-automation trust (dispositional trust, situational trust, and learned trust), which we organize into a model. We propose design recommendations for creating trustworthy automation and identify environmental conditions that can affect the strength of the relationship between trust and reliance. Future research directions are also discussed for each layer of trust. Our three-layered trust model provides a new lens for conceptualizing the variability of trust in automation. Its structure can be applied to help guide future research and develop training interventions and design procedures that encourage appropriate trust. © 2014, Human Factors and Ergonomics Society.

No Ifs, No Butts: Compliance with Smoking Cessation in Secondary Care Guidance (NICE PH48 by Providers of Cancer Therapies (Radiotherapy and Chemotherapy in the UK

Directory of Open Access Journals (Sweden)

Daniel Hutton

2016-12-01

Full Text Available Background: Legislation preventing smoking in public places was introduced in England in July 2007. Since then, smoke-free policies have been extended to the majority of hospitals including those providing cancer therapies. Whilst studies have been conducted on the impact and effectiveness of hospital smoke-free policy in the UK and other countries, there have not been any studies with a focus on cancer care providers. Cancer patients are a priority group for smoking cessation and support and this study aimed to examine implementation of the National Institute Clinical Excellence (NICE guidance (PH48 in acute cancer care trusts in the UK. Methods: Participants were recruited from UK radiotherapy and chemotherapy departments (total 80 sites, 65 organisations and asked to complete a 15 min online questionnaire exploring the implementation of NICE guidance at their hospital site. Results: Considerable variability in implementation of the NICE guidance was observed. A total of 79.1% trusts were smoke-free in theory; however, only 18.6% were described as smoke-free in practice. Areas of improvement were identified in information and support for patients and staff including in Nicotine Replacement Therapy (NRT provision, staff training and clarity on e-cigarette policies. Conclusions: While some trusts have effective smoke-free policies and provide valuable cessation support services for patients, improvements are required to ensure that all sites fully adopt the NICE guidance.

Competition policy for health care provision in Norway.

Science.gov (United States)

Brekke, Kurt R; Straume, Odd Rune

2017-02-01

Competition policy has played a very limited role for health care provision in Norway. The main reason is that Norway has a National Health Service (NHS) with extensive public provision and a wide set of sector-specific regulations that limit the scope for competition. However, the last two decades, several reforms have deregulated health care provision and opened up for provider competition along some dimensions. For specialised care, the government has introduced patient choice and (partly) activity (DRG) based funding, but also corporatised public hospitals and allowed for more private provision. For primary care, a reform changed the payment scheme to capitation and (a higher share of) fee-for-service, inducing almost all GPs on fixed salary contracts to become self-employed. While these reforms have the potential for generating competition in the Norwegian NHS, the empirical evidence is quite limited and the findings are mixed. We identify a set of possible caveats that may weaken the incentives for provider competition - such as the partial implementation of DRG pricing, the dual purchaser-provider role of regional health authorities, and the extensive consolidation of public hospitals - and argue that there is great scope for competition policy measures that could stimulate provider competition within the Norwegian NHS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

An exploratory study of the role of trust in medication management within mental health services.

Science.gov (United States)

Maidment, Ian D; Brown, Patrick; Calnan, Michael

2011-08-01

To develop understandings of the nature and influence of trust in the safe management of medication within mental health services. Mental health services in the UK. Qualitative methods were applied through focus groups across three different categories of service user--older adult, adults living in the community and forensic services. An inductive thematic analysis was carried out, using the method of constant comparison derived from grounded theory. Participants' views on the key factors influencing trust and the role of trust in safe medication management. The salient factors impacting trust were: the therapeutic relationship; uncertainty and vulnerability; and social control. Users of mental health services may be particularly vulnerable to adverse events and these can damage trust. Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust.

Foundation Trusts: economics in the 'postmodern hospital'.

Science.gov (United States)

Newbold, David

2005-09-01

Foundation Trust Hospitals are community-controlled health care providers which have increased autonomy about how they produce outcomes for the British National Health Service. Although there is a literature on hospital economics it is unclear how these innovative providers will behave, if they have to compete for scarce resources with other hospitals. This paper reviews some of the earlier theories, such as the neoclassical theory of the firm, and discusses their relevance along with 'newer' economic theories such as the transaction costs and evolutionary theory of the firm, plus organizational and human resources theory, to the performance of Foundation Trusts. Much contemporary health care provision is shaped along modernist lines, using scientific endeavour to maximize the impact on health outcomes and technical and social efficiency. However, there is an increasingly postmodern standpoint--critical of modernity--being taken by both patients and hospital staff, to deconstruct processes in the organizations that serve them. Foundation Trusts are postmodern hospitals insomuch as they (to attract scarce resources in a competitive environment), need to marshal the diverse theories of the firm together in order to provide a mass-customized, quality experience, transparently and at least cost--whilst maintaining a stable organizational culture for staff.

Calculativeness and trust

DEFF Research Database (Denmark)

Frederiksen, Morten

2014-01-01

Williamson’s characterisation of calculativeness as inimical to trust contradicts most sociological trust research. However, a similar argument is found within trust phenomenology. This paper re-investigates Williamson’s argument from the perspective of Løgstrup’s phenomenological theory of trust....... Contrary to Williamson, however, Løgstrup’s contention is that trust, not calculativeness, is the default attitude and only when suspicion is awoken does trust falter. The paper argues that while Williamson’s distinction between calculativeness and trust is supported by phenomenology, the analysis needs...... to take actual subjective experience into consideration. It points out that, first, Løgstrup places trust alongside calculativeness as a different mode of engaging in social interaction, rather conceiving of trust as a state or the outcome of a decision-making process. Secondly, the analysis must take...

Banking system trust, bank trust, and bank loyalty

NARCIS (Netherlands)

van Esterik-Plasmeijer, P.; van Raaij, W.F.

2017-01-01

Purpose The purpose of this paper is to test a model of banking system trust as an antecedent of bank trust and bank loyalty. Six determinants of trust and loyalty are included: competence, stability, integrity, customer orientation, transparency, and value congruence. The study provides insights

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers.

Science.gov (United States)

Mosca, Ilaria; van der Wees, Philip J; Mot, Esther S; Wammes, Joost J G; Jeurissen, Patrick P T

2016-08-17

The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU's European Semester. This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC

Trust and Leadership

DEFF Research Database (Denmark)

Bordum, Anders

2005-01-01

The concept and phenomenon of trust and its relation to leadership has recently come into focus. What role does trust play? Can trust be created strategically? Questions like these are often raised. How we conceive of and conceptualize trust is not as often discussed. Among those conceptualizations...... flexibility of form for example, the idea that one with leadership tools can consciously bring forth trust. In the conclusion, the question about trust communication is addressed. In this section I argue that trust is positively value-laden, becausesincerity is a functional and pragmatic condition...

Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence.

Science.gov (United States)

Millar, Ross; Freeman, Tim; Mannion, Russell

2015-06-16

Hospital boards, those executive members charged with developing appropriate organisational strategies and cultures, have an important role to play in safeguarding the care provided by their organisation. However, recent concerns have been raised over boards' ability to enact their duty to ensure the quality and safety of care. This paper offers critical reflection on the relationship between hospital board oversight and patient safety. In doing so it highlights new perspectives and suggestions for developing this area of study. The article draws on 10 interviews with key informants and policy actors who form part of the 'issue network' interested in the promotion of patient safety in the English National Health Service. The interviews surfaced a series of narratives regarding hospital board oversight of patient safety. These elaborated on the role of trust and intelligence in highlighting the potential dangers and limitations of approaches to hospital board oversight which have been narrowly focused on a risk-based view of organisational performance. In response, a need to engage with the development of trust based organisational relationships is identified, in which effective board oversight is built on 'trust' characterised by styles of leadership and behaviours that are attentive to the needs and concerns of both staff and patients. Effective board oversight also requires the gathering and triangulating of 'intelligence' generated from both national and local information sources. We call for a re-imagination of hospital board oversight in the light of these different perspectives and articulate an emerging research agenda in this area.

Obesity Prevention Practices and Policies in Child Care Settings Enrolled and Not Enrolled in the Child and Adult Care Food Program.

Science.gov (United States)

Liu, Sherry T; Graffagino, Cheryl L; Leser, Kendall A; Trombetta, Autumn L; Pirie, Phyllis L

2016-09-01

Objectives The United States Department of Agriculture's Child and Adult Care Food Program (CACFP) provides meals and snacks to low-income children in child care. This study compared nutrition and physical activity practices and policies as well as the overall nutrition and physical activity environments in a sample of CACFP and non-CACFP child care settings. Methods A random stratified sample of 350 child care settings in a large Midwestern city and its suburbs, was mailed a survey on obesity prevention practices and policies concerning menu offerings, feeding practices, nutrition and physical activity education, activity levels, training, and screen time. Completed surveys were obtained from 229 of 309 eligible child care settings (74.1 % response rate). Chi square tests were used to compare practices and policies in CACFP and non-CACFP sites. Poisson and negative binomial regression were used to examine associations between CACFP and total number of practices and policies. Results Sixty-nine percent of child care settings reported CACFP participation. A significantly higher proportion of CACFP sites reported offering whole grain foods daily and that providers always eat the same foods that are offered to the children. CACFP sites had 1.1 times as many supportive nutrition practices as non-CACFP sites. CACFP participation was not associated with written policies or physical activity practices. Conclusions for Practice There is room for improvement across nutrition and physical activity practices and policies. In addition to food reimbursement, CACFP participation may help promote child care environments that support healthy nutrition; however, additional training and education outreach activities may be needed.

Advancing team-based primary health care: a comparative analysis of policies in western Canada.

Science.gov (United States)

Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

2017-07-17

We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus

Directory of Open Access Journals (Sweden)

McDonald Julie

2012-03-01

Full Text Available Abstract Background Ongoing care for chronic conditions such as diabetes is best provided by a range of health professionals working together. There are challenges in achieving this where collaboration crosses organisational and sector boundaries. The aim of this article is to explore the influence of power dynamics and trust on collaboration between health professionals involved in the management of diabetes and their impact on patient experiences. Methods A qualitative case study conducted in a rural city in Australia. Forty five health service providers from nineteen organisations (including fee-for-service practices and block funded public sector services and eight patients from two services were purposively recruited. Data was collected through semi-structured interviews that were audio-taped and transcribed. A thematic analysis approach was used using a two-level coding scheme and cross-case comparisons. Results Three themes emerged in relation to power dynamics between health professionals: their use of power to protect their autonomy, power dynamics between private and public sector providers, and reducing their dependency on other health professionals to maintain their power. Despite the intention of government policies to support more shared decision-making, there is little evidence that this is happening. The major trust themes related to role perceptions, demonstrated competence, and the importance of good communication for the development of trust over time. The interaction between trust and role perceptions went beyond understanding each other's roles and professional identity. The level of trust related to the acceptance of each other's roles. The delivery of primary and community-based health services that crosses organisational boundaries adds a layer of complexity to interprofessional relationships. The roles of and role boundaries between and within professional groups and services are changing. The uncertainty and

Job satisfaction as a matter of time, team, and trust

DEFF Research Database (Denmark)

Uhrenfeldt, Lisbeth; Hall, Elisabeth

2015-01-01

Support and variety regarding work, autonomy, organizational constraints, and promotion opportunities are factors contributing to job satisfaction or lack thereof among hospital nurses together with self-perceived health, education and career orientation. The aim of this study was to explore public...... hospital nurses’ experiences of job satisfaction. This qualitative study was undertaken in a caring theory context. Ten proficient Danish hospital nurses were interviewed twice and data were analysed using a hermeneutic approach. The analysis revealed that time, team, and trust were essential components...... in job satisfaction. Time, team and trust helped the nurses collaborate with patients, care for relatives, and work in teams with other hospital staff members. Lack of job satisfaction occurred when time was to short or quality care was threatened, when the nurses felt alone and had to finish their job...

Who are Your Joneses? Socio-Specific Income Inequality and Trust.

Science.gov (United States)

Stephany, Fabian

2017-01-01

Trust is a good approach to explain the functioning of markets, institutions or society as a whole. It is a key element in almost every commercial transaction over time and might be one of the main explanations of economic success and development. Trust diminishes the more we perceive others to have economically different living realities. In most of the relevant contributions, scholars have taken a macro perspective on the inequality-trust linkage, with an aggregation of both trust and inequality on a country level. However, patterns of within-country inequality and possibly influential determinants, such as perception and socioeconomic reference, remained undetected. This paper offers the opportunity to look at the interplay between inequality and trust at a more refined level. A measure of (generalized) trust emerges from ESS 5 survey which asks "... generally speaking, would you say that most people can be trusted, or that you can't be too careful in dealing with people? ". With the use of 2009 EU-SILC data, measurements of income inequality are developed for age-specific groups of society in 22 countries. A sizable variation in inequality measures can be noticed. Even in low inequality countries, like Sweden, income imbalances within certain age groups have the potential to undermine social trust.

Trust in Vaccines: Why It Takes More than Good Faith.

Science.gov (United States)

Begg, Norman

2013-08-12

This Vaccines issue on "Confidence in Vaccines" provides sound evidence through multiple perspectives of life-saving impacts when vaccination programs are effectively implemented in a population. Yet there remain challenges to achieving this impact, including scientific, medical, manufacturing, policy-related and logistical issues. Additionally, socio-cultural, religious and political agendas can come into play, taking public health hostage and sometimes allowing the circulation of myths regarding vaccination. All of these challenges play a role in public confidence in vaccines and vaccination. What we trust, we embrace. What we do not trust, we do not embrace.

Dimensions of trust

DEFF Research Database (Denmark)

Frederiksen, Morten

2012-01-01

Georg Simmel is the seminal author on trust within sociology, but though inspired by Simmel, subsequent studies of intersubjective trust have failed to address Simmel’s suggestion that trust is as differentiated as the social relations of which it is part. Rather, trust has been studied within...... limited sets of exchange or work relations. This article revisits Simmel’s concept of trust as social form in order to investigate this differentiation. From an interview study, the differentiation and limits of trust are analysed within different types of social relations. Trust is found to vary greatly...... in scope and mode influenced by the intersecting dimensions of relations, objects and situations. Furthermore, trust exists between an outer threshold of expected deceit and an inner threshold of confident reliance. The findings from the qualitative study contribute new knowledge on the diversity of trust...

Interface management of pharmacotherapy. Joint hospital and primary care drug recommendations.

Science.gov (United States)

Björkhem-Bergman, Linda; Andersén-Karlsson, Eva; Laing, Richard; Diogene, Eduardo; Melien, Oyvind; Jirlow, Malena; Malmström, Rickard E; Vogler, Sabine; Godman, Brian; Gustafsson, Lars L

2013-05-01

In September 2012 an interactive course on the "Interface Management of Pharmacotherapy" was organized by the Stockholm Drug and Therapeutics Committee in cooperation with Department of Clinical Pharmacology at Karolinska Institutet and at Karolinska University Hospital in Stockholm, Sweden, in collaboration with the WHO. The basis for the course was the "Stockholm model" for the rational use of medicines but also contained presentations about successful models in interface management of pharmacotherapy in other European countries. The "Stockholm model" consists of 8 components: 1) Independent Drug and Therapeutics Committee with key role for respected drug experts with policy for "interest of conflicts", 2) The "Wise List", recommendations of medicines jointly for primary and hospital care, 3) Communication strategy with continuous medical education, 4) Systematic introduction of new expensive medicines, 5) E-pharmacological support at "point of care", 6) Methods and tools for follow-up of medicines use, 7) Medicines policy strategy and 8) Operative resources. The course highlighted the importance of efficient and targeted communication of drug recommendations building on trust among prescribers and patients for the guidelines to achieve high adherence. Trust is achieved by independent Drug and Therapeutics Committees with a key role for respected experts and a strict policy for "conflicts of interest". Representations of GPs are also crucial for successful implementation, being the link between evidence based medicine and practice. The successful models in Scotland and in Stockholm as well as the ongoing work in Catalonia were considered as examples of multifaceted approaches to improve the quality of medicine use across primary and hospital care.

Exploring the Change from Low-Trust to High-Trust Organizations

DEFF Research Database (Denmark)

Jagd, Søren

what the notion of high-trust organization actually means, and that the change process in the direction of high trust organizations involves not only a quantitative growth in trust, but may involve important qualitative changes in the organization, especially concerning the relations between management......A growing body of literature point to the increasing importance of trust for organizations and for the explicit use of trust as a management tool. The explicit or implicit message in both management literature and research literature on trust as a management tool is that managers should pursue...... projects of personal and organizational change leading to high-trust organizations. In this paper I explore how we may understand this change towards high-trust organizations: What does it mean, what is the content of such a change, and what may be the consequences. I show that it is still rather unclear...

Learning to Trust

NARCIS (Netherlands)

Nooteboom, B.

2005-01-01

Trust is full of puzzle and paradox.Trust is both rational and emotional. Trust can go beyond calculative self-interest, but has its limits.People may want to trust, while they may also feel threatened by it.If trust is not in place prior to a relationship, on the basis of institutions, prior

Healthcare professionals' perspectives on delivering end-of-life care within acute hospital trusts: a qualitative study.

Science.gov (United States)

Reid, Colette; Gibbins, Jane; Bloor, Sophia; Burcombe, Melanie; McCoubrie, Rachel; Forbes, Karen

2015-12-01

The quality of end-of-life (EOL) care in acute hospitals is variable and interventions to improve this care, such as EOL care pathways, are not always used. The underlying reasons for this variability are not fully understood. We explored healthcare professionals' views on delivering EOL care within an acute hospital trust in the South West of England. We employed qualitative methods (focus groups, in-depth interviews and questerviews) within a study investigating the impact of a simple EOL tool on the care of dying patients. We invited a range of staff of all grades with experience in caring for dying patients from medicine, surgery and care of the elderly teams to participate. Six focus groups, seven interviews and five questerviews were conducted. Two main themes emerged: (a) delays (difficulties and avoidance) in diagnosing dying and (b) the EOL tool supporting staff in caring for the dying. Staff acknowledged that the diagnosis of dying was often made late; this was partly due to prognostic uncertainty but compounded by a culture that did not acknowledge death as a possible outcome until death was imminent. Both the medical and nursing staff found the EOL tool useful as a means of communicating ceilings of care, ensuring appropriate prescribing for EOL symptoms, and giving nurses permission to approach the bedside of a dying patient. The culture of avoiding death and dying in acute hospitals remains a significant barrier to providing EOL care, even when EOL tools are available and accepted by staff. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Green Purchasing Behavior Analysis of Government Policy About Paid Plastic Bags

Directory of Open Access Journals (Sweden)

Muhammad Khoiruman

2017-06-01

Full Text Available This research will be conducted to know: 1 The influence of green perceived value to consumer green trust to use plastic bag after the policy of using plastic bag paid at modern retail store in Surakarta. 2 The influence of green perceived risk to consumer green trust to use plastic bag after the policy of using plastic bag paid at modern retail store in Surakarta. 3 The effect of green trust on green purchase behavior of consumers to use plastic bags after the policy of using plastic bag paid at modern retail store in Surakarta. The study was conducted in modern retail stores (Alfamart, Indomart and Superindo in Surakarta using 200 respondents who shop at the modern retail store. A model that can be used to measure green purchasing behavior in the use of paid plastic bags using four interrelated variables: green perceived value, green perceived risk, green trust and green purchasing. Data analysis using Structural Equation Model (SEM. The result of analysis and discussion showed that green perceived value have positive and significant effect to green trust, green trust has positive effect on green purchasing, but green perceived risk has no significant effect to green trust.

Security and trust: taking care of the human factor

NARCIS (Netherlands)

Egger, F.N.; Abrazhevich, D.

2001-01-01

In the e-business chain, the last link that needs to be convinced of the security of an online transaction is the end-user. That is why this article puts forward a user-centred perspective of the problem of trust in online payments, derived from the discipline of Human-Computer Interaction (HCI). We

Initial Efficacy of a Cardiac Rehabilitation Transition Program: Cardiac TRUST

Science.gov (United States)

Zullo, Melissa; Boxer, Rebecca; Moore, Shirley M.

2012-01-01

Patients recovering from cardiac events are increasingly using postacute care, such as home health care and skilled nursing facility services. The purpose of this pilot study was to test the initial efficacy, feasibility, and safety of a specially designed postacute care transitional rehabilitation intervention for cardiac patients. Cardiac Transitional Rehabilitation Using Self- Management Techniques (Cardiac TRUST) is a family-focused intervention that includes progressive low-intensity walking and education in self-management skills to facilitate recovery following a cardiac event. Using a randomized two-group design, exercise self-efficacy, steps walked, and participation in an outpatient cardiac rehabilitation program were compared in a sample of 38 older adults; 17 who received the Cardiac TRUST program and 21 who received usual care only. At discharge from postacute care, the intervention group had a trend for higher levels of self-efficacy for exercise outcomes (X=39.1, SD=7.4) than the usual care group (X=34.5; SD=7.0) (t-test 1.9, p=.06). During the 6 weeks following discharge, compared with the usual care group, the intervention group had more attendance in out-patient cardiac rehabilitation (33% compared to 11.8%, F=7.1, p=.03) and a trend toward more steps walked during the first week (X=1,307, SD=652 compared to X=782, SD=544, t-test 1.8, p=.07). The feasibility of the intervention was better for the home health participants than for those in the skilled nursing facility and there were no safety concerns. The provision of cardiac-focused rehabilitation during postacute care has the potential to bridge the gap in transitional services from hospitalization to outpatient cardiac rehabilitation for these patients at high risk for future cardiac events. Further evidence of the efficacy of Cardiac TRUST is warranted. PMID:22084960

Trust Building Recruitment Strategies for Researchers Conducting Studies in African American (AA) Churches: Lessons Learned.

Science.gov (United States)

Bonner, Gloria; Williams, Sharon; Wilkie, Diana; Hart, Alysha; Burnett, Glenda; Peacock, Geraldine

2017-12-01

An initial and vital important step in recruiting participants for church-based hospice and palliative care research is the establishment of trust and credibility within the church community. Mistrust of medical research is an extremely important barrier hindering recruitment in African American (AA) communities. A church-based EOL dementia education project is currently being conducted at four large urban AA churches. Church leaders voiced mistrust concerns of previous researchers who conducted investigations in their faith-based institutions. We explored strategies to ameliorate the mistrust concerns. Specific aim: To identify trust-rebuilding elements for researchers following others who violated trust of AA church leaders. Face-to-face, in-depth interviews were conducted from a convenient sample of four established AA church leaders. Interviews were held in the informants' churches to promote candor and comfort in revealing sensitive information about trust /mistrust. Content analysis framework was used to analyze the data. Elements identified from the analysis were then used to create themes. Multidimensional overarching themes emerged from the analysis included: Experience with researchers (positive and extremely negative), violation of trust and trust building strategies. Findings suggest that researchers who wish to conduct successful studies in the AA religious institutions must implement trust rebuilding strategies that include mutual respect, collaboration and partnership building. If general moral practices continue to be violated, threat to future hospice and palliative care research within the institutions may prevail. Thus, potential benefits are thwarted for the church members, AA community, and advancement of EOL care scholarship.

Development of an Internet Security Policy for health care establishments.

Science.gov (United States)

Ilioudis, C; Pangalos, G

2000-01-01

The Internet provides unprecedented opportunities for interaction and data sharing among health care providers, patients and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality and integrity of information. This paper defines the basic security requirements that must be addressed in order to use the Internet to safely transmit patient and/or other sensitive Health Care information. It describes a suitable Internet Security Policy for Health Care Establishments and provides the set of technical measures that are needed for its implementation. The proposed security policy and technical approaches have been based on an extensive study of the related recommendations from the security and standard groups both in EU amid USA and our related work and experience. The results have been utilized in the framework of the Intranet Health Clinic project, where the use of the Internet for the transmission of sensitive Health Care information is of vital importance.

Orphanhood, Poverty and the Care Dilemma: Review of Global Policy Trends

Directory of Open Access Journals (Sweden)

Abebe, Tatek

2009-07-01

Full Text Available The care and protection of children experiencing orphanhood presents a major child-care policy challenge. This paper draws on a review of the literature to document divergent conceptualizations of orphanhood, how the hurdles for the care of orphans reflect wider issues of poverty and inequality, as well as the ways in which different care interventions (familial, institutional, community-based and rights-based might be appropriated for children in need. It is argued that the map of contemporary orphanhood overlaps with the contours of global poverty, inequality, age-based deprivations and marginalization. An example of a ‘globalised’ model of orphan care, namely SOS Children’s Villages, is presented and its implications for policy are examined. The paper highlights the significance of fighting poverty and enhancing the care-giving capabilities of extended families in the care and protection of children from a rights-based perspective. It suggests that external interventions should primarily address the structural causes of poverty and marginality, rather than amplifying inequalities through the selective support of orphans in economically vulnerable communities.

Can we trust robots?

NARCIS (Netherlands)

Coeckelbergh, Mark

2011-01-01

Can we trust robots? Responding to the literature on trust and e-trust, this paper asks if the question of trust is applicable to robots, discusses different approaches to trust, and analyses some preconditions for trust. In the course of the paper a phenomenological-social approach to trust is

Developing and implementing an oral care policy and assessment tool.

LENUS (Irish Health Repository)

Stout, Michelle

2012-01-09

Oral hygiene is an essential aspect of nursing care. Poor oral care results in patients experiencing pain and discomfort, puts individuals at risk of nutritional deficiency and infection, and has an adverse effect on quality of life. This article describes how an oral care policy and assessment tool were updated to ensure the implementation of evidence-based practice at one hospital in the Republic of Ireland.

Interventions for improving patients' trust in doctors and groups of doctors.

Science.gov (United States)

Rolfe, Alix; Cash-Gibson, Lucinda; Car, Josip; Sheikh, Aziz; McKinstry, Brian

2014-03-04

Trust is a fundamental component of the patient-doctor relationship and is associated with increased satisfaction, adherence to treatment, and continuity of care. Our 2006 review found little evidence that interventions improve patients' trust in their doctor; therefore an updated search was required to find out if there is further evidence of the effects of interventions that may improve trust in doctors or groups of doctors. To update our earlier review assessing the effects of interventions intended to improve patients' trust in doctors or a group of doctors. In 2003 we searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE, Health Star, PsycINFO, CINAHL, LILACS, African Trials Register, African Health Anthology, Dissertation Abstracts International and the bibliographies of studies selected for inclusion. We also contacted researchers active in the field. We updated and re-ran the searches on available original databases (Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library issue 2, 2013), MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), CINAHL (Ebsco)) as well as Proquest Dissertations and Current Contents for the period 2003 to 18 March 2013. Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series of interventions (informative, educational, behavioural, organisational) directed at doctors or patients (or carers) where trust was assessed as a primary or secondary outcome. Two review authors independently extracted data and assessed the risk of bias of included studies. Where mentioned, we extracted data on adverse effects. We synthesised data narratively. We included 10 randomised controlled trials (including 7 new trials) involving 11,063 patients. These studies were all undertaken in North America, and all but two involved primary care.  As expected, there was considerable heterogeneity between

From the general to the specific: How social trust motivates relational trust.

Science.gov (United States)

Robbins, Blaine G

2016-01-01

When people form beliefs about the trustworthiness of others with respect to particular matters (i.e., when individuals trust), theory suggests that they rely on preexistent cognitive schemas regarding the general cooperativeness of individuals and organizations (i.e., social trust). In spite of prior work, the impact of social trust on relational trust-or what Russell Hardin (2002) calls trust as a three-part relation where actor A trusts actor B with reference to matter Y-is not well established. Four vignette experiments were administered to Amazon.com Mechanical Turk workers (N = 1388 and N = 1419) and to public university undergraduate students (N = 995 and N = 956) in order to investigate the relationship between social trust and relational trust. Measures of general social trust and particular social trust produced statistically equivalent effects that were positively associated with relational trust. Political trust, however, was statistically unrelated to relational trust. These results support the idea that people rely on schemas and stereotypes concerned with the general cooperativeness and helpfulness of others when forming beliefs about another person's trustworthiness with respect to a particular matter at hand. Copyright © 2015 Elsevier Inc. All rights reserved.

Evidence-informed primary health care workforce policy: are we asking the right questions?

Science.gov (United States)

Naccarella, Lucio; Buchan, Jim; Brooks, Peter

2010-01-01

Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan's visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making.

Alignment between chronic disease policy and practice: case study at a primary care facility.

Science.gov (United States)

Draper, Claire A; Draper, Catherine E; Bresick, Graham F

2014-01-01

Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar

Bridging the gap in ageing: Translating policies into practice in Malaysian Primary Care

Directory of Open Access Journals (Sweden)

Ambigga Krishnapillai S

2011-03-01

Full Text Available Abstract Population ageing is poised to become a major challenge to the health system as Malaysia progresses to becoming a developed nation by 2020. This article aims to review the various ageing policy frameworks available globally; compare aged care policies and health services in Malaysia with Australia; and discuss various issues and challenges in translating these policies into practice in the Malaysian primary care system. Fundamental solutions identified to bridge the gap include restructuring of the health care system, development of comprehensive benefit packages for older people under the national health financing scheme, training of the primary care workforce, effective use of electronic medical records and clinical guidelines; and empowering older people and their caregivers with knowledge, skills and positive attitudes to ageing and self care. Ultimately, family medicine specialists must become the agents for change to lead multidisciplinary teams and work with various agencies to ensure that better coordination, continuity and quality of care are eventually delivered to older patients across time and settings.

Trust in Security-Policy Enforcement Mechanisms

National Research Council Canada - National Science Library

Schneider, Fred B; Morrisett, Greg

2006-01-01

.... but provides the strong security guarantees of modern languages such as Java. A second avenue of language-based work explored a general class of policy enforcement mechanism based on in-line reference monitors (IRM...

Nuclear knowledge, trust and public acceptance of nuclear developments

Energy Technology Data Exchange (ETDEWEB)

Berdahl, A.L.; Bell, B.S.; Bourassa, C.M.; Fried, D.J., E-mail: Loleen.Berdahl@usask.ca, E-mail: Bourassa@edwards.usask.ca, E-mail: Scott.Bell@usask.ca, E-mail: Jana.Fried@usask.ca [Univ. of Saskatchewan, Saskatoon, SK (Canada)

2014-07-01

While nuclear sector activities remain contentious public issues, studies suggest that knowledge levels and trust in nuclear actors can influence public attitudes. Drawing on original data from a 2013 representative telephone survey of Saskatchewan residents, this paper considers the extent to which knowledge and trust influence support for nuclear developments. Saskatchewan provides an interesting case study: while the province has a robust uranium mining industry, there are no nuclear power facilities, and the potential development of nuclear energy and nuclear fuel waste storage has been a source of spirited public debate. The study's results have implications for public education and policy initiatives regarding nuclear power developments. (author)

Nuclear knowledge, trust and public acceptance of nuclear developments

International Nuclear Information System (INIS)

Berdahl, A.L.; Bell, B.S.; Bourassa, C.M.; Fried, D.J.

2014-01-01

While nuclear sector activities remain contentious public issues, studies suggest that knowledge levels and trust in nuclear actors can influence public attitudes. Drawing on original data from a 2013 representative telephone survey of Saskatchewan residents, this paper considers the extent to which knowledge and trust influence support for nuclear developments. Saskatchewan provides an interesting case study: while the province has a robust uranium mining industry, there are no nuclear power facilities, and the potential development of nuclear energy and nuclear fuel waste storage has been a source of spirited public debate. The study's results have implications for public education and policy initiatives regarding nuclear power developments. (author)

To Trust or Not to Trust? What Drives Public Trust in Science in Social Media Engagement

Science.gov (United States)

Hwong, Y. L.; Oliver, C.; Van Kranendonk, M. J.

2017-12-01

The erosion of public trust in science is a serious concern today. This climate of distrust has real consequences, from the anti-vaccination movement to climate change denials. The age of social media promises opportunities for improved interactivity between scientists and the public, which experts hope will help improve public confidence in science. However, evidence linking social media engagement and public attitude towards science is scarce. Our study aimed to help fill this gap. We examined Twitter engagement and its impact on public trust in science, focusing on two related science issues: space science and climate change. Our datasets comprised of 10,000 randomly sampled tweets over a month's period in 2016. We used human annotation and machine learning to analyse the tweets. Results revealed the level of distrust was significantly higher in the climate change tweets. However, in the climate change network, people who engaged with science personalities trust science more than those who did not. This difference in trust levels was not present in the space science network. There the two clusters of people displayed similar levels of trust in science. Additionally, we used machine learning to predict the trust labels of tweets and conducted feature analysis to find the properties of trust-inspiring tweets. Our supervised learning algorithm was able to predict trust in science in our sample tweets with 84% accuracy. The strongest predictors of trust in science (as conveyed by tweets) were similarity, presence of URL and authenticity. Contrast this with the findings of our previous study investigating the features of highly engaging space science related social media messages, authenticity is the only feature that also inspires trust. This indicates that what works to promote engagement (e.g. `retweets', `Likes') does not necessarily build trust in science. Social media science communication is not as simple as `we engage, therefore they trust'. We suggest that

The role of ethical banks in health care policy and financing in Spain.

Science.gov (United States)

Salvador-Carulla, Luis; Solans, Josep; Duaigues, Mónica; Balot, Jordi; García-Gutierrez, Juan Carlos

2009-01-01

Ethical, social, or civic banks, constitute a secondary source of financing, which is particularly relevant in Southern and Central Europe. However there is no information on the scientific literature on this source of health care financing. We review the characteristics of saving banks in Spain and illustrate the contribution of one institution "Obra Social Caixa Catalunya" (OS-CC) to the health care financing in Spain. Savings bank health care funding was equivalent to 3 percent of the public health expenditure for 2008. The programs developed by OS-CC illustrate the complex role of savings banks in health financing, provision, training, and policy, particularly in the fields of integrated care and innovation. Financing is a basic tool for health policy. However, the role of social banking in the development of integrated care networks has been largely disregarded, in spite of its significant contribution to complementary health and social care in Southern and Central Europe. Decision makers both at the public health agencies and at the social welfare departments of savings banks should become aware of the policy implications and impact of savings bank activities in the long-term care system.

Does social trust increase willingness to pay taxes to improve public healthcare? Cross-sectional cross-country instrumental variable analysis.

Science.gov (United States)

Habibov, Nazim; Cheung, Alex; Auchynnikava, Alena

2017-09-01

The purpose of this paper is to investigate the effect of social trust on the willingness to pay more taxes to improve public healthcare in post-communist countries. The well-documented association between higher levels of social trust and better health has traditionally been assumed to reflect the notion that social trust is positively associated with support for public healthcare system through its encouragement of cooperative behaviour, social cohesion, social solidarity, and collective action. Hence, in this paper, we have explicitly tested the notion that social trust contributes to an increase in willingness to financially support public healthcare. We use micro data from the 2010 Life-in-Transition survey (N = 29,526). Classic binomial probit and instrumental variables ivprobit regressions are estimated to model the relationship between social trust and paying more taxes to improve public healthcare. We found that an increase in social trust is associated with a greater willingness to pay more taxes to improve public healthcare. From the perspective of policy-making, healthcare administrators, policy-makers, and international donors should be aware that social trust is an important factor in determining the willingness of the population to provide much-needed financial resources to supporting public healthcare. From a theoretical perspective, we found that estimating the effect of trust on support for healthcare without taking confounding and measurement error problems into consideration will likely lead to an underestimation of the true effect of trust. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Effects of Trust Transference, Mobile Attributes and Enjoyment on Mobile Trust

Directory of Open Access Journals (Sweden)

Cristiane Junqueira Giovannini

2015-01-01

Full Text Available Trust is essential in building relationships. In mobile commerce, as in electronic commerce, trust is even more valuable given the absence of human contact and direct observation of the service provider. Despite the importance of trust for mobile commerce, there has been little academic effort to study the relationships between mobile devices unique components of interactivity and customer trust, or the relationship between offline, online and mobile trust. This study proposes a trust-mediated model for customer attitude and transaction intentions in mobile commerce contexts that incorporates trust transference and unique factors present in mobile commerce. Data were collected in an online survey and analyzed via structural equations modeling. Results suggest that trust transferred from online contexts and ease of use have significant effects on mobile trust formation, while also indicating that mobile trust influences consumers’ attitudes and intentions to purchase using mobile devices.

Looking for Trust

DEFF Research Database (Denmark)

Bøge, Ask Risom; Lauritsen, Peter

Trust and surveillance are often seen as opposites. Trust is regularly characterized as the glue that holds society together, while surveillance is seen as corrosive. However, in Scandinavia high levels of trust and surveillance coexist. It is therefore interesting to investigate...... if there is a connection between these phenomena and ask what is the role of trust in the spread of surveillance in Scandinavia? The aim of this paper is: 1) to investigate the role of trust in the history of the Danish DNA database and 2) to experiment with Actor-Network-Theory (ANT) as an ap-proach in studies of trust....

Elderly and long-term care trends and policy in Taiwan: Challenges and opportunities for health care professionals

Directory of Open Access Journals (Sweden)

Hsiu-Hung Wang

2012-09-01

Full Text Available The purpose of this article is to address the trends and policy of elderly and long-term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long-term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long-term care, long-term care policy in Taiwan, draft of the Long-term Care Services Act, and draft of the Long-term Care Insurance Act. After the 10-year long-term care project was proposed by the Taiwan government, the supply of health care services and demand for long-term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long-term care related manpower, services and education reform related to long-term care for the future society, and interprofessional collaboration and team work of long-term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long-term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long-term care services that ensure elderly and disabled people can live a healthier and better life.

What Is Trust? Ethics and Risk Governance in Precision Medicine and Predictive Analytics.

Science.gov (United States)

Adjekum, Afua; Ienca, Marcello; Vayena, Effy

2017-12-01

Trust is a ubiquitous term used in emerging technology (e.g., Big Data, precision medicine), innovation policy, and governance literatures in particular. But what exactly is trust? Even though trust is considered a critical requirement for the successful deployment of precision medicine initiatives, nonetheless, there is a need for further conceptualization with regard to what qualifies as trust, and what factors might establish and sustain trust in precision medicine, predictive analytics, and large-scale biology. These new fields of 21st century medicine and health often deal with the "futures" and hence, trust gains a temporal and ever-present quality for both the present and the futures anticipated by new technologies and predictive analytics. We address these conceptual gaps that have important practical implications in the way we govern risk and unknowns associated with emerging technologies in biology, medicine, and health broadly. We provide an in-depth conceptual analysis and an operative definition of trust dynamics in precision medicine. In addition, we identify three main types of "trust facilitators": (1) technical, (2) ethical, and (3) institutional. This three-dimensional framework on trust is necessary to building and maintaining trust in 21st century knowledge-based innovations that governments and publics invest for progressive societal change, development, and sustainable prosperity. Importantly, we analyze, identify, and deliberate on the dimensions of precision medicine and large-scale biology that have carved out trust as a pertinent tool to its success. Moving forward, we propose a "points to consider" on how best to enhance trust in precision medicine and predictive analytics.

Education and Health Care Policies in Ghana

Directory of Open Access Journals (Sweden)

Ziblim Abukari

2015-10-01

Full Text Available Education and health care policies in Ghana since independence have been universalist in approach providing free universal health care and free basic and tertiary education until the early 1980s. Precipitated primarily by a severe drought, stagnant economic growth, mismanagement, and political instability, Ghana undertook major economic reforms with prodding from the World Bank and International Monetary Fund in a bid to salvage the economy. These economic measures included cost recovery and cutback spending in education and health sectors. However, in recent years, purposive targeted interventions have been pursued to address inequalities in education and health care. These new programs include the Education Capitation Grant, school feeding program, and the National Health Insurance Scheme (NHIS, which are propelling Ghana toward the achievement of the Millennium Development Goals. The prospects of these programs in addressing disparities in access to education and health care in the country and recommendations for improved delivery are discussed.

Child protection and out of home care: Policy, practice, and research connectionsAustralia and New Zealand

Directory of Open Access Journals (Sweden)

2014-03-01

Full Text Available This article provides an outline of the early development of care and protection in Australia and New Zealand as a backdrop to an overview of child protection systems and policies and the current childprotection profile in both countries. Key issues that have become the focus of policy reform are canvassed and legislative and policy initiatives to promote child safety as well as strengthen families are elaborated. An overview of trends in relation to out of home care, including routes into care, care arrangements and permanency policies is provided. The article profiles selected research studies from Australia focusing on outcomes of care: stability of care, mental health and educational outcomes of looked after children, abuse in care, and routes out of care through reunification and aging out. Other issues treated are the overrepresentation of indigenous children in care systems in both countries and the challenges of maintaining cultural connections. The article concludes with a brief comparative analysis identifying similarities and differences in child welfare systems in both countries.

Respect, trust, and the management of sickle cell disease pain in hospital: comparative analysis of concern-raising behaviors, preliminary model, and agenda for international collaborative research to inform practice

Science.gov (United States)

Elander, James; Beach, Mary Catherine; Haywood, Carlton

2011-01-01

Background/objectives Qualitative interview studies suggest that adult patients’ experiences of hospital treatment for sickle cell disease (SCD) pain reflect an absence of respect by providers for patients, and an absence or breakdown of trust. Systematic comparisons between treatment settings could help identify contextual influences on respect and trust. Design Quantitative comparison of concern-raising behaviors (pain treatment outcomes indicating breakdowns of trust) among adult SCD patients in Baltimore, Maryland, USA, and London, UK, followed by analysis of potential explanations for differences, including socio-cultural and behavioral factors, with a preliminary model of the processes leading to concern-raising behaviors. Results Rates of concern-raising behaviors were significantly higher in Baltimore than London. The model identifies respect and trust as key factors which could be targeted in efforts to improve the quality of SCD pain management in hospital. Conclusion An agenda for international, interdisciplinary research to improve the treatment of SCD pain in hospital should include: comparative analyses between countries and treatment settings of factors that could influence respect and trust; research to test hypotheses derived from models about the roles of respect and trust in the treatment of pain; studies of the impact of healthcare structures and policy on patients’ experiences of care; research focusing on developmental and interpersonal processes related to respect and trust; applications of attribution and other social psychology theories; and development and evaluation of interventions to improve the hospital treatment of SCD pain by increasing respect and trust. PMID:21797726

Misplaced Trust: Racial Differences in Use of Tobacco Products and Trust in Sources of Tobacco Health Information.

Science.gov (United States)

Alcalá, Héctor E; Sharif, Mienah Z; Morey, Brittany N

2017-10-01

Recently, the rates of utilization of alternative tobacco products have increased. Providing health information about tobacco products from trustworthy sources may help decrease the popularity of these products. Using a nationally representative study of adults, we fill the current gap in research on racial and ethnic disparities in utilization of alternative tobacco products as well as in trust of sources of health information about tobacco products. Data came from the Health Information National Trends Survey (N = 3738), which was collected in 2015. Logistic regression models were used to calculate odds of use of seven different tobacco product (eg, hookah, e-cigarettes, etc.), trust in seven different sources of e-cigarette health information (eg, family or friends, health care providers, etc.), and trust in six different sources of tobacco health information, adjusting for control variables. There were disparities in utilization of alternative tobacco products and in trust, in tobacco companies across racial and ethnic groups. Blacks and Asians were far more likely than whites to trust tobacco (adjusted odds ratios = 8.67 and 4.34) and e-cigarette companies (adjusted odds ratios = 6.97 and 3.13) with information about the health effects of e-cigarettes than whites. The popularity of alternative tobacco products appears to be high and may offset recent observed decreases in cigarette use. Blacks and Asians appear to trust tobacco companies as sources of information when compared to whites. Higher levels of trust in tobacco companies among Asians and blacks may translate to greater susceptibility to utilize tobacco products among these groups, thereby increasing disparities. There is a need for social marketing and education efforts focused on increasing awareness of adverse health effects of using alternative tobacco products as well as on the untrustworthiness of tobacco and e-cigarette companies, especially among racial and ethnic minorities. © The Author

Interpersonal Trust across Six Asia-Pacific Countries: Testing and Extending the ‘High Trust Society’ and ‘Low Trust Society’ Theory

Science.gov (United States)

Ward, Paul R.; Mamerow, Loreen; Meyer, Samantha B.

2014-01-01

Background Trust is regarded as a necessary component for the smooth running of society, although societal and political modernising processes have been linked to an increase in mistrust, potentially signalling social and economic problems. Fukuyama developed the notion of ‘high trust’ and ‘low trust’ societies, as a way of understanding trust within different societies. The purpose of this paper is to empirically test and extend Fukuyama’s theory utilising data on interpersonal trust in Taiwan, Hong Kong, South Korea, Japan, Australia and Thailand. This paper focuses on trust in family, neighbours, strangers, foreigners and people with a different religion. Methods Cross-sectional surveys were undertaken in 2009–10, with an overall sample of 6331. Analyses of differences in overall levels of trust between countries were undertaken using Chi square analyses. Multivariate binomial logistic regression analysis was undertaken to identify socio-demographic predictors of trust in each country. Results Our data indicate a tripartite trust model: ‘high trust’ in Australia and Hong Kong; ‘medium trust’ in Japan and Taiwan; and ‘low trust’ in South Korea and Thailand. Trust in family and neighbours were very high across all countries, although trust in people with a different religion, trust in strangers and trust in foreigners varied considerably between countries. The regression models found a consistent group of subpopulations with low trust across the countries: people on low incomes, younger people and people with poor self-rated health. The results were conflicting for gender: females had lower trust in Thailand and Hong Kong, although in Australia, males had lower trust in strangers, whereas females had lower trust in foreigners. Conclusion This paper identifies high, medium and low trust societies, in addition to high and low trusting population subgroups. Our analyses extend the seminal work of Fukuyama, providing both corroboration and

Antibiotic Policies in the Intensive Care Unit

Directory of Open Access Journals (Sweden)

Nese Saltoglu

2003-08-01

Full Text Available The antimicrobial management of patients in the Intensive Care Units are complex. Antimicrobial resistance is an increasing problem. Effective strategies for the prevention of antimicrobial resistance in ICUs have focused on limiting the unnecessary use of antibiotics and increasing compliance with infection control practices. Antibiotic policies have been implemented to modify antibiotic use, including national or regional formulary manipulations, antibiotic restriction forms, care plans, antibiotic cycling and computer assigned antimicrobial therapy. Moreover, infectious diseases consultation is a simple way to limit antibiotic use in ICU units. To improve rational antimicrobial using a multidisiplinary approach is suggested. [Archives Medical Review Journal 2003; 12(4.000: 299-309

Toward Trust: Recalibrating Accreditation Practices for Postsecondary Arts Education

Science.gov (United States)

Warburton, Edward C.

2018-01-01

This article charts the influence of American accreditation policies on postsecondary arts education practices. Some commentators suggest that accreditation is a standards- and evidence-based process. I argue that trust is at the center of concerns about assessment in higher education, especially in the arts. The purpose of this article is to…

Therapeutic Residential Care for Children and Youth:

DEFF Research Database (Denmark)

Whittaker, James K.; Holmes, Lisa; del Valle, Jorge F.

2016-01-01

so in closer collaboration with their families and in closer proximity to their home communities; and, (3) with the hope of reducing the high costs often associated with group residential provision. In some jurisdictions, efforts to reduce residential care resources in the absence of sufficient...... alternatives to serve high-resource needing youth has had unintended and negative consequences. It is within this context that a working group international experts representing research, policy, service delivery and families (International Work Group for Therapeutic Residential Care) convened at the Centre...... for Child and Family Research, Loughborough University in the U.K. for a Summit meeting on therapeutic residential care for children and youth funded by the Sir Halley Stewart Trust (UK). The focus centered on what is known about therapeutic residential care and what key questions should inform a priority...

76 FR 21894 - Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations...

Science.gov (United States)

2011-04-19

... contractual clauses or provisions 2. Tying sales (either explicitly or implicitly through pricing policies) of... Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings... (the ``Agencies'') are proposing an enforcement policy regarding the application of the antitrust laws...

Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.

Science.gov (United States)

Anafi, Patricia; Mprah, Wisdom K; Jackson, Allen M; Jacobson, Janelle J; Torres, Christopher M; Crow, Brent M; O'Rourke, Kathleen M

2018-01-01

In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.

To trust or not to trust: social decision-making in post-institutionalized, internationally adopted youth.

Science.gov (United States)

Pitula, Clio E; Wenner, Jennifer A; Gunnar, Megan R; Thomas, Kathleen M

2017-05-01

Chronic parental maltreatment has been associated with lower levels of interpersonal trust, and depriving environments have been shown to predict short-sighted, risk-averse decision-making. The present study examined whether a circumscribed period of adverse care occurring only early in life was associated with biases in trust behavior. Fifty-three post-institutionalized (PI) youth, adopted internationally on average by 1 year of age, and 33 never-institutionalized, non-adopted youth (M age  = 12.9 years) played a trust game. Participants decided whether or not to share coins with a different anonymous peer in each trial with the potential to receive a larger number of coins in return. Trials were presented in blocks that varied in the degree to which the peers behaved in a trustworthy (reciprocal) or untrustworthy (non-reciprocal) manner. A comparison condition consisted of a computerized lottery with the same choices and probabilistic risk as the peer trials. Non-adopted comparison youth showed a tendency to share more with peers than to invest in the lottery and tended to maintain their level of sharing across trials despite experiencing trials in which peers failed to reciprocate. In contrast, PI children, particularly those who were adopted over 1 year of age, shared less with peers than they invested in the lottery and quickly adapted their sharing behavior to peers' responses. These results suggest that PI youth were more mistrusting, more sensitive to both defection and reciprocation, and potentially more accurate in their trusting decisions than comparison youth. Results support the presence of a sensitive period for the development of trust in others, whereby conditions early in life may set long-term biases in decision-making. © 2016 John Wiley & Sons Ltd.

[Intercultural health care policy from the perspective of health care providers and Mapuche clients].

Science.gov (United States)

Alarcón, Ana María; Astudillo, Paula; Barrios, Sara; Rivas, Edith

2004-09-01

Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients. To explore the perception in providers and Mapuche clients about intercultural health. A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers. Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices. There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

Balancing Trust and Control

DEFF Research Database (Denmark)

Jagd, Søren

This paper focuses on the leadership challenge of balancing trust and control. The relation between trust and control has for a long time been a puzzling issue for management researchers. In the paper I first show that there has been a dramatic change in the way the relation between trust...... and control has been conceptualized in trust research. While the relation between trust and control earlier was conceptualized as a more or less stable balance between trust and control, more recent research conceptualizes the relation between trust and control more as a dynamical process that involves...... an ongoing process of balancing the relation between trust and control. Second, taking the departure in the recent conceptualization of the balance between trust and control as an interactive process I discuss the challenges for management in handling this more subtle balancing of trust and control...

?You don?t want to lose that trust that you?ve built with this patient??: (Dis)trust, medical tourism, and the Canadian family physician-patient relationship

OpenAIRE

Crooks, Valorie A; Li, Neville; Snyder, Jeremy; Dharamsi, Shafik; Benjaminy, Shelly; Jacob, Karen J; Illes, Judy

2015-01-01

Background Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Medical tourism introduces challenges to decision-making that impact and are impacted by the physician-patient trust relationship—a relationship on which the foundation of beneficent health care lies. The objective of the study is to examine the views of Canadian family physicians about the roles that trust plays in decision-making about medical tourism, and the impact of medic...

An evaluation of staff engagement programmes in four National Health Service Acute Trusts.

Science.gov (United States)

Hewison, Alistair; Gale, Nicola; Yeats, Rowena; Shapiro, Jonathan

2013-01-01

The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four National Health Service (NHS) hospital Trusts in England. It seeks to examine this development in the context of current policy initiatives aimed at increasing the level of staff involvement in decision-making, and the related literature. A mixed-methods approach incorporating document analysis, interviews, a survey and appreciative inquiry, informed by the principles of impact evaluation design, was used. The main finding to emerge was that leadership was crucial if widespread staff engagement was to be achieved. Indeed, in some of the trusts the staff engagement programmes were seen as mechanisms for developing leadership capability. The programmes had greater impact when they were "championed" by the Chief Executive. Effective communication throughout the organisations was reported to be a prerequisite for staff engagement. Problems were identified at the level of middle management where the lack of confidence in engaging with staff was a barrier to implementation. The nature of the particular organisational context is crucial to the success of efforts to increase levels of staff engagement. The measures that were found to work in the trusts would need to be adapted and applied to best meet the needs of other organisations. Many health care organisations in England will need to harness the efforts of their workforce if they are to meet the significant challenges of dealing with financial restraint and increasing patient demand. This paper provides some insights on how this can be done.

Dimensionality of trust: An analysis of the relations between propensity, trustworthiness and trust

Directory of Open Access Journals (Sweden)

Marita Heyns

2015-05-01

Research purpose: This study examined the dynamic interplay between trust propensity, trustworthiness beliefs and the decision to trust, as perceived within dyadic workplace relationships. Motivation for the study: No studies, as far as the authors are aware, have ever attempted to use a combination of Mayer and Davis’s well-known assessment of trustworthiness and Gillespie’s measure of behavioural trust within the same study. By including measures of main antecedents and the actual decision to trust in the same study, the multidimensionality of trust can be established more concretely. Research approach, design and method: A cross-sectional survey design with a convenience sample (N = 539 was used. The Behavioural Trust Inventory and the Organisational Trust Instrument were administered. Main findings: Results confirmed the distinctness of propensity, trustworthiness and trust as separate main constructs. Trust was strongly associated with trustworthiness beliefs. Trustworthiness beliefs fully mediated the relationship between propensity and trust. The observed relations between propensity and trustworthiness suggest that individuals with a natural predisposition to trust others will be more inclined to perceive a specific trust referent as trustworthy. Practical/managerial implications: Leaders should realise that their attitudes and behaviour have a decisive impact on trust formation processes: if they are being perceived as trustworthy, followers will be likely to respond by engaging in trusting behaviours towards them. Tools to assess followers’ perceptions of the trustworthiness of the leader may provide useful feedback that can guide leaders. Contribution/value-add: This study contributes to scientific knowledge regarding the influence of propensity to trust and trustworthiness on trust of leaders.

Stakeholder Perspectives on Creating and Maintaining Trust in Community-Academic Research Partnerships.

Science.gov (United States)

Frerichs, Leah; Kim, Mimi; Dave, Gaurav; Cheney, Ann; Hassmiller Lich, Kristen; Jones, Jennifer; Young, Tiffany L; Cene, Crystal W; Varma, Deepthi S; Schaal, Jennifer; Black, Adina; Striley, Catherine W; Vassar, Stefanie; Sullivan, Greer; Cottler, Linda B; Brown, Arleen; Burke, Jessica G; Corbie-Smith, Giselle

2017-02-01

Community-academic research partnerships aim to build stakeholder trust in order to improve the reach and translation of health research, but there is limited empirical research regarding effective ways to build trust. This multisite study was launched to identify similarities and differences among stakeholders' perspectives of antecedents to trust in research partnerships. In 2013-2014, we conducted a mixed-methods concept mapping study with participants from three major stakeholder groups who identified and rated the importance of different antecedents of trust on a 5-point Likert-type scale. Study participants were community members ( n = 66), health care providers ( n = 38), and academic researchers ( n = 44). All stakeholder groups rated "authentic communication" and "reciprocal relationships" the highest in importance. Community members rated "communication/methodology to resolve problems" ( M = 4.23, SD = 0.58) significantly higher than academic researchers ( M = 3.87, SD = 0.67) and health care providers ( M = 3.89, SD = 0.62; p importance of issues related to "sustainability." The importance of communication and relationships across stakeholders indicates the importance of colearning processes that involve the exchange of knowledge and skills. The differences uncovered suggest specific areas where attention and skill building may be needed to improve trust within partnerships. More research on how partnerships can improve communication specific to problem solving and sustainability is merited.

Online trust building through third party trust transfer and third party protection

Science.gov (United States)

Wandoko, Wanda; Saleh Abbas, Bahtiar; Budiastuti, Dyah; Kosala, Raymond

2017-03-01

The primary objective of this research is to develop an online trust building mechanism for SME (Small Medium Enterprise). Trust is very important in e-commerce. The nature of online shopping has a greater uncertainty than offline shopping. Seeing as there is an uncertainty that can produce risks, a prospective buyer’s trust is needed. A lot of people’s unwillingness to shop online is caused by their lack of trust toward e-commerce. E-commerce is said to be one of the ways for SME to compete with bigger companies. However, building trust requires immense time and cost. SME with limited resources may experience difficulties in building trust just with their own resources. Base on literature research that needs to be validated in next research, we found that trust can be built through trust transfer from the reputable and well-known trust-mark issuer, and third party protection such as escrow account service and credit card issuer.

Exploring the influence of trust relationships on motivation in the health sector: a systematic review.

Science.gov (United States)

Okello, Dickson R O; Gilson, Lucy

2015-03-31

Dedicated and motivated health workers (HWs) play a major role in delivering efficient and effective health services that improve patients' experience of health care. Growing interest in HW motivation has led to a global focus on pay for performance strategies, but less attention has been paid to nurturing intrinsic motivation. Workplace trust relationships involve fair treatment and respectful interactions between individuals. Such relationships enable cooperation among HWs and their colleagues, supervisors, managers and patients and may act as a source of intrinsic motivation. This paper presents findings from a qualitative systematic review of empirical studies providing evidence on HW motivation, to consider what these studies suggest about the possible influence of workplace trust relationships over motivation. Five electronic databases were searched for articles reporting research findings about HW motivation for various cadres published in the 10-year period 2003 to 2013 and with available full free text in the English language. Data extraction involved consideration of the links between trust relationships and motivation, by identifying how studies directly or indirectly mention and discuss relevant factors. Twenty-three articles from low- and middle-income countries and eight from high-income countries that met predetermined quality and inclusion criteria were appraised and subjected to thematic synthesis. Workplace trust relationships with colleagues, supervisors and managers, employing organisation and patients directly and indirectly influence HW motivation. Motivational factors identified as linked to trust include respect; recognition, appreciation and rewards; supervision; teamwork; management support; autonomy; communication, feedback and openness; and staff shortages and resource inadequacy. To the authors' knowledge, this is the first systematic review on trust and motivation in the health sector. Evidence indicates that workplace trust

[Crises of trust].

Science.gov (United States)

Chen, Thai-Form; Tseng, Hsing-Chau

2006-02-01

Extensive media coverage is warning of a crisis of trust that has emerged as a serious issue in our society. This article explores the meaning of "crisis," concepts of crisis management, mechanisms for building trust, and the underlying significance of trust and distrust. Evidence is adduced to testify to the erosion of trust and factors in our society that reflect the potential for crises of trust. Organizational decision makers, including hospital managers, are urged to identify and reflect upon weaknesses in their organizations in order that remedial action can be taken to preempt such crises.

Trust makers, breakers and brokers: building trust in the Australian food system

OpenAIRE

Wilson, Annabelle; Coveney, John; Henderson, Julie; Meyer, Samantha; Calnan, Michael; Caraher, Martin; Webb, Trevor; Elliott, Anthony; Ward, Paul

2013-01-01

Background The importance of consumer trust in the food supply has previously been identified, and dimensions of consumer trust in food?who they trust and the type of trust that they exhibit?has been explored. However, there is a lack of research about the mechanisms through which consumer trust in the food supply is developed, maintained, broken and repaired. This study seeks to address this gap by exploring if, and how, consumer trust in the food supply is considered by the media, food indu...

Caring: Implications for Child Care and for Family Policy

Directory of Open Access Journals (Sweden)

Roderic Beaujot

2009-12-01

Full Text Available Canadian families have changed, in part due to an economy that provides more work opportunities for women, and a cultural orientation that values equal opportunity and diversity in families. In spite of the change, both quantitative and qualitative evidence suggest a continued preference for mothers to spend considerable time with children, especially in the infant and toddler years. Thus, in an average couple, the presence of young children in the home brings wives to reduce their paid work and husbands to increase their paid work. Our reading of parental preferences suggests an interest in more services for young children in the form of early childhood education and child care, but also an interest in policies that would allow parents to spend more time with children through parental leaves, part-time work with good benefits, and subsidies that supplement market income. Many options available to two-parent families are often less feasible for lone parents, giving a higher priority to child care.

The Importance of Cultural Values and Trust for Innovation - A European Study

DEFF Research Database (Denmark)

Zhu, Bing; Habisch, André; Thøgersen, John

2018-01-01

covering 27 European countries, we find that innovation at the country level is positively correlated with the level of societal trust and with three cultural value dimensions: “Autonomy vs. Embeddedness”, “Egalitarianism vs. Hierarchy”, and “Harmony vs. Mastery”. A multivariate SEM analysis reveals...... that when “Autonomy vs. Embeddedness” is controlled, the two other cultural value dimensions are no longer significant. Further, a SEM path analysis confirms that the relationship between cultural values and innovation performances is completely mediated through the level of trust in a society. Overall...... settings (i.e., policy makers) are discussed. It is suggested that for successful innovation to blossom, the actors on both levels should aim at strengthening the cultural emphasis on individual autonomy, institutional integrity and mutual trust....

Fostering interpersonal trust on social media: physicians' perspectives and experiences.

Science.gov (United States)

Panahi, Sirous; Watson, Jason; Partridge, Helen

2016-02-01

The problem of developing and sustaining mutual trust is one of the main barriers to knowledge sharing on social media platforms such as blogs, wikis, micro-blogs and social networking websites. While many studies argue that mutual trust is necessary for online communication and knowledge sharing, few have actually explored and demonstrated how physicians can establish and sustain trusted relationships on social media. To identify approaches through which physicians establish interpersonal trust on social media. Twenty-four physicians, who were active users of social media, were interviewed using a semi-structured approach between 2013 and 2014. Snowball sampling was employed for participant recruitment. The data were analysed using a thematic analysis approach. Physicians trust their peers on social media in a slightly different way than in face-to-face communication. The study found that the majority of participants established trust on social media mainly through previous personal interaction, authenticity and relevancy of voice, professional standing, consistency of communication, peer recommendation, and non-anonymous and moderated sites. Healthcare professionals need to approach social media carefully when using it for knowledge sharing, networking and developing trusted relations with like-minded peers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Social trust, interpersonal trust and self-rated health in China: a multi-level study.

Science.gov (United States)

Feng, Zhixin; Vlachantoni, Athina; Liu, Xiaoting; Jones, Kelvyn

2016-11-08

Trust is important for health at both the individual and societal level. Previous research using Western concepts of trust has shown that a high level of trust in society can positively affect individuals' health; however, it has been found that the concepts and culture of trust in China are different from those in Western countries and research on the relationship between trust and health in China is scarce. The analyses use data from the national scale China General Social Survey (CGSS) on adults aged above 18 in 2005 and 2010. Two concepts of trust ("out-group" and "in-group" trust) are used to examine the relationship between trust and self-rated health in China. Multilevel logistical models are applied, examining the trust at the individual and societal level on individuals' self-rated health. In terms of interpersonal trust, both "out-group" and "in-group" trust are positively associated with good health in 2005 and 2010. At the societal level, the relationships between the two concepts of trust and health are different. In 2005, higher "out-group" social trust (derived from trust in strangers) is positively associated with better health; however, higher "in-group" social trust (derived from trust in most people) is negatively associated with good health in 2010. The cross-level interactions show that lower educated individuals (no education or only primary level), rural residents and those on lower incomes are the most affected groups in societies with higher "out-group" social trust; whereas people with lower levels of educational attainment, a lower income, and those who think that most people can be trusted are the most affected groups in societies with higher "in-group" social trust. High levels of interpersonal trust are of benefit to health. Higher "out-group" social trust is positively associated with better health; while higher "in-group" social trust is negatively associated with good health. Individuals with different levels of educational

Progress in the development of integrated mental health care in Scotland

Directory of Open Access Journals (Sweden)

Kevin Woods

2002-06-01

Full Text Available The development of integrated care through the promotion of ‘partnership working’ is a key policy objective of the Scottish Executive, the administration responsible for health services in Scotland. This paper considers the extent to which this goal is being achieved in mental health services, particularly those for people with severe and enduring mental illness. Distinguishing between the horizontal and vertical integration of services, exploratory research was conducted to assess progress towards this objective by examining how far a range of functional activities in Primary Care Trusts (PCTs and their constituent Local Health Care Co-operatives (LHCCs were themselves becoming increasingly integrated. All PCTs in Scotland were surveyed by postal questionnaire, and followed up by detailed telephone interviews. Six LHCC areas were selected for detailed case study analysis. A Reference Group was used to discuss and review emerging themes from the fieldwork. The report suggests that faster progress is being made in the horizontal integration of services between health and social care organisations than is the case for vertical integration between primary health care and specialist mental health care services; and that there are significant gaps in the extent to which functional activities within Trusts are changing to support the development of integrated care. A number of models are briefly considered, including the idea of ‘intermediate care’ that might speed the process of integration.

Developing a prioritisation framework in an English Primary Care Trust

Directory of Open Access Journals (Sweden)

Fordham Richard J

2006-02-01

Full Text Available Abstract Background In the English NHS, Primary Care Trusts (PCTs are required to commission health services, to maximise the well-being of the population, subject to the available budget. There are numerous techniques employed to make decisions, some more rational and transparent than others. A weighted benefit score can be used to rank options but this does not take into account value for money from investments. Methods We developed a weighted benefit score framework for use in an English PCT which ranked options in order of 'cost-value' or 'cost per point of benefit'. Our method differs from existing techniques by explicitly combining cost and a composite weighted benefit score into the cost-value ratio. Results The technique proved readily workable, and was able to accommodate a wide variety of data and competing criteria. Participants felt able to assign scores to proposed services, and generate a ranked list, which provides a solid starting point for the PCT Board to discuss and make funding decisions. Limitations included potential for criteria to be neither exhaustive nor mutually exclusive and the lack of an interval property in the benefit score limiting the usefulness of a cost-value ratio. Conclusion A technical approach to decision making is insufficient for making prioritisation decisions, however our technique provides a very valuable, structured and informed starting point for PCT decision making.

Trust in telemedicine portals for rehabilitation care: an exploratory focus group study with patients and healthcare professionals

NARCIS (Netherlands)

van Velsen, Lex Stefan; Wildevuur, Sabine; Flierman, Ina; van Schooten, B.W.; Tabak, Monique; Hermens, Hermanus J.

2016-01-01

Background: For many eServices, end-user trust is a crucial prerequisite for use. Within the context of Telemedicine, the role of trust has hardly ever been studied. In this study, we explored what determines trust in portals that facilitate rehabilitation therapy, both from the perspective of the

Preventive care utilization: Association with individual- and workgroup-level policy and practice perceptions.

Science.gov (United States)

Sabbath, Erika L; Sparer, Emily H; Boden, Leslie I; Wagner, Gregory R; Hashimoto, Dean M; Hopcia, Karen; Sorensen, Glorian

2018-06-01

Preventive medical care may reduce downstream medical costs and reduce population burden of disease. However, although social, demographic, and geographic determinants of preventive care have been studied, there is little information about how the workplace affects preventive care utilization. This study examines how four types of organizational policies and practices (OPPs) are associated with individual workers' preventive care utilization. We used data collected in 2012 from 838 hospital patient care workers, grouped in 84 patient care units at two hospitals in Boston. Via survey, we assessed individuals' perceptions of four types of OPPs on their work units. We linked the survey data to a database containing detailed information on medical expenditures. Using multilevel models, we tested whether individual-level perceptions, workgroup-average perceptions, and their combination were associated with individual workers' preventive care utilization (measured by number of preventive care encounters over a two-year period). Adjusting for worker characteristics, higher individual-level perceptions of workplace flexibility were associated with greater preventive care utilization. Higher average unit-level perceptions of people-oriented culture, ergonomic practices, and flexibility were associated with greater preventive care utilization. Overall, we find that workplace policies and practices supporting flexibility, ergonomics, and people-oriented culture are associated with positive preventive care-seeking behavior among workers, with some policies and practices operating at the individual level and some at the group level. Improving the work environment could impact employers' health-related expenditures and improve workers' health-related quality of life. Copyright © 2018 Elsevier Inc. All rights reserved.

Survivors of intimate partner violence speak out: trust in the patient-provider relationship.

Science.gov (United States)

Battaglia, Tracy A; Finley, Erin; Liebschutz, Jane M

2003-08-01

To identify characteristics that facilitate trust in the patient-provider relationship among survivors of intimate partner violence (IPV). Semistructured, open-ended interviews were conducted to elicit participants' beliefs and attitudes about trust in interactions with health care providers. Using grounded theory methods, the transcripts were analyzed for common themes. A community advisory group, composed of advocates, counselors and IPV survivors, helped interpret themes and interview excerpts. Together, key components of trust were identified. Eastern Massachusetts. Twenty-seven female survivors of IPV recruited from community-based IPV organizations. Participants' ages ranged from 18 to 56 years, 36% were African American, 32% Hispanic, and 18% white. We identified 5 dimensions of provider behavior that were uniquely important to the development of trust for these IPV survivors: 1) communication about abuse: provider was willing to openly discuss abuse; 2) professional competency: provider asked about abuse when appropriate and was familiar with medical and social histories; 3) practice style: provider was consistently accessible, respected confidentiality, and shared decision making; 4) caring: provider demonstrated personal concern beyond biomedical role through nonjudgmental and compassionate gestures, empowering statements, and persistent, committed behaviors; 5) emotional equality: provider shared personal information and feelings and was perceived by the participant as a friend. These IPV survivors identified dimensions of provider behavior that facilitate trust in their clinical relationship. Strengthening these provider behaviors may increase trust with patients and thus improve disclosure of and referral for IPV.

Development of a national health care waste management policy for South Africa

CSIR Research Space (South Africa)

Molefe, GS

2006-09-01

Full Text Available A Policy for Health Care Risk Waste (HCRW) Management is being developed by the Department of Environmental Affairs and Tourism in collaboration with the national Department of Health. The HCRW Management Policy aims at: i) Setting of standards...

Faith, Trust and the Perinatal Healthcare Maze in Urban India

Directory of Open Access Journals (Sweden)

S. Raman

2014-05-01

Full Text Available How women access and utilise health services through pregnancy, childbirth and infancy needs to be understood if we are to improve the delivery of and access to appropriate healthcare. Drawing on ethnographic observations of clinic encounters and in-depth interviews with women in Bangalore, South India, this paper reports on the complexities of negotiating healthcare throughout the perinatal continuum in urban India. Key themes identified include faith and trust in health services, confusion over right to healthcare; and the contested nature of choice for women. What is revealed is a socially restrictive framework that results in choices that seem arbitrary, irrational and self-defeating; poor women being particularly vulnerable. Given the current policy support for public-private-partnerships in reproductive healthcare delivery in India, both public and private health services need to move substantially to achieve true partnership and provide care that is respectful and valued by women and children in urban India.

Decision solution, data manipulation and trust: The (un-)willingness to donate organs in Germany in critical times.

Science.gov (United States)

Schwettmann, Lars

2015-07-01

In 2011 and 2012 a change of rules and a data-manipulation scandal focused German public attention on organ donation. This increased citizens' background knowledge as well as their willingness to respond to surveys. The present study is an effort to seize this research opportunity and to create evidence on which policy recommendations can be conceivably based. It uses data from two major representative surveys from 2011 to 2012 to address four central questions: Which characteristics, experiences and attitudes correlate with the written or unwritten willingness of individuals to donate (WTD) their own organs post-mortem? How has the WTD changed over time? To what extent does the WTD depend on normative trust? Which factors correlate with trust? The data is analyzed through summary statistics and regression models. Several hypotheses regarding factors connected with the WTD are confirmed in the survey results. Altruistic motives, relevant knowledge and trust are decisive. The special role of trust is corroborated by the data. As current German politics prevents the introduction of post-mortem donation incentives, potential policy making proposals are restricted to institutional changes to regain trust including the implementation of an organ donor registry and the advancement of counselling talks with general practitioners. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Implementation as transfer between policy, research and practice in care.

OpenAIRE

Heiligers, P.J.M.; Niet, A. van der

2010-01-01

Background: Health Services Research is policy related and results have an impact on practices. Implementation of research output into practices is performed with a variety of strategies. Type of policy intentions and research output create a specific context for implementation. The main question here is: what combinations of background factors and implementation strategies lead to successful implementations in health care? Methods: Sources for this study are evaluations of 72 completed imple...

Patient-physician trust among adults of rural Tamil Nadu: a community-based survey.

Science.gov (United States)

Baidya, M; Gopichandran, V; Kosalram, K

2014-01-01

Trust is the acceptance of a vulnerable situation in which the truster believes that the trustee will act in the truster's best interests. The cornerstone of the patient-physician relationship is "trust". Despite the intensity and importance of trust relationship of patients toward their physician, the phenomenon is rarely studied in developing countries. Our study aimed to explore the concept of patient-physician trust among adults of rural Tamil Nadu to assess the factors affecting patient-physician trust relationship and patient satisfaction. A cross-sectional descriptive household survey was carried out on 112 individuals selected by a multistage random sampling method. Men and women aged above 40 years who have visited a health care service at least once during the last 5 years were included in the study. Thom et al's modification of the Anderson and Dedrick Physician Trust scale was used to measure patient trust in physician. Trust is a one-dimensional construct in the surveyed population as revealed by an exploratory factor analysis which extracted one component explaining 50% of the overall variance. Trust influences patient's self-reported satisfaction (β coefficient of 0.048; P Trust in physicians seems to not depend on any of the assessed factors and largely seems to be implicit in the physician-patient relationship. Trust in physician is associated with patient satisfaction. Further studies are needed to assess trust in physicians in developing country settings.

Sustaining critical care: using evidence-based simulation to evaluate ICU management policies.

Science.gov (United States)

Mahmoudian-Dehkordi, Amin; Sadat, Somayeh

2017-12-01

Intensive Care Units (ICU) are costly yet critical hospital departments that should be available to care for patients needing highly specialized critical care. Shortage of ICU beds in many regions of the world and the constant fire-fighting to make these beds available through various ICU management policies motivated this study. The paper discusses the application of a generic system dynamics model of emergency patient flow in a typical hospital, populated with empirical evidence found in the medical and hospital administration literature, to explore the dynamics of intended and unintended consequences of such ICU management policies under a natural disaster crisis scenario. ICU management policies that can be implemented by a single hospital on short notice, namely premature transfer from ICU, boarding in ward, and general ward admission control, along with their possible combinations, are modeled and their impact on managerial and health outcome measures are investigated. The main insight out of the study is that the general ward admission control policy outperforms the rest of ICU management policies under such crisis scenarios with regards to reducing total mortality, which is counter intuitive for hospital administrators as this policy is not very effective at alleviating the symptoms of the problem, namely high ED and ICU occupancy rates that are closely monitored by hospital management particularly in times of crisis. A multivariate sensitivity analysis on parameters with diverse range of values in the literature found the superiority of the general ward admission control to hold true in every scenario.

Emergent Trust and Work Life Relationships: How to Approach the Relational Moment of Trust

Directory of Open Access Journals (Sweden)

Tone Bergljot Eikeland

2015-10-01

Full Text Available How do we trust? What does the basic mechanism of trust look like? These questions define the starting point for a comparison of the classic ideas of how trust works by Mayer et al. (1995, Möllering’s (2006 re-adaption of Giddens’, Simmel’s, and James’ classic ideas of trust, and a phenomenological approach focusing on “emergent trust.” Introducing the concept of emergent trust, the idea is to suggest a phenomenological approach to studies of trust in work-life relationships in professional organizations, as an alternative to trust as a cognitive attitude, where trust becomes a stable, individual possession. The term “emergent” demonstrates a trust that emerges in meetings between persons, it has an immediate, unconditional quality, and shows itself in situations of life where there is a potential for trust to appear. Trust’s basic relationality makes the person morally responsible for the other. Trust appears between persons, as an event, constituting risk and uncertainty as a natural and positive part of our lives. Still, in larger social settings, the responsibility of trust also disperses on to the work itself, and our wider social networks.

[National Policy of Humanization and education of health care professionals: integrative review].

Science.gov (United States)

Barbosa, Guilherme Correa; Meneguim, Silmara; Lima, Silvana Andréa Molina; Moreno, Vania

2013-01-01

The National Policy of Humanization aims at innovations in health production, management and care with emphasis on permanent education for workers in the Unified Public Health System and training of university students in the health care field. This study aimed to know, through an integrative review of the literature, the scientific production about the National Policy of Humanization and education of health care professionals, from 2002 to 2010. Ten articles were analyzed in thematic strand through three axes: humanization and users caring, humanization and the work process, humanization and training. The articles point to the need to overcome the biological conception, valuing cultural aspects of users. The work process is marked by the devaluation of workers and by users deprived of their rights. The training of health professionals is grounded in health services where the prevailing standards are practices that hinder innovative attitudes.

Trust and controlling

OpenAIRE

Bieńkowska Agnieszka; Zabłocka-Kluczka Anna

2016-01-01

The purpose of this study is to discuss the trust within and towards an organisation in the context of implementation of controlling therein. In this context the essence of trust and its importance in organisation management was presented, as well as trust in the contemporary management methods and concepts. Controlling as a trust-building factor inside an organisation was pointed out. Especially controlling and control were described. Moreover management by considering deviations in controll...

Globalization and Trust: Non-financial Information

Directory of Open Access Journals (Sweden)

Oscar Banda Lefaure

2015-09-01

Full Text Available Changes in the way of doing business that have resulted from globalization of markets have enabled countless benefits, but also a significant number of risks, that have been evident as since 2001 revelations about financial scandals around the world have occurred one after another. These unfortunate events showed the vulnerability to which investors (and other stakeholders are exposed for not having timely, clear and accurate information of the business progress in which they invest, and therefore not being able to take precautions. In addition, these business disasters have shown how the most unscrupulous executives do not hesitate to act illegally to hide their shady financial and accounting manoeuvres, in order to promote their personal benefit. Then the executive compensations policy lies behind. At this juncture, the importance of migrating to a new model of disclosure where the global financial community can take shelter of these malpractices and trust the board controls and the management stablishes has been increasing. This new model of disclosure has one of its pillars in non-financial information reports. This is not an alchemist solution, but is one of many efforts to be undertaken by companies to recover damaged trust. The international financial crisis affecting the world economy at the moment is another example of the need to give greater trust to the stakeholders –through transparency in the information they provide–. Only then, their participation in the capital market will be maintained and increased, and the costs that brings widespread lack of trust in which we live will be reduced.

Empirical Studies on the Economic Impact of Trust

NARCIS (Netherlands)

R. de Bliek (Ruben)

2015-01-01

markdownabstract__Abstract__ Generally speaking, would you say that most people can be trusted, or that you cannot be too careful when dealing with strangers?” This survey question is frequently asked to thousands of individuals globally. The aim of this question is to obtain a measure for how

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

Science.gov (United States)

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

The One-Child Policy, Elder Care, and LGB Chinese: A Social Policy Explanation for Family Pressure.

Science.gov (United States)

Hildebrandt, Timothy

2018-01-03

Lesbian, gay, and bisexual (LGB) people in China consistently report family pressure as the greatest challenge they face in their daily lives. This problem has been explained primarily by highlighting sociocultural factors. While such explanations are important to understanding family pressure, they do not easily lead to actionable policy interventions to relieve it. This article suggests a new way of looking at family pressure by positing a social policy explanation. In particular, it reveals how both the one-child policy and elder care reforms have strong heteronormative biases that negatively and disproportionately affect LGB people, and it explores social policy interventions that may help address them. Beyond the China case, the article seeks to open up new avenues for research into how sexuality could be better accounted for in analyses of social policies and considered in broader discussions on defamilization and welfare state reform.

Balancing Trust and Control

DEFF Research Database (Denmark)

Jagd, Søren

2010-01-01

of balancing trust and control becomes an issue that deserve ongoing attention. This paper adds to the discussion on the relation between trust and control by showing that the process perspective reframes the problem of balancing trust and control. More generally, by demonstrating the importance of the process......The purpose of this paper is to show that conceptualizing trust and control as interactively related processes, as opposed to more static conceptualizations of the two concepts and the relations between them, adds importantly towards understanding the challenges involved in balancing of trust...... on trust and control made the problem of finding a balance between trust and control a once and for all decision the process perspective introduced here implies that balancing trust and control is an ongoing process of balancing and rebalancing. The implication for management is that the problem...

A taxonomy of accountable care organizations for policy and practice.

Science.gov (United States)

Shortell, Stephen M; Wu, Frances M; Lewis, Valerie A; Colla, Carrie H; Fisher, Elliott S

2014-12-01

To develop an exploratory taxonomy of Accountable Care Organizations (ACOs) to describe and understand early ACO development and to provide a basis for technical assistance and future evaluation of performance. Data from the National Survey of Accountable Care Organizations, fielded between October 2012 and May 2013, of 173 Medicare, Medicaid, and commercial payer ACOs. Drawing on resource dependence and institutional theory, we develop measures of eight attributes of ACOs such as size, scope of services offered, and the use of performance accountability mechanisms. Data are analyzed using a two-step cluster analysis approach that accounts for both continuous and categorical data. We identified a reliable and internally valid three-cluster solution: larger, integrated systems that offer a broad scope of services and frequently include one or more postacute facilities; smaller, physician-led practices, centered in primary care, and that possess a relatively high degree of physician performance management; and moderately sized, joint hospital-physician and coalition-led groups that offer a moderately broad scope of services with some involvement of postacute facilities. ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations. © Health Research and Educational Trust.

Trust and Society: Suggestions for Further Development of Niklas Luhmann's Theory of Trust.

Science.gov (United States)

Morgner, Christian

2018-05-01

This paper addresses an apparent gap in the work of Niklas Luhmann. While the issue of trust continues to receive widespread attention in the social sciences, Luhmann's interest in this topic declined following the development of his systems theory. It is argued that this decline does not reflect any diminished relevance of trust for systems theory, but rather that the architectural remodeling of theory cannot easily be applied to the issue of trust. Here, the issue of trust is reconceptualized as a connection medium. This entails a reconstruction of Luhmann's early theory of trust, especially with regard to function and social positioning. In this context, trust can in turn be linked to the concept of medium in Luhmann's late work. As a connection medium, trust mediates between the different levels of sociality-interaction, organization, and society. These theoretical considerations are employed to develop a more applied framework for empirical research, with a brief case study from southern Italy. From this perspective, the idea of trust as society's glue is seen to be overly simplistic. The common ethical understanding that more trust leads to a better society is also questioned on the grounds that social cooperation can also lead to social sclerosis. Finally, risk and trust are shown to accommodate the formation of different cultures of trust. The paper shows how Luhmann's updated version of trust can inspire current research and enhance our understanding of how trust operates in contemporary society. © 2018 Canadian Sociological Association/La Société canadienne de sociologie.

Trust Management V

DEFF Research Database (Denmark)

2011-01-01

from 42 submissions. The papers feature both theoretical research and real-world case studies from academia, business and government focusing on areas such as: trust models, social and behavioral aspects of trust, trust in networks, mobile systems and cloud computation, privacy, reputation systems...

Local variability in long-term care services: local autonomy, exogenous influences and policy spillovers.

Science.gov (United States)

Fernandez, José-Luis; Forder, Julien

2015-03-01

In many countries, public responsibility over the funding and provision of long-term care services is held at the local level. In such systems, long-term care provision is often characterised by significant local variability. Using a panel dataset of local authorities over the period 2002-2012, the paper investigates the underlying causes of variation in gross social care expenditure for older people in England. The analysis distinguishes between factors outside the direct control of policy makers, local preferences and local policy spillovers. The results indicate that local demand and supply factors, and to a much lesser extent local political preferences and spatial policy spillovers, explain a large majority of the observed variation in expenditure. Copyright © 2015 John Wiley & Sons, Ltd.

Trust and controlling

Directory of Open Access Journals (Sweden)

Bieńkowska Agnieszka

2016-12-01

Full Text Available The purpose of this study is to discuss the trust within and towards an organisation in the context of implementation of controlling therein. In this context the essence of trust and its importance in organisation management was presented, as well as trust in the contemporary management methods and concepts. Controlling as a trust-building factor inside an organisation was pointed out. Especially controlling and control were described. Moreover management by considering deviations in controlling and the teamwork in controlling were described. The role of controlling in process of trust-building to an organisation was presented. Establishing relations with the environment and systems of measurement of organisation’s achievements were presented, too.

Is it feasible to pool funds for local children's services in England? Evidence from the national evaluation of children's trust pathfinders.

Science.gov (United States)

Lorgelly, Paula; Bachmann, Max; Shreeve, Ann; Reading, Richard; Thorburn, June; Mugford, Miranda; O'Brien, Margaret; Husbands, Chris

2009-01-01

To describe how funds were pooled or otherwise jointly managed by National Health Service (NHS) primary care trusts and local authorities in England. To compare expenditure on local children's services by health, education and social services. We conducted a questionnaire survey of all 35 children's trust pathfinders, six months after they were launched, with a follow-up at 2.5 years. We also undertook an in-depth analysis of local authorities and primary care trusts, within eight pathfinder areas and three non-pathfinder areas, whereby we compared expenditure on children's services, interviewed managers and professionals and examined financial documents. Local authorities and NHS trusts coordinated expenditure in various ways, most commonly through informal agreements and aligning budgets but also by formally pooling budgets. The latter were usually for selected services such as child and adolescent mental health services, though four children's trusts pathfinders pooled (or aligned) their budgets for all children's services. Total expenditure per child was greatest for education, lowest for social services and intermediate for health. However, it was difficult to quantify education expenditure on children with health and social care needs, and health care expenditure on children. Sharing money for local children's services requires shared objectives, trust, and legal and accounting expertise. Several different mechanisms are permitted and many are feasible but programme budgeting for children's services could make them more effective.

Trust in Scientific Publishing

NARCIS (Netherlands)

Hummels, Harry; Roosendaal, Hans E.

2001-01-01

Trust is an important phenomenon to reduce organisational complexity and uncertainty. In the literature many types of trust are distinguished. An important framework to understand the variety and development of trust in organisations is provided by Zucker. She distinguishes three types of trust:

Youth transitioning out of foster care: an evaluation of a Supplemental Security Income policy change.

Science.gov (United States)

King, Laura; Rukh-Kamaa, Aneer

2013-01-01

Youths with disabilities face numerous challenges when they transition to adulthood. Those who are aging out of foster care face the additional challenge of losing their foster care benefits, although some will be eligible for Supplemental Security Income (SSI) payments after foster care ceases. However, the time needed to process SSI applications exposes those youths to a potential gap in the receipt of benefits as they move between foster care and SSI. We evaluate the effects of a 2010 Social Security Administration policy change that allows such youths to apply for SSI payments 60 days earlier than the previous policy allowed. The change provides additional time for processing claims before the applicant ages out of the foster care system. We examine administrative records on SSI applications from before and after the policy change to determine if the change has decreased the gap between benefits for the target population.

CROWN: A service grid middleware with trust management mechanism

Institute of Scientific and Technical Information of China (English)

HUAI Jinpeng; HU Chunming; LI Jianxin; SUN Hailong; WO Tianyu

2006-01-01

Based on a proposed Web service-based grid architecture, a service grid middleware system called CROWN is designed in this paper. As the two kernel points of the middleware, the overlay-based distributed grid resource management mechanism is proposed, and the policy-based distributed access control mechanism with the capability of automatic negotiation of the access control policy and trust management and negotiation is also discussed in this paper. Experience of CROWN testbed deployment and application development shows that the middleware can support the typical scenarios such as computing-intensive applications, data-intensive applications and mass information processing applications.

Antenatal Care Strengthening in Jimma, Ethiopia: A Mixed-Method Needs Assessment

Directory of Open Access Journals (Sweden)

Sarah Fredsted Villadsen

2014-01-01

Full Text Available Objective. We assessed how health system priorities matched user expectations and what the needs for antenatal care (ANC strengthening were for improved maternal health in Jimma, Ethiopia. Methods. A questionnaire survey among all recent mothers in the study area was conducted to study the content of ANC and to identify the predictors of low ANC satisfaction. Further, a qualitative approach was applied to understand perceptions, practices, and policies of ANC. Results. There were no national guidelines for ANC in Ethiopia. Within the health system, the teaching of health professional students was given high priority, and that contributed to a lack of continuity and privacy. To the women, poor user-provider interaction was a serious concern hindering the trust in the health care providers. Further, the care provision was compromised by the inadequate laboratory facilities, unstructured health education, and lack of training of health professionals. Conclusions. Health system trials are needed to study the feasibility of ANC strengthening in the study area. Nationally and internationally, the leadership needs to be strengthened with supportive supervision geared towards building trust and mutual respect to protect maternal and infant health.

Intersectional policy analysis of self-directed mental health care in Canada.

Science.gov (United States)

Cook, Judith A; Morrow, Marina; Battersby, Lupin

2017-06-01

Recovery from mental illness is influenced by one's social location along multiple dimensions of identity, such as race, class, gender, age, and ability, and by how these social locations are expressed through structural and institutional barriers. This project was developed using an intersectional policy analysis framework designed to promote equity across identity locations-called the multistrand method-to examine the potential use of self-directed care financing approaches in the Canadian mental health system. A panel of 16 diverse stakeholders came together 4 times at structured 6-hr meetings to examine the evidence for self-directed care and explore its application in the Canadian context. Telephone interviews with evidence panel members were conducted to assess their perceptions of the group process and outcomes. Our analysis revealed ways that intersecting strand locations might differentially influence the degree of choice and recovery experienced by self-directed care participants. Individualized resource allocation, draining financial resources from ethnically specific services, unevenness in acceptance of the recovery orientation, and paucity of service options in different geographical regions were identified as contexts in which self-directed care policies could promote inequity. However, greater peer involvement in the model's implementation, use of indigenous community supports, purchase of material goods by economically disenfranchised persons, and access to services from ethnically diverse clinicians in the private sector were identified as equity-promoting model features. By couching their analysis at the level of unique socially-situated perspectives, the group developed detailed policy recommendations and insights into both the potential and limitations of self-directed care. The knowledge gained from our project can be used to develop uniquely Canadian self-directed care models tailored to promote recovery through empowerment and self

Health care in Canada: a citizen's guide to policy and politics

National Research Council Canada - National Science Library

Fierlbeck, Katherine

2011-01-01

... outlines the basic framework of the health care system with reference to speci fi c areas such as administration and governance, public health, human resources, drugs and drug policy, and mental health. She also discusses alternative models in other countries such as Britain, the United States, and France. As health care becomes increasingly complex...

Intermediaries in Trust: Indirect Reciprocity, Incentives, and Norms

Directory of Open Access Journals (Sweden)

Giangiacomo Bravo

2015-01-01

Full Text Available Any trust situation involves a certain amount of risk for trustors that trustees could abuse. In some cases, intermediaries exist who play a crucial role in the exchange by providing reputational information. To examine under what conditions intermediary opinion could have a positive impact on cooperation, we designed two experiments based on a modified version of the investment game where intermediaries rated the behaviour of trustees under various incentive schemes and different role structures. We found that intermediaries can increase trust if there is room for indirect reciprocity between the involved parties. We also found that the effect of monetary incentives and social norms cannot be clearly separable in these situations. If properly designed, monetary incentives for intermediaries can have a positive effect. On the one hand, when intermediary rewards are aligned with the trustor’s interest, investments and returns tend to increase. On the other hand, fixed monetary incentives perform less than any other incentive schemes and endogenous social norms in ensuring trust and fairness. These findings should make us reconsider the mantra of incentivization of social and public conventional policy.

Obstacles and facilitators of open visiting policy in Intensive Care Units:A qualitative study

Directory of Open Access Journals (Sweden)

Shiva Khaleghparast

2016-07-01

Full Text Available Open visiting policy in intensive care units is proposed as an essential requirement for patients and their families, so this study is aimed to explain open visiting policy obstacles and facilitators from patients, families and health team members’ viewpoint. This qualitative study implemented in intensive care units of a hospital specialized in cardiology in Tehran-Iran. Patients’, families’, nurses’, doctors’ and guards’ viewpoint was determined regarding open visiting policy obstacles and facilitators by semi-structured interviews. Data analysis method was conventional approach of qualitative content analysis with thematic technique. Data analysis was performed using Max QDA10 software. Two main categories of data regarding open visiting obstacles and facilitators were extracted. Factors related to service systems and visitors derived from open visiting obstacles, and factors related to management system and personnel derived from open visiting facilitators. One of the most important obstacles of open visiting policy implementation is shortage of staff and personnel negative attitude. Regarding open visiting policy facilitators, designing visiting cards for close family and observing specific rules, modification of intensive care unit structure and facilities for families are useful. Finally, what is important as an open visiting policy implementation facilitator is presence of nursing profession as a humanitarian and ethical profession.

State CCDBG Plans to Promote Opportunities for Babies and Toddlers in Child Care. Policy Brief

Science.gov (United States)

Lim, Teresa; Schumacher, Rachel

2009-01-01

State child care policies--including licensing, subsidy, and quality enhancement strategies--can promote the quality and continuity of early childhood experiences and foster the healthy growth and development of babies and toddlers in child care settings, especially if they are informed by research. One of the policy levers states may use to…

Policies and procedures in the workplace: how health care organizations compare.

Science.gov (United States)

Loo, R

1993-01-01

Many organizations are implementing programs and services to manage the human and economic costs of stress. A mail survey was conducted of 500 randomly selected Canadian organizations having at least 500 employees. The survey tapped four major areas: organizational policies and procedures for managing stress; programs and services offered; perceived benefits and constraints for the organization; and projected future directions in this area. Analyses of returns from 210 organizations-43 health and 167 non-health-revealed various findings. For example, over half of health care organizations have policies and procedures as opposed to less than half of non-health care organizations. Also, health care organizations place greater emphasis on smoking cessation, weight control programs and on stress management training. Although some Canadian organizations are addressing stress, much more could and should be done, especially by organizations that do not yet recognize the impact of stress on employees and their work performance.

How Supervisor Experience Influences Trust, Supervision, and Trainee Learning: A Qualitative Study.

Science.gov (United States)

Sheu, Leslie; Kogan, Jennifer R; Hauer, Karen E

2017-09-01

Appropriate trust and supervision facilitate trainees' growth toward unsupervised practice. The authors investigated how supervisor experience influences trust, supervision, and subsequently trainee learning. In a two-phase qualitative inductive content analysis, phase one entailed reviewing 44 internal medicine resident and attending supervisor interviews from two institutions (July 2013 to September 2014) for themes on how supervisor experience influences trust and supervision. Three supervisor exemplars (early, developing, experienced) were developed and shared in phase two focus groups at a single institution, wherein 23 trainees validated the exemplars and discussed how each impacted learning (November 2015). Phase one: Four domains of trust and supervision varying with experience emerged: data, approach, perspective, clinical. Early supervisors were detail oriented and determined trust depending on task completion (data), were rule based (approach), drew on their experiences as trainees to guide supervision (perspective), and felt less confident clinically compared with more experienced supervisors (clinical). Experienced supervisors determined trust holistically (data), checked key aspects of patient care selectively and covertly (approach), reflected on individual experiences supervising (perspective), and felt comfortable managing clinical problems and gauging trainee abilities (clinical). Phase two: Trainees felt the exemplars reflected their experiences, described their preferences and learning needs shifting over time, and emphasized the importance of supervisor flexibility to match their learning needs. With experience, supervisors differ in their approach to trust and supervision. Supervisors need to trust themselves before being able to trust others. Trainees perceive these differences and seek supervision approaches that align with their learning needs.

HMM-based Trust Model

DEFF Research Database (Denmark)

ElSalamouny, Ehab; Nielsen, Mogens; Sassone, Vladimiro

2010-01-01

Probabilistic trust has been adopted as an approach to taking security sensitive decisions in modern global computing environments. Existing probabilistic trust frameworks either assume fixed behaviour for the principals or incorporate the notion of ‘decay' as an ad hoc approach to cope...... with their dynamic behaviour. Using Hidden Markov Models (HMMs) for both modelling and approximating the behaviours of principals, we introduce the HMM-based trust model as a new approach to evaluating trust in systems exhibiting dynamic behaviour. This model avoids the fixed behaviour assumption which is considered...... the major limitation of existing Beta trust model. We show the consistency of the HMM-based trust model and contrast it against the well known Beta trust model with the decay principle in terms of the estimation precision....

'Waiting for' and 'waiting in' public and private hospitals: a qualitative study of patient trust in South Australia.

Science.gov (United States)

Ward, Paul R; Rokkas, Philippa; Cenko, Clinton; Pulvirenti, Mariastella; Dean, Nicola; Carney, A Simon; Meyer, Samantha

2017-05-05

Waiting times for hospital appointments, treatment and/or surgery have become a major political and health service problem, leading to national maximum waiting times and policies to reduce waiting times. Quantitative studies have documented waiting times for various types of surgery and longer waiting times in public vs private hospitals. However, very little qualitative research has explored patient experiences of waiting, how this compares between public and private hospitals, and the implications for trust in hospitals and healthcare professionals. The aim of this paper is to provide a deep understanding of the impact of waiting times on patient trust in public and private hospitals. A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals). Data collection occurred in 2012-13, and data were analysed using pre-coding, followed by conceptual and theoretical categorisation. Participants differentiated between experiences of 'waiting for' (e.g. for specialist appointments and surgery) and 'waiting in' (e.g. in emergency departments and outpatient clinics) public and private hospitals. Whilst 'waiting for' public hospitals was longer than private hospitals, this was often justified and accepted by public patients (e.g. due to reduced government funding), therefore it did not lead to distrust of public hospitals. Private patients had shorter 'waiting for' hospital services, increasing their trust in private hospitals and distrust of public hospitals. Public patients also recounted many experiences of longer 'waiting in' public hospitals, leading to frustration and anxiety, although they rarely blamed or distrusted the doctors or nurses, instead blaming an underfunded system and over-worked staff. Doctors and nurses were seen to be doing their best, and therefore trustworthy. Although public patients experienced longer 'waiting for' and 'waiting in' public hospitals, it did not lead to widespread distrust

Overview of royalty trusts

International Nuclear Information System (INIS)

Panarites, P.

1996-01-01

The nature of royalty trusts as a means of financing exploration, development, production, and refining of oil sand and heavy oil to produce competitively marketable petroleum products, was reviewed. Attributes of the two distinct classes of royalty trusts - reflexive class and the fundamental class royalty trusts - and the considerations underlying each one, were summarized. The overall conclusion was that the future performance of conventional oil and gas royalty trusts (reflexive class) will depend heavily on interest rate levels and management's ability to complete acquisitions financed with new trust unit issues. Fundamental class royalty trusts also offer long term pure exposure to the underlying business, in addition to yield

Characteristics of Primary Care Trusts in financial deficit and surplus - a comparative study in the English NHS.

Science.gov (United States)

Badrinath, Padmanabhan; Currell, Rosemary Anne; Bradley, Peter M

2006-06-01

Recently the financial status of primary care trusts has come under considerable scrutiny by the government, and financial deficits have been blamed on poor local management of resources. This paper examines the factors that differ between those Primary Care Trusts (PCT) in financial deficit and those in surplus, using readily available data at PCT level. PCTs are the National Health Service organisations in England responsible for improving the health of their population, developing primary and community health services, and commissioning secondary care services. A descriptive comparative study using data from 58 PCTs; 29 in greatest financial surplus and 29 in greatest deficit in the English National Health Service. Nearly half the study deficit PCTs (14 out of 29) are in the East of England and of the 29 surplus PCTs, five each are in Birmingham and Black Country Strategic Health Authority (SHA), and Greater Manchester SHA. The median population density of the deficit PCTs is almost seven times lower than that of surplus PCTs (p = 0.004). Surplus PCTs predominantly serve deprived communities. Nearly half the surplus PCTs are 'spearhead' PCTs compared to only one of the deficit PCTs. Percentage population increase by local authority of the PCT showed that on average deficit PCTs had 2.7 times higher change during 1982-2002 (13.37% for deficit and 4.94% for surplus PCTs). Work pressure felt by staff is significantly higher in deficit PCTs, and they also reported working higher amount of extra hours due to work pressures. The proportion of dispensing general practitioners is significantly higher in deficit PCTs 40.5% vs. 12.9% (p = 0.002). Deficit PCTs on average received pound123 less per head of registered population compared to surplus PCTs. The two groups of PCTs serve two distinct populations with marked differences between the two. Deficit PCTs tend to be in relatively affluent and rural areas. Poor management alone is unlikely to be the cause of deficits